AUGUSTA – Gov. Janet Mills has signed into law two bills from Sen. Stacy Brenner, D-Scarborough, and Sen. Cameron Reny, D-Bristol, that will reduce barriers to accessing certain kinds of health care.
LD 1383, “An Act to Regulate Insurance Carrier Prior Authorization Requirements for Rehabilitative and Habilitative Services,” from Sen. Brenner, will limit when insurance companies can require prior authorization for rehabilitation and occupational therapy. LD 722, “An Act to Expedite the Health Insurance Referral Process for Specialists by Allowing Referrals During Urgent Care Visits,” from Sen. Reny, will help Maine patients access needed physical therapy and behavioral health care in a timely, efficient manner.
“Rehabilitation and occupational therapy are vital to helping patients recover from an injury or surgery, or manage a chronic condition. When we remove red tape and help Mainers access the care their doctors know they need, we make sure that they have better health outcomes,” said Sen. Brenner, who is a nurse-midwife. “I’m grateful to Gov. Mills for signing this bill into law, and for helping Maine patients.”
“I’ve seen first-hand how critical it is for folks, especially young people, to be able to access mental health care when they need it. I’ve also heard far too many stories about insurance regulations needlessly standing in the way of a patient receiving that care,” said Sen. Reny, who is a school counselor. “I’m proud of the work that went into this bill, and I’m excited to see it become law.”
LD 1383 will prohibit health insurance carriers from requiring prior authorization for the first 12 visits of rehabilitation or habilitation services, according to the Senate Majority Office. The bill will require a health insurance carrier to provide clear, written policies and procedures on how to obtain prior authorization. This legislation does not limit carriers from denying claims when services or treatment rendered were not medically necessary.
In April 2022, the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services published a report on the use of prior authorization by Medicare Advantage Organizations (MAOs). OIG indicated that the use of prior authorization frequently caused delays in the beneficiary’s access to medically necessary services and denial of payments to providers for covered services that should have been paid.
LD 722 will prohibit health insurance companies from denying payment for any behavioral health care service or physical therapy service covered under an enrollee’s health plan based solely on the basis that the patient’s referral was not made by the enrollee’s primary care provider, as long as the referral is made by a provider during an urgent care visit and the provider notifies their primary care provider of the referral.
A national survey conducted in 2022 by AMN HealthCare and Merritt Hawkins shows that wait times to see a primary care physician have increased by 8% since 2017 and by 24% since 2004. This translates to an average wait time of 26 days to schedule a new patient physician appointment. The survey also highlights that the wait times for certain specialties, such as orthopedic surgery, also have increased significantly.
According to Northern Light Acadia Hospital and the CEO of Kennebec Behavioral Health, waitlists for mental health specialists are months long, with many patients waiting 15 to 30 weeks to get an appointment.
LD 1383 will go into effect 90 days after the Legislature adjourns sine die. The requirements in LD 722 will go into effect on Jan. 1, 2024.
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