CHAPTER 459

S.P. 48 - L.D. 125

An Act to Promote Fairness and Opportunity for Working

Amputees

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4315 is enacted to read:

§4315.__Coverage of prosthetic devices

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.

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, in accordance with section 4301-A, subsection 10-A, to be the most appropriate model that adequately meets the medical needs of the enrollee.

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.

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.