Bill > LD1496

This bill addresses prior authorization requirements for health care services and prescriptions, particularly for chronic conditions or long-term care. Specifically, it mandates that once a prior authorization is approved, it remains valid for the duration of treatment or one year, whichever is longer. For treatments lasting more than a year, health plans can only require prior authorization renewal once every five years. The bill also prohibits health plans from restricting coverage for a previously approved health care service or prescription within 90 days of a patient enrolling in a new health plan, provided the patient is stable on that treatment as determined by a healthcare provider. Additionally, health plans must provide at least 90 days' notice before restricting coverage of a previously approved service. Key terms include "prior authorization" (a pre-approval process for medical services or medications) and "utilization review entity" (typically an insurance company that reviews medical service requests). The bill aims to reduce administrative burdens on patients with chronic or long-term medical conditions and ensure more consistent access to necessary medical treatments and medications.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=1496&snum=132