‘An Act To Strengthen Disclosure about Provider Networks in Health Insurance Plans to Consumers and Providers’
| HP1199 LD 1676 |
Session - 126th Maine Legislature C "A", Filing Number H-718, Sponsored by
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LR 2395 Item 2 |
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| Bill Tracking, Additional Documents | Chamber Status | ||
Amend the bill by striking out the title and substituting the following:
‘An Act To Strengthen Disclosure about Provider Networks in Health Insurance Plans to Consumers and Providers’
Amend the bill by striking out everything after the enacting clause and before the summary and inserting the following:
‘Sec. 1. 24-A MRSA §4303, sub-§19 is enacted to read:
Sec. 2. 24-A MRSA §4303-B is enacted to read:
§ 4303-B. Disclosure related to provider networks
SUMMARY
This amendment is the majority report of the committee and replaces the bill. The amendment requires a health insurance carrier to disclose information about its provider networks, including whether there are any hospitals, health care facilities, physicians or other providers not included in the provider's network and any differences in an enrollee's financial responsibilities for payment of covered services to a participating provider and to a provider not included in a provider network. The amendment authorizes the Superintendent of Insurance to adopt rules setting forth the manner, content and required disclosure of the information and specifies that those rules are routine technical rules.
The amendment also requires a health insurance carrier to disclose upon request from a provider the reason for the carrier's decision not to offer the provider the opportunity to participate or to include the provider in any provider network of the carrier. The amendment requires that the written explanation indicate whether the reason was related to the provider's performance with respect to quality, cost or cost-efficiency.
The amendment stipulates that a provider has no right of action as the result of such a disclosure.