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132nd MAINE LEGISLATURE
FIRST SPECIAL SESSION-2025
Legislative Document No. 1589H.P. 1047House of Representatives, April 10, 2025
An Act to Improve Parity in Insurance Coverage for Outpatient
Counseling Services in Maine
Reference to the Committee on Health Coverage, Insurance and Financial Services
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative CRAFTS of Newcastle. Page 1 - 132LR1782(01)
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2 as repealed and replaced by PL 2005, c. 683,
3 Pt. A, §39, is repealed.
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5 683, Pt. A, §39, is amended to read:
6 2 apply Subsection 1 applies with respect to the following
7 types of professionals:
8 A. A psychologist licensed to practice in this State;
9 B. A certified social worker licensed for the independent practice of social work in
10 this State;
11 C. A licensed clinical professional counselor licensed for the independent practice of
12 counseling in this State;
13 D. A licensed nurse who is certified by the American Nurses' Association as a clinical
14 specialist in adult psychiatric and mental health nursing or as a clinical specialist in
15 child and adolescent psychiatric and mental health nursing;
16 E. A marriage and family therapist licensed as a marriage and family therapist in this
17 State; and
18 F. A licensed pastoral counselor licensed as a pastoral counselor in this State.
19 as repealed and replaced by PL 2005, c. 683,
20 Pt. A, §39, is repealed.
21 is enacted to read:
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23 An insurer that issues individual health care contracts providing coverage for mental health
24 services shall provide coverage for outpatient counseling services in accordance with this
25 subsection.
26 A. An insurer shall reimburse for outpatient counseling services when those services
27 are provided by a licensed counseling professional providing services that are within
28 the lawful scope of practice of the counseling professional’s license, including a master
29 social worker, clinical social worker, clinical professional counselor, pastoral
30 counselor or marriage and family therapist.
31 B. At a minimum, an insurer shall reimburse for outpatient counseling services in an
32 amount equal to 150% of the MaineCare reimbursement rate for that service.
33 C. An insurer may not discriminate against a licensed counseling professional as
34 described in paragraph A or arbitrarily reduce the reimbursement rate for outpatient
35 counseling services provided by a licensed counseling professional based solely on the
36 type of license held by a licensed counseling professional.
37 D. An insurer may not impose prior authorization or referral requirements as a
38 condition of coverage for outpatient counseling services or impose any restriction or
39 limitation on access to outpatient counseling services that does not have a clinical basis. Page 2 - 132LR1782(01)
1 E. An insurer shall maintain an adequate network of licensed counseling professionals
2 to ensure reasonable access to outpatient counseling services.
3 as repealed and replaced by PL 2005, c. 683,
4 Pt. A, §40, is repealed.
5
6 683, Pt. A, §40, is amended to read:
7 2 apply Subsection 1 applies with respect to the following
8 types of professionals:
9 A. A psychologist licensed to practice in this State;
10 B. A certified social worker licensed for the independent practice of social work in
11 this State;
12 C. A licensed clinical professional counselor licensed for the independent practice of
13 counseling in this State;
14 D. A licensed nurse who is certified by the American Nurses' Association as a clinical
15 specialist in adult psychiatric and mental health nursing or as a clinical specialist in
16 child and adolescent psychiatric and mental health nursing;
17 E. A marriage and family therapist licensed as a marriage and family therapist in this
18 State; and
19 F. A licensed pastoral counselor licensed as a pastoral counselor in this State.
20 as repealed and replaced by PL 2005, c. 683,
21 Pt. A, §40, is repealed.
22 is enacted to read:
23
24 An insurer that issues group health care contracts providing coverage for mental health
25 services shall provide coverage for outpatient counseling services in accordance with this
26 subsection.
27 A. An insurer shall reimburse for outpatient counseling services when those services
28 are provided by a licensed counseling professional providing services that are within
29 the lawful scope of practice of the counseling professional’s license, including a master
30 social worker, clinical social worker, clinical professional counselor, pastoral
31 counselor or marriage and family therapist.
32 B. At a minimum, an insurer shall reimburse for outpatient counseling services in an
33 amount equal to 150% of the MaineCare reimbursement rate for that service.
34 C. An insurer may not discriminate against a licensed counseling professional as
35 described in paragraph A or arbitrarily reduce the reimbursement rate for outpatient
36 counseling services provided by a licensed counseling professional based solely on the
37 type of license held by a licensed counseling professional.
38 D. An insurer may not impose prior authorization or referral requirements as a
39 condition of coverage for outpatient counseling services or impose any restriction or
40 limitation on access to outpatient counseling services that does not have a clinical basis. Page 3 - 132LR1782(01)
1 E. An insurer shall maintain an adequate network of licensed counseling professionals
2 to ensure reasonable access to outpatient counseling services.
3 as amended by PL 2003, c. 20, Pt. VV,
4 §23 and affected by §25, is repealed.
5 is enacted to read:
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8 care contracts providing coverage for mental health services shall provide coverage for
9 outpatient counseling services in accordance with this subsection.
10 A. A health maintenance organization shall reimburse for outpatient counseling
11 services when those services are provided by a licensed counseling professional
12 providing services that are within the lawful scope of practice of the counseling
13 professional’s license, including a master social worker, clinical social worker, clinical
14 professional counselor, pastoral counselor or marriage and family therapist.
15 B. At a minimum, a health maintenance organization shall reimburse for outpatient
16 counseling services in an amount equal to 150% of the MaineCare reimbursement rate
17 for that service.
18 C. A health maintenance organization may not discriminate against a licensed
19 counseling professional as described in paragraph A or arbitrarily reduce the
20 reimbursement rate for outpatient counseling services provided by a licensed
21 counseling professional based solely on the type of license held by a licensed
22 counseling professional.
23 D. A health maintenance organization may not impose prior authorization or referral
24 requirements as a condition of coverage for outpatient counseling services or impose
25 any restriction or limitation on access to outpatient counseling services that does not
26 have a clinical basis.
27 E. A health maintenance organization shall maintain an adequate network of licensed
28 counseling professionals to ensure reasonable access to outpatient counseling services.
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30 executed, delivered, issued for delivery, continued or renewed in this State on or after
31 January 1, 2026. For purposes of this Act, all contracts are deemed to be renewed no later
32 than the next yearly anniversary of the contract date.
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34 This bill requires insurers and health maintenance organizations that provide individual
35 and group health coverage to provide coverage for outpatient counseling services when
36 those services are provided by a licensed counseling professional acting within the lawful
37 scope of the counseling professional's license, including a master social worker, clinical
38 social worker, clinical professional counselor, pastoral counselor or marriage and family
39 therapist. The bill requires these counseling professionals to be reimbursed, at a minimum,
40 in an amount equal to 150% of the MaineCare reimbursement rate for the same services.
41 The bill also prohibits discrimination against a licensed counseling professional or an
42 arbitrary reduction in reimbursement rates based solely on the type of license held by a
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43 licensed counseling professional. The bill prohibits the imposition of prior authorization or
44 referral requirements as a condition of coverage for outpatient counseling services or the
45 imposition of any restriction or limitation on access to outpatient counseling services that
46 does not have a clinical basis. The bill also requires that insurers and health maintenance
47 organizations maintain an adequate network of licensed counseling professionals to ensure
48 reasonable access to outpatient counseling services. The requirements apply beginning
49 January 1, 2026.
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