An Act to Ensure
Maine Legislature, Session 132, LD 1496
Committee Amendment CA_A_H666 (House)
Amends: 24-A MRSA §4304-B, 24-A MRSA §4311

COMMITTEE AMENDMENT" A" to H.P. 980, L.D. 1496, "An Act to Ensure 
Ongoing Access to Medications and Care for Chronic Conditions and Conditions Requiring 
Long-term Care by Changing Requirements for Prior Authorizations'' 
Amend the bill by striking out the title and substituting the following: 
'An Act to Ensure Ongoing Access to Medications and Care for Chronic Conditions 
by Changing Requirements for Prior Authorizations' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec, 1. 24-A MRSA §4304-B is enacted to read: 
§4304-B. Prior authorization for treatment of chronic conditions 
1. Length of prior authorization for treatment of chronic conditions. If a ca11·ier 
requires a prior authorization for health care services for the treatment of a chronic 
condition. the approved prior authorization remains valid for the duration of the treatment 
01· for one year. whichever is longer. If health care services for the treatment of a chronic 
condition are necessa1y for more than one year, a carrier may not require the renewal of the 
prior authorization more frequently than once eve1y 3 years. The prior authorization 
approval is valid from the date the enrollee receives the notice of the approval. If an enrollee 
has received prior authorization for health care services for the treatment of a chronic 
condition, the carrier shall honor the prior authorization until the prior authorization expires 
as long as the enrollee continues to be covered under the same health plan. 
2. Length of prior authorization for diagnostic procedures or tests related to 
treatment of chronic conditions. A prior authorization for a diagnostic procedure or test 
related to the treatment of a chronic condition remains valid for subsequent, necessa1y 
recuning orders of the diagnostic procedure or test for the duration of the diagnosis of the 
chronic condition or for one year, whichever is longer. A carrier may not require the 
renewal of a prior authorization more frequently than once eve1y 3 years for a diagnostic 
procedure or test that continues for more than one year. and the prior authorization remains 
valid from the date the enrollee receives notice of the approval. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT 'A" to H.P. 980, L.D. 1496 
3, Coverage restriction prohibition; notice. A carrier may not restrict coverage for 
a health care service, diagnostic procedure or test used in the treatment of a chronic 
condition under this section, including coverage for a prescription, that received prior 
authorization approval under a previous carrier within 90 days of enrollment in the carrier's 
health plan by an emollee if that enrollee's health care provider determines that the emollee 
should continue receiving that health care service, diagnostic procedure or test as 
detennined by a health care provider. The carrier shall provide the enrollee with at least 90 
days' notice prior to restricting coverage pursuant to this subsection. 
4. Chronic condition, For the purposes of this section, "chronic condition" means a 
medical condition diagnosed by a health care provider that is expected to last 6 months or 
more and that: 
A. Requires ongoing medical attention by a health care provider to effectively manage 
the condition or to prevent an adverse health event: or 
B. Limits one or more activities of daily living, as defined in Title 22, section 1717, 
subsection 1, paragraph A. 
Sec. 2. 24-A MRSA §4311, sub-§1-A, 1A, as amended by PL 2019, c. 273, §3, is 
further amended to read: 
A. The canier must determine whether it will cover the dmg requested and notify the 
enrollee, the enrollee's designee, if applicable, and the person who has issued the valid 
prescription for the enrollee of its coverage decision within 72 hours or 2 business days, 
whichever is less, following receipt of the request. A carrier that grants coverage under 
this paragraph must provide coverage of the drug for the duration of the prescription, 
including refills. A prior authorization for a prescription is valid for the duration of the 
prescription, including refills, or for one year, whichever is longer. A canier may not 
require the renewal of a prior authorization more frequently than once eve1y 3 years 
for a prescription that continues for more than one year. The prior authorization 
approval is valid from the date the enrollee receives notice of the approval and remains 
valid for a prescription drug prescribed by a provider regardless of a change in dosage. 
A carrier may rescind the prior authorization approval for prescription drug doses that 
exceed limitations set by federal or state law, regulation or rule. 
Sec. 3. 
Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Departments and Agencies - Statewide 0016 
Initiative: Provides funding to expand coverage for enrollees with chronic conditions. The 
expanded requirements apply to health plans issued or renewed on or after January 1, 2026. 
GENERAL FUND 
2025-26 
2026-27 
All Other 
$0 
$1,779,648 
GENERAL FUND TOTAL 
IDGHW AY FUND 
All Other 
$0 
2025-26 
$0 
COMMITTEE AMENDMENT 
$1,779,648 
2026-27 
$619,008 
COMMITTEE AMENDMENT "fx:_' to H.P. 980, L.D. 1496 
HIGHWAY FUND TOTAL 
$0 
$619,008 
Amend the bill by relettering or renumbering any nonconsecutive Prut letter or section 
number to read consecutively. 
SUMMARY 
This amendment, which is the majority repo1t of the committee, replaces the bill and 
changes the title. It narrows the scope of the prior authorization process required by health 
insurance carriers to chronic conditions and removes language related to conditions 
requiring long-term care used in the bill. The amendment defines "chronic condition" and 
clarifies that the limits placed on caniers related to prior authorizations extend to health 
care services for the treatment of a chronic condition and to diagnostic procedures or tests 
related to the treatment of a chronic condition. It prohibits a canier from requiring the 
renewal of a prior authorization more frequently than once every 3 years for treatment that 
is necessary for more than one year, instead of 5 years as proposed in the bill. Finally, the 
amendment removes the provision in the bill that prohibits a health care plan from 
restricting coverage for a health care service or a prescription that was approved under a 
previous health care plan within 90 days of enrollment in the new health care plan because 
it is duplicative of requirements in existing law. 
The amendment also adds an 
appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/06/25 LRL 
LD 1496 
LR 788(02) 
An Act to Ensure Ongoing Access to Medications and Care for Chronic Conditions and Conditions 
Requiring Long-term Care by Changing Requirements for Prior Authorizations 
Fiscal Note for Bill as Amended by Committee Amendment 'p;_ Ct-t-(J(o(i' 
Committee: Health Coverage, Insurance and Financial SerVIces 
O} 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/ Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2025-26 
$0 
$0 
$0 
$0 
FY 2026-27 
$1,779,648 
$619,008 
$1,779,648 
$619,008 
Projections 
FY2027-28 
$1,779,648 
$619,008 
$1,779,648 
_$619,008 
Projections 
FY2028-29 
$1,779,64.~ 
$619,1. 
$1,779,648 
$619,008 
This bill defines "chronic condition
and clarifies that the limits placed on health insurance carriers related to prior 
authorizations extend to health care services for the treatment of a chronic condition and to ·diagnostic procedures or 
tests related to the treatment of a chronic condition. 
The requirements-of the bill apply to health plans issued-or renewed on or after January 1, 2026. The State Employee 
Health Plan's first impacted plan year will be 'fiscal y,ear 2026-27 and is estimated to cost $3,868,800 annually 
thereafter. The costs are split across the General Fund ($1,779,648), Highway Fund ($619,008), and all other funds 
($1,170,144). 
LR0788(02) - Fiscal Note - Page 1 of 1