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Page 1 - 132LR0670(03)
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FIVE
_____
H.P. 173 - L.D. 270
Resolve, Regarding Legislative Review of Portions of Chapter 850: Health
Plan Accountability, a Major Substantive Rule of the Department of
Professional and Financial Regulation, Bureau of Insurance
Emergency preamble. Whereas, acts and resolves of the Legislature do not
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A requires
legislative authorization before major substantive agency rules may be finally adopted by
the agency; and
Whereas, a major substantive rule has been submitted to the Legislature for review;
and
Whereas, immediate enactment of this resolve is necessary to record the Legislature's
position on final adoption of the rule; and
Whereas, in the judgment of the Legislature, these facts create an emergency within
the meaning of the Constitution of Maine and require the following legislation as
immediately necessary for the preservation of the public peace, health and safety; now,
therefore, be it
Sec. 1. Adoption. Resolved: That final adoption of portions of Chapter 850: Health
Plan Accountability, a provisionally adopted major substantive rule of the Department of
Professional and Financial Regulation, Bureau of Insurance that has been submitted to the
Legislature for review pursuant to the Maine Revised Statutes, Title 5, chapter 375,
subchapter 2-A, is authorized only if the following changes are made:
1. The rule is amended in Section 8(G)(1)(c)(i) to remove the requirement that a
written adverse health care treatment decision include the name and title of the person or
persons evaluating the appeal and replace it with a requirement that the decision attest to
the credentials of the person or persons evaluating the appeal and that the person or persons
evaluating the appeal were not involved in the initial decision and a requirement that the
carrier identify a point of contact by name, address and telephone number to answer
specific questions from the enrollee; and
APPROVED
MAY 23, 2025
BY GOVERNOR
CHAPTER
31
RESOLVES
Page 2 - 132LR0670(03)
2. The rule is amended in Section 9(B)(2)(b)(i) to remove the requirement that a
written adverse benefit determination that does not involve a health care treatment decision
include the name and title of the person or persons participating in the grievance review
process and replace it with a requirement that the determination attest to the credentials of
the person or persons participating in the grievance review process and that the person or
persons participating in the grievance review process were not involved in the initial
determination and a requirement that the carrier identify a point of contact by name, address
and telephone number to answer specific questions from the enrollee.
Emergency clause. In view of the emergency cited in the preamble, this legislation
takes effect when approved.