An Act to Update the
Maine Legislature, Session 132, LD 1502
Committee Amendment CA_A_H916 (House)
Amends: 24 MRSA §2325-C, 24-A MRSA §2745-G, 24-A MRSA §2837-H, 24-A MRSA §4244

COMMITTEE AMENDMENT " ^\" to H.P, 986, L.D. 1502, "An Act to Update the
Requirements for Health Insurance Coverage of Prostate Cancer Screening"
Amend the bill by stalking out everything after the enacting clause and inserting the
following:
'See. 1. 24 MRSA §2325-C, as enacted by PL 1997, c. 754, §1, is amended to read:
§2325-C. Coverage for prostate cancer screening
1. Definition Services for the early detection of prostate cancer; definition. As
used in this section, "services for the early detection of prostate cancer" means the
followiag procedures provided to a man for the purpose of early detection of prostate
cancer:
A, A digital rectal examination; and
B, A prostate-specific antigen test,
1-A. Nationally recoenized clinical practice euideline; definition. As used in this
section, unless the context otherwise indicates, "national^ recognized cUnical practice
euidelme" means an evidence-based clinical uractice guideline:
A.Developed usine a transparent methodoloev and reportme sta-ucture by an
independent organization or medical professional society that has adopted a conflict of
interest oolicv:
B, That establishes a standard of care informed by a systematic review of evidence
and an assessment of the benefits and risks of alternative care options; and
C. That includes recommendations intended to optimize patient care.
2. Required coverage for prostate cancer screening. All individual and group
nonprofit hospital and medical services plan contracts must provide coverage for services
for the early detection of prostate cancer. The contracts must reimburse for services for the
early detection of prostate cancer, if recommended by a physician, at least once a year for
men 50 years of age or older until a man reaches the age of 72 when supported by medical
COMMITTEE AMENDMENT
"h
COMMITTEE AMENDMENT " f^ to H,P. 986, L.D. 1502
and scientific evidence according to the most recently published nationally recoenized
clinical practice guideline.
3. Application. The requirements of this section apply to all policies, contracts and
cortifioutos exoouted, doliverod, iaauod for delivery, continued or ronowed in. thia State on
or after September 1, 1998. For purposes of this Beotion, all oontracts are deemed to be
renewed no later than the next yearly anniversary oftho contract date.
4. Cost sharing prohibited. An individual or grouo nonprofit hospital and medical
services plan contract may not impose any deductible, copayment, coinsurance__or other
cost-sharine requirement for the costs of services for the early detection of prostate cancer
required to be covered under subsection 2. This subsection does not aoolv to a contract
offered for use with a health savines account unless the federal Internal Revenue Service
determines that the requirements in this subsection are permissible in a high deductible
health plan as defined m the federal Internal Revenue Code of 1986. Section 223(c}(2').
Sec. 2. 24-A MRSA §2745-G, as reallocated by RR 1997,c. 2, §51, is amended to
read:
§2745-G. Coverage for prostate cancer screening
1. Definition Services for the early detection of prostate canceu definition. As
used in this section, "services for the early detection of prostate cancer" means the
following procedures provided to a man for the purpose of early detection of prostate
cancer:
A. A digital rectal examination; and
B. A prostate-specific antigen test.
1-A. Nationally recoenized clinical practice suideline; definition. As used in this
section, unless the context otherwise indicates, "nationally recognized clinical oractice
guideline" means an evidence-based clinical practice euideline:
A. Developed using a transparent methodoloev and reoortine structure by an
independent organization or medical professional society that has adopted a conflict of
interest policy:
B. That establishes a standard of care informed by a systematic review of evidence
and_an assessment of the benefits and risks of alternative care options; and
C. That includes recQmmendations mtended to optimize patient care,
2. Required coverage for prostate cancer screening. All individual insurance
policies and contracts except accidental injury, specified disease, hospital indemnity,
Medicare supplement, long-term care and other limited benefit health insurance policies
and contracts must provide coverage for services for the early detection of prostate cancer.
The contracts must reimbyrse for services for the early detection of prostate cancer, if
recommended by a physician, at least once a year for men 50 years of age or older until a
8 man reaches the age-e^-?3 when supported by medical and scientific evidence according to
the most recently published nationaUy recoRnized clinical practice euideline.
3. Application. The requirements of this section apply to all policies, contracts and
oertificateo executod, delivered, issued for delivety, continued or renewed in this State on
COMMITTEE AMENDMENT
COMMHTEE AMENDMENT "£V" to H.P. 986, L.D. 1502
or after Soptombor 1, 1998. For purpoaos of this sootion, all oontruoto arc deemed to bo
renewed no later than the next yearly anniversary of the contract date.
4. Cost sharing prohibited. An individual insurance policy or contract may not
impose any deductible, copayment. coinsuiance or ofher cost-sharmg requirement for the
costs of services for the early detection of prostate cancer reauired to be covered under
subsection 2. This subsection does not aoolv to a policy or contract offered for use wifh a
health savines account unless the federal Internal Revenue Service determines that the
requirements in this subsection are permissible m a high deductible health plan as defined
in the federal Internal Revenue Code of 1986, Section 223(c)C2).
Sec. 3. 24-A MRSA §2837-H, as reallocated by RR 1997,c.2,§52, is amended to
read:
§2837-H. Coverage for prostate cancer screening
1. Definition Services for the early detection of prostate cancer; definition. As
used in this section, services for the early detection of prostate cancer means the
following procedures provided to a man for the purpose of early detection of prostate
cancer:
A. A digital rectal examination; and
B. A prostate-specific antigen test,
1-A. Nationally recoenized clinical practice euideline; definition. As used m this
section^urdess the context otherwise indicates, "nationally recoenized clinical oractice
guideline" means an evidence-based clinical practice guideline;
A. Developed using a transparent methodoloev and reportine structure by an
independent oreanization or medical urofessional society that has adopted a conflict of
interest policy:
B. That establishes a standard of care infonned bv a systematic review of evidence
and an assessment of the benefits and risks of alternative care outions; and
C. That includes recommendations intended to optimize patient care.
2. Required coverage for prostate cancer screening. All group insurance policies
and contracts except accidental injury, specified disease, hospital indemnity, Medicare
supplement, long-term care and other limited benefit health insurance policies and
contracts must provide coverage for services for the early detection of prostate cancer. The
contracts must reimburse for services for the early detection of prostate cancer, if
3 recommended by a physician, at least once a year for men 50 years of age or older until a
man reaches the age-e^TS when supported by medical and scientific evidence accordine to
the most recently published nationally recognized clinical practice guideline.
3. Application. The requirements of this section apply to all policies, contraotQ and
oortificates oxoouted, delivered, issued for delivery, continued or renewed in this State-ea
or after September 1, 1998. For purpooeQ ofthio oootion, all contraota are deemed to be
renewed no later than the next yearly anniversary of the contract date.
4. Cost sharins prohibited. A group insurance policy or contract may not unpose
any deductible, cooavment, coinsurance or other cost-sharine requirement for the costs of
services for the early detectionof prostate cancer required to be covered under subsection
COMMITTEE AMENDMENT
COMMTTTEE AMENDMENT " Dr" to H.P. 986, L.D. 1502
"i\"<
2. This subsection does not aoplv to a policy or contract offered for use with a health
savings account unless the federal Internal Revenue Service detemimes_that the
requirements in this subsection are oennissible in a high deductible health plan as defined
in the federal Internal Revenue Code. Section 223 (c)(2) ,
Sec. 4. 24-A MRSA §4244, as reallocated by RR 1997, c. 2, §53, is amended to
read:
§4244. Coverage for prostate cancer screening
1. Definition Services for the early detection of prostate cancer; definition. As
used in this section, "services for the early detection of prostate cancer" means the
following procedures provided to a man for the purpose of early detection of prostate
cancer:
A. A digital rectal examination; and
B. A prostate-specific antigen test.
1-A. Nationally recoenized clinical practice euideUne; definition. As used m this
section, unless the context otherwise indicates, "nationally recognized clinical practice
euidelme" means an evidence-based clinical oractice euideline:
A. Developed using a transparent methodoloev and reuortine structure by an
independent organization or medical orofessional society that has adopted a conflict of
interest policy:
B. That establishes a standard of care informed by a systematic review of evidence
and an assessment of the benefits and risks of alternative care options; and
C. That includes recommendations intended to ootimize oatient
2. Required coverage for prostate cancer screening. All health maintenance
organization individual and group contracts must provide coverage for services for the
early detection of prostate cancer. The contracts must reimburse for services for the early
detection of prostate cancer, if recommended by a physician, at least onoe a year for men
50 years of age or older until a man reaches the ago of 72 when supported by medical and
scientific evidence according to the most recently published nationally recomized clinical
practice guideline.
3. Application. The requirements of this section apply to all policies, contracts and
certificates executed, delivered, issued for delivery, continued or renewed in this State on
or after September 1, 1998. For purpooeii of this section, all oontmcte are deemed to be
renewed no later than tho next yearly anniversary of the contract date.
4. Cost sharing nrohibited. An individual or erouD contract may not impose any
deductible, cooayment. coinsurance or other cost-sharmg requirement for the costs of
services for the early detection of prostate cancer required to be covered under subsection
2. This subsection does not apply to a contract offered for use with a health savings account
unless the federal Internal Revenue Service determines that the reauirements m this
subsection are permissible in a high deductible health plan as defined in the federal Internal
Revenue Code. Section 223fcY2).
Sec. 5. Application. This Act applies to all policies, contracts and certificates
executed, delivered, issued for delivery, continued or renewed in this State on or after
Page4-132LR2380(02)
COMMITTEE AMENDMENT
COMMFTTEE AMENDMENT "^-" to H.P. 986, L.D. 1502
January 1, 2027, For purposes of this Act, all contracts are deemed to be renewed no later
than the next yearly amuversary of the contract date.'
Amend the bill by relettermg or renumbering any nonconsecutive Part letter or section
number to read consecutively.
SUMMARY
This amendment replaces the bill. Under current law, health insurance coverage must
be provided for annual prostate cancer screening, if recommended by a physician, to men
50 years of age or olderuntil attaining 72 years of age. The amendment updates the required
coverage by doing the following.
1, It retains the provision in current law that requires coverage of a digital rectal
examination and a prostate-specific antigen test.
2. It requires the coverage of services for the early detection of prostate cancer, if
recommended by a physician, when supported by medical and scientific evidence
according to the most recently published nationally recognized clinical practice guideline.
3. It prohibits the use of any deductible, copayment, comsurance or other cost-sharing
requirement for the costs of services for fhe early detection of prostate cancer.
The requirements apply to individual and group health insurance policies and health
maintenance organization contracts issued or renewed on or after January 1, 2027.
FISCAL NOTE REQUIRED
(See attached)
COMMITTEE AMENDMENT
Approved: 03/24/26 I^KL
LD 1502 LR 2380(02)
An Act to Update the Requirements for Health Insurance Coverage of Prostate Cancer Screening
Fiscal Note for Bill as Amended by Committee Amendment 'J^ ( ^-t
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
Fiscal Note
FY 2025-26
$0
$0
$0
$0
FY 2026-27
$0
$0
$0
$0
Projections
FY 2027-28
$50,223
$17,469
$50,223
$17,469
Projections
FY 2028-29
$50,2^
$17,,
$50,223
$17,469
Net Cost (Savings)
General Fund
Highway Fund
Appropriations/AIlocations
General Fund
Highway Fund
Fiscal Detail and Notes
This bill expands the coverage of services for early detection of prostate cancer, and prohibits health insurance
carriers from using any deductible, copayment, coinsurance, or other cost-sharing requirements for these services. The
requirements of this bill apply to health plans issued or renewed on or after January 1, 2027.
The State Employee Health Plan annual impact will be $109,181 beginning in fiscal year 2027-28, The annual costs
are split across General Fund ($50,223), Highway Fund ($17,469) and all other ($41,489),
LR23 80(02) - Fiscal Note - Page 1 of 1