§4238. Medical food coverage for inborn error of metabolism
1. Inborn error of metabolism; special modified low-protein food product. As used in this section, "inborn error of metabolism" means a genetically determined biochemical disorder in which a specific enzyme defect produces a metabolic block that may have pathogenic consequences at birth or later in life. As used in this section, "special modified low-protein food product" means food formulated to reduce the protein content to less than one gram of protein per serving and does not include foods naturally low in protein.
[PL 1995, c. 369, §4 (NEW).]
2. Required coverage. All health maintenance organization individual and group contracts must provide coverage for metabolic formula and special modified low-protein food products that have been prescribed by a licensed physician for a person with an inborn error of metabolism. The contracts must reimburse:
A. For metabolic formula; and [PL 1995, c. 369, §4 (NEW).]
B. Up to $3,000 per year for special modified low-protein food products. [PL 1995, c. 369, §4 (NEW).]
[PL 1995, c. 369, §4 (NEW).]
3. Application. The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1996. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
[PL 1995, c. 369, §4 (NEW).]
SECTION HISTORY
RR 1995, c. 1, §19 (RNU). PL 1995, c. 369, §4 (NEW).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS
24-A §4202. Definitions (REPEALED)
24-A §4203. Establishment of health maintenance organizations
24-A §4204. Issuance of certificate of authority
24-A §4204-A. Surplus requirements
24-A §4205. Powers of health maintenance organizations
24-A §4205-A. Continuity of licensure; business combinations
24-A §4207. Evidence of coverage and charges for health care services
24-A §4207-A. Point-of-service products
24-A §4208. Annual and interim reports
24-A §4209. Information to enrollees
24-A §4210-A. Continuity of health insurance coverage (REPEALED)
24-A §4212. Prohibited practices
24-A §4213. Regulation of agents
24-A §4214. Powers of insurers and nonprofit hospital or medical service corporations
24-A §4216. Suspension or revocation of certificate of authority
24-A §4217. Rehabilitation, liquidation or conservation of health maintenance organizations
24-A §4218-A. Compliance with the Affordable Care Act
24-A §4219. Administrative procedures
24-A §4221. Penalties and enforcement
24-A §4222. Statutory construction and relationship to other laws
24-A §4223. Filings and reports as public documents
24-A §4224. Confidentiality; liability; access to records
24-A §4224-A. Loss information (REPEALED)
24-A §4225. Commissioner of Health and Human Services' authority to contract
24-A §4226. Federal legislation
24-A §4227. Choice of alternative coverage
24-A §4228. Utilization review data
24-A §4229. Acquired Immune Deficiency Syndrome
24-A §4230. Trade practices and frauds (REPEALED)
24-A §4231. Insolvency or withdrawal; alternative coverage
24-A §4232. Replacement coverage
24-A §4233. Registration, regulation and supervision of holding company systems
24-A §4233-A. Extension of coverage for dependent children
24-A §4233-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
24-A §4233-C. Mandatory offer of coverage for certain adults with disabilities
24-A §4234-A. Mental health services coverage
24-A §4234-B. Maternity and routine newborn care
24-A §4234-C. Newborn children coverage
24-A §4234-D. Off-label use of prescription drugs for cancer
24-A §4234-E. Off-label use of prescription drugs for HIV or AIDS
24-A §4234-F. Maternity and postpartum care
24-A §4235. Standardized claim forms
24-A §4236. Chiropractors in health maintenance organizations
24-A §4237. Coverage for breast cancer treatment
24-A §4237-A. Screening mammograms
24-A §4238. Medical food coverage for inborn error of metabolism
24-A §4239. Medical child support
24-A §4240. Coverage for diabetes supplies
24-A §4241. Gynecological and obstetrical services
24-A §4242. Coverage for Pap tests (REALLOCATED FROM TITLE 24-A, SECTION 4240)
24-A §4243. Limits on priority liens; subrogation
24-A §4244. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 4243)
24-A §4245. NCQA accreditation survey report
24-A §4246. Coverage for services provided by registered nurse first assistants
24-A §4247. Coverage for contraceptives (REALLOCATED FROM TITLE 24-A, SECTION 4245)
24-A §4249. Mandated offer of domestic partner benefits
24-A §4250. Coverage for hospice care services (REALLOCATED FROM TITLE 24-A, SECTION 4249)
24-A §4252. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
24-A §4253. Enrollment for individuals or families establishing eligibility for MaineCare
24-A §4254. Coverage for colorectal cancer screening
24-A §4255. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 4253)
24-A §4257. Coverage for services provided by independent practice dental hygienist
24-A §4258. Coverage for children's early intervention services