This bill prohibits prior authorization requirements and step therapy protocols under the MaineCare program for prescription drugs used to assess or treat serious mental illness. The implementation of the prohibition must be consistent with the requirements of the Medicaid drug rebate program.

This bill repeals the Hospital and Health Care Provider Cooperation Act.

This bill amends the Maine Insurance Code in the following ways. 1. It allows a health care provider to object to a health insurance carrier’s material change to a provider agreement within 60 days of receiving notice of the change and extends the date on which a change to a provider agreement takes effect based on that objection. 2. It requires a health insurance carrier to include an estimate of any adverse financial impact on a provider as part of a notice of an amendment to a provider agreement. 3. It clarifies that the requirement for interest to be paid on overdue insurance claims payments also applies to 3rd-party administrators that furnish provider networks to carriers. 4. It restricts the authority of a health insurance carrier to retroactively deny a previously paid claim to no later than 24 months from the date of the claims payment.

This bill prohibits health care providers from balance billing Medicare beneficiaries for any amount in excess of the reasonable charge for a service, procedure or treatment paid to that entity under the Medicare program.

This bill establishes the Health Care Provider Assistance Division within the Department of Professional and Financial Regulation, Bureau of Insurance to assist health care providers in obtaining information about health insurance plans, assist health care providers in navigating the health insurance industry, assist health care providers with concerns specific to coverage for individual patients and issues that may have market-wide impact and provide a system for health care providers to submit complaints about violations of statutes or rules.

This bill requires insurance coverage, including coverage in the MaineCare program, for biomarker testing.

This resolve establishes the Blue Ribbon Commission to Design a Plan for Sustained Investment in Preventing Disease and Improving the Health of Maine Communities to evaluate funding models and structures that allow for the sustained investment in the health and prosperity of youth and families in the State and make recommendations for further legislative action.