An Act to Designate First Responders and Other Public Safety Professionals as a Special Risk Population for the Purposes of Improving Insurance Coverage for the Effects of Trauma
Maine Legislature, Session 131, LD 0444
Committee Amendment CA_A_S636 (Senate)
Amends: 24-A MRSA §4317-F

COMMITTEE AMENDMENT " 1^ " to S.P. 199, L.D. 444, "An Act to Designate
First Responders and Other Public Safety Professionals as a Special Risk Population for
the Purposes of Improving Insurance Coverage for the Effects of Trauma"
Amend the bill by striking out the title and substituting the following:
'An Act to Require Health Insurance Coverage for Specialized Risk Screening for
First Responders and Other Public Safety Professionals'
Amend the bill by striking out everything after the enacting clause and inserting the
following:
'See. 1. 24-A MRSA §4317-F is enacted to read:
S4317-F. Coveraee of specialized risk screenine associated with health of first
responders
1. Definitions. As used in this section, unless the context otherwise indicates, the
followine terms have the following meanings.
A. "First responder" means an employee or occasional employee or volunteer that is a
member of a state, county or municipal government entity that provides or has the
authority to provide fire. emereencv medjcal, emergency communications, correctional
or police services.
B^ _ 'LSp^^^^ means any of the following standard, medically
accepted tests:
d) Tests for evidence of any cancer with a known employment-related risk of
exposure for a first responder;
(2~) Blood tests, includme tests conducted for a complete blood count.
comprehensive metabolic panel, renal panel and hepatic panel;
(3}M&mmQsr&ph\,colo^oscor)YQtm^ examinations regardless of the aee of
the person who is the subiect of the examination;
COMMITTEE AMENDMENT
^Oc> COMMITTEE AMENDMENT " 4- " to S.P. 199, L.D. 444 C^- (^3 (A
(4) Tests of any measure of serum activity of liDODroteui-associated phospholipase
enzyme A2, oxidized low-densitv lipoorotein or additional indicators of
endovascular inflammation; or
(5} Tests to measure vitamin deficiencies, nutritional deficits and minerallevels.
2, Eligible enrollee. An enrollee is eligjble^fQr coverage under this section if the
enrollee meets the followins conditions;
A. The enrollee is a first resoondec
B, As determined by the enrollee's provider, the enrollee's receipt of specialized risk
screenine has meaningful potential for preventive clmical benefit to the enrollee; and
C, The enrollee's provider has determined that specialized risk screenmg is medicallv
aoprooriate based upon the satisfaction of the conditions in paragraphs A and B.
3. Coverase for specialized risk screenins. A carrier offering: a health plan in this
State may not deny coverage to an enrollee for specialized risk screemn& recommended by
a provider pursuant to subsection 2.
4. Limits on prior authorization; first responder health and wellness providers.
Notwithstanding any requirements in section 4320-A to the contrar/. a carrier may not
subiect any specialized risk screenjngjtaLanyjmorauthorization reguirement except that:
A. A carrier may request verification of an enrollee's status as a first responder; and
B. A carrier may request prior authorization if the sDecializecLrisk^ screening will be
conducted by a recognized first responder health or wellness provider or a laborator/
not affiliated with the em'ollee' s provider.
5, Cost sharing prohibited. A health plan may not impose any deductible, copayment,
coinsurance or other cost-sharing requirementfor the costs of specialized risk screening.
This subsection does not apply to a health plan offered for use with a health savmgs account
unless the federal Internal Revenue Service determines^ that the requirements in this
subsection are permissible in a highjieductible health plan as defined in the federal Internal
Revenue Code. Section 223(c)(2~).
Sec. 2. Application. The requirements of this Act apply to all policies, contracts and
certificates executed, delivered, issued for delivery, continued or renewed in this State on
or after January 1, 2025. For purposes of this Act, all contracts are deemed to be renewed
no later than the next yearly anniversary of the contract date.'
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
number to read consecutively.
SUMMARY
This amendment replaces the bill, which is a concept draft, and changes the title. For
policies issued or renewed on or after January 1, 2025, the amendment prohibits a health
insurance carrier from denying coverage to an enrollee who is a first responder for
8 specialized risk screening recommended by a health care provider. It limits the ability of a
health insurance carrier to require prior authorization for specialized risk screening. It also
prohibits a carrier from imposing any out-of-pocket costs for specialized risk screening
COMMITTEE AMENDMENT
^J COMMITTEE AMENDMENT "ft " to S.P. 199, L.D. 444 ^$- <^t^
except for high deductible health plans offered for use in connection with a health savings
account to the extent required under federal regulations.
FISCAL NOTE REQmRED
(See attached)
COMMITTEE AMENDMENT
Revised: 03/21/24 ^y^e=-
LD 444 LR 1803(02)
An Act to Designate First Responders and Other Public Safety Professionals as a Special Risk
Population for the Purposes of Improving Insurance Coverage for the Effects of Trauma
Fiscal Note for Bill as Amended by Committee Amendment 7)"^ 5-
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
Fiscal Note
FY 2023-24
$0
$0
$0
$0
FY 2024-25
$0
$0
$0
$0
Projections
FY 2025-26
$418,548
$154,472
$418,548
$154,472
Projections
FY 2026-27
$418,548
$154,472
$418,548
$154,472
Net Cost (Savings)
General Fund
Highway Fund
Appropriations/Allocations
General Fund
Highway Fund
Fiscal Detail and Notes
This bill prohibits carriers of health plans in this State from denying coverage to an enrollee who is a first responder
for specialized risk screening recommended by a health care provider. It also limits the ability of a health insurance
can-ier to require prior authorization for specialized risk screening and prohibits a carrier from imposing any out-of-
pocket costs for specialized screening except for high-deductible health plans offered for use in connection with a
health savings account to the extent required under federal regulations. The requirements of the bill apply to health
plans issued or renewed on or after January 1, 2025. The State Employee Health Plan's first impacted plan year will be
SPY 2026 and is estimated to cost $927,046 annually thereafter. The costs are split across the General Fluid
($418,548), Highway Funds ($154,472) and all other funds ($354,026).
The bill could potentially be considered a mandate by the federal government which would require the State to
reimburse the federal government for the State's defrayal cost. The potential mandate would go into effect on January
1, 2025 and would impact costs in future biennia.
LR1803(02) - Fiscal Note - Page 1 of 1