Maine Revised Statutes Title 24-A Sec. 4320-P – Coverage for health care services for COVID-19
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Notwithstanding any requirements of this Title to the contrary, a carrier offering a health plan in this State shall provide, at a minimum, coverage as required by this section for screening, testing and immunization for COVID-19. [PL 2021, c. 28, Pt. A, §3 (NEW).]
1. Definitions. For the purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.
A. “COVID-19” means the coronavirus disease 2019 resulting from SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, and any virus mutating from that virus. [PL 2021, c. 28, Pt. A, §3 (NEW).]
B. “Surveillance testing program” means a structured program of asymptomatic testing at a community or population level to understand the incidence or prevalence of COVID-19 in a group. “Surveillance testing program” does not include a program of testing that occurs less often than once per month per individual. [PL 2021, c. 28, Pt. A, §3 (NEW).]
[PL 2021, c. 28, Pt. A, §3 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4320-P
- Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-ADependent: A person dependent for support upon another. Enrollee: means an individual who is enrolled in a health plan or a managed care plan. See Maine Revised Statutes Title 24-A Sec. 4301-A Health plan: means a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan, other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage not subject to the requirements of the federal Affordable Care Act. See Maine Revised Statutes Title 24-A Sec. 4301-A Month: means a calendar month. See Maine Revised Statutes Title 1 Sec. 72 Provider: means a practitioner or facility licensed, accredited or certified to perform specified health care services consistent with state law. See Maine Revised Statutes Title 24-A Sec. 4301-A United States: includes territories and the District of Columbia. See Maine Revised Statutes Title 1 Sec. 72
2. Testing. A carrier shall provide coverage for screening and testing for COVID-19 as follows.
A. A carrier shall provide coverage for screening and testing for COVID-19, except when such screening and testing is part of a surveillance testing program. [PL 2021, c. 28, Pt. A, §3 (NEW).]
B. A carrier may not impose any deductible, copayment, coinsurance or other cost-sharing requirement for the costs of COVID-19 screening and testing, including all associated costs of administration. [PL 2021, c. 28, Pt. A, §3 (NEW).]
C. A carrier may not make coverage without cost sharing as required by paragraph B dependent on any prior authorization requirement. [PL 2021, c. 28, Pt. A, §3 (NEW).]
D. A carrier may not make coverage without cost sharing as required by paragraph B dependent on the use of a provider in a carrier’s network unless an enrollee is offered screening and testing by a network provider without additional delay and the enrollee chooses instead to obtain screening from an out-of-network provider or to be tested by an out-of-network laboratory. [PL 2021, c. 28, Pt. A, §3 (NEW).]
E. For the purposes of this subsection, with respect to COVID-19 screening and testing rendered by an out-of-network provider, a carrier shall reimburse the out-of-network provider in accordance with section 4303?C, subsection 2, paragraph B. [PL 2021, c. 28, Pt. A, §3 (NEW).]
[PL 2021, c. 28, Pt. A, §3 (NEW).]
3. Immunization; COVID-19 vaccines. A carrier shall provide coverage for COVID-19 vaccines as follows.
A. A carrier shall provide coverage for any COVID-19 vaccine licensed or authorized under an emergency use authorization by the United States Food and Drug Administration that is recommended by the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, or successor organization, for administration to an enrollee. [PL 2021, c. 28, Pt. A, §3 (NEW).]
B. A carrier may not impose any deductible, copayment, coinsurance or other cost-sharing requirement for the cost of COVID-19 vaccines, including all associated costs of administration. [PL 2021, c. 28, Pt. A, §3 (NEW).]
C. A carrier may not make coverage without cost sharing as required by paragraph B dependent on any prior authorization requirement. [PL 2021, c. 28, Pt. A, §3 (NEW).]
D. A carrier may not make coverage without cost sharing as required by paragraph B dependent on the use of a provider in a carrier’s network unless an enrollee is offered immunization by a network provider without additional delay and the enrollee chooses instead to obtain immunization from an out-of-network provider. [PL 2021, c. 28, Pt. A, §3 (NEW).]
[PL 2021, c. 28, Pt. A, §3 (NEW).]
4. Rules. The superintendent may adopt rules to implement and administer this section to align with any applicable federal requirements. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2?A.
[PL 2021, c. 28, Pt. A, §3 (NEW).]
Revisor’s Note: §4320-P. Coverage for services provided by a certified registered nurse anesthetist (As enacted by PL 2021, c. 39, §1 is REALLOCATED TO TITLE 24-A, SECTION 4320-Q)
SECTION HISTORY
PL 2021, c. 28, Pt. A, §3 (NEW). PL 2021, c. 39, §1 (NEW).