| | | Be it enacted by the People of the State of Maine as follows: |
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| | | Sec. 1. 24 MRSA §2332-G, as reallocated by RR 1995, c. 2, §49 and | | affected by §50, is repealed. |
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| | | Sec. 2. 24-A MRSA §2847-F, as reallocated by PL 1997, c. 370, Pt. H, | | §1, is repealed. |
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| | | Sec. 3. 24-A MRSA §4241, as enacted by PL 1995, c. 617, §5 and | | affected by §6, is repealed. |
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| | | Sec. 4. 24-A MRSA §4301, sub-§§2-A, 4-A, 4-B and 7 are enacted to read: |
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| | | 2-A.__Health care treatment decision.__"Health care treatment | | decision" means a determination made when medical services are | | provided by the health plan or a decision that affects the | | quality of the diagnosis, care or treatment provided to an | | enrollee of a health plan. |
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| | | 4-A.__Medically appropriate care.__"Medically appropriate | | care" means care that meets the standard for care for health care | | services as determined by health care providers in accordance | | with the prevailing practices and standards of the medical | | profession and community. |
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| | | 4-B.__Ordinary care.__"Ordinary care" means, in the case of a | | carrier, the degree of care that a carrier of ordinary prudence | | would use under the same or similar circumstances.__For a person | | who is an employee, agent, ostensible agent or representative of | | a carrier, "ordinary care" means the degree of care that a person | | of ordinary prudence in the same profession, specialty or area of | | practice would use in the same or similar circumstances. |
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| | | 7.__Point-of-service option.__"Point-of-service option" means | | a health care delivery system that permits a health plan enrollee | | to receive services outside the network of participating | | providers without a referral from the enrollee's primary care | | provider. |
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| | | Sec. 5. 24-A MRSA §4303, sub-§3-B is enacted to read: |
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| | | 3-B.__Prohibition on financial incentives.__A carrier offering | | a managed care plan in this State may not offer or pay any type | | of material inducement, bonus or other financial incentive to a | | participating provider to deny, reduce, withhold, limit or delay | | specific medically necessary and appropriate health care services | | covered under the plan to an enrollee. |
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| | | Sec. 6. 24-A MRSA §4303, sub-§§5 and 6 are enacted to read: |
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