An Act to Expedite the Health Insurance Referral Process for Specialists by Allowmg Referrals from Urgent Care Facihties
Maine Legislature, Session 131, LD 0722
Committee Amendment CA_B_S81 (Senate)
Amends: 24-A MRSA §4301-A, 24-A MRSA §4303

COMMITTEE AMENDMENT " 13" to S P 280, L D 722, "An Act to Expedite the 
Health Insurance Referral Process for Specialists by Allowmg Referrals from Urgent Care 
Facihties" 
Amend the bill by stnkmg out the title and substitutmg the followmg 
'An Act to Expedite the Health Insurance Referral Process for Specialists by Allowmg 
Referrals Durmg Urgent Care Visits' 
Amend the bill by stnkmg out everythmg after the enactmg clause and msertmg the 
followmg 
'Sec. 1. 24-A MRSA §4301-A, sub-§2-A is enacted to read 
2-A. Behavioral health care service. "Behavioral health care service" means a health 
care service or treatment to address mental health and substance use conditions 
Sec. 2. 24-A MRSA §4301-A, sub-§21 is enacted to read 
21. Urgent care. "Urgent care" means health care or treatment provided m response 
to exigent circumstances 
Sec. 3. 24-A MRSA §4303, sub-§22-A is enacted to read 
22-A. Demal of referral durmg urgent care visit prohibited. A carrier may not 
deny payment for any behavioral health care service or physical therapy service covered 
under an enrollee's health plan based solely on the basis that the enrollee's 1mtial referral 
was not made by the enrollee's pnmary care provider and, if a referral is required from a 
pnmary care provider, as long as the enrollee's referral is made by a provider dunng an 
urgent care VlSlt and the enrollee's referral is approved by the enrollee's pnmary care 
provider pnor to the date the behavioral health care service or physical therapy service ts 
rendered to the enrollee A camer may not apply a deductible, comsurance or copayment 
greater than the apphcable deductible, comsurance or copayment that would apply to the 
same health care service if the service was referred by the enrollee's primary care provider 
A camer may regmre a provider providmg urgent care that is makmg a referral to provide 
addit10nal mformat1on necessary to tmplement this subsect10n 
COMMITTEE AMENDMENT 
oc., 
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COMMITTEE AMEND:MENT "(b "to SP 280, L D 722 ( ';:;,- 'zS' f) 
Sec. 4. Applicat1on. The requirements of tlus Act apply to all policies, contracts and 
certifications executed, delivered, issued for delivery, contmued or renewed m tlus State 
an or after January 1, 2024 For purposes oftlus Act, all policies, contracts and certificates 
are deemed to be renewed no later than the next yearly anniversary of the contract date' 
Amend the bill by relettenng or renumbermg any nonconsecutive Part letter or section 
number to read consecutively 
SUMMARY 
This amendment replaces the bill and changes the title The amendment proh1b1ts a 
health msurance earner from denymg payment for any behavioral health care service or 
physical therapy service covered under an enrollee's health plan based solely on the basis 
that the enrollee's initial referral was not made by the enrollee's primary care provider as 
long as the enrollee's referral is approved by the enrollee's pnmary care provider pnor to 
the date the behavioral health care service or physical therapy service 1s rendered to the 
enrollee The requirements apply begmnmg January 1, 2024 
COMMITTEE AMENDMENT