| | | Be it enacted by the People of the State of Maine as follows: |
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| | | Sec. 1. 24-A MRSA §4315 is enacted to read: |
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| | | §4315.__Coverage of prosthetic devices |
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| | | 1.__Definition.__As used in this section, "prosthetic | | device" means an artificial device to replace, in whole or in | | part, an arm or a leg. |
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| | | 2.__Required coverage.__A carrier shall provide coverage for | | prosthetic devices in all health plans that, at a minimum, | | equals the coverage and payment for prosthetic devices | | provided under federal laws and regulations for the aged and | | disabled pursuant to 42 United States Code, Sections 1395k, | | 1395l and 1395m and 42 Code of Federal Regulations, Sections | | 414.202, 414.210, 414.228 and 410.100.__Covered benefits must | | be provided for a prosthetic device determined by the | | enrollee's provider to be the most appropriate model that | | adequately meets the medical needs of the enrollee. |
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| | | 3.__Prior authorization.__A carrier may require prior | | authorization for prosthetic devices in the same manner as | | prior authorization is required for any other covered benefit. |
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| | | 4.__Repair or replacement.__Coverage under this section must | | also be provided for repair or replacement of a prosthetic | | device if repair or replacement is determined appropriate by | | the enrollee's provider. |
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| | | 5.__Coverage under managed care plan.__If coverage under | | this section is provided through a managed care plan, a | | carrier may require that prosthetic services be rendered by a | | provider who contracts with the carrier and that a prosthetic | | device be provided by a vendor designated by the carrier. |
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| | | 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, 2004. For purposes of this Act, all | | contracts are deemed to be renewed no later than the next | | yearly anniversary of the contract date. |
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| | | This bill requires carriers to provide coverage for | | prosthetic devices in all health plans, except those providing | | supplemental coverage for a specific disease or other limited | | benefits. Benefits for coverage of prosthetic devices must be |
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