An Act To Establish a Health Care Bill of Rights
Sec. A-1. 24-A MRSA §2809-A, sub-§1-A, ¶B-2 is enacted to read:
Sec. A-2. 24-A MRSA §4302, sub-§1, ¶A, as enacted by PL 1995, c. 673, Pt. C, §1 and affected by §2, is amended to read:
(1) Health care services excluded from coverage;
(2) Health care services requiring copayments or deductibles paid by enrollees;
(3) Restrictions on access to a particular provider type; and
(4) Health care services that are or may be provided only by referral; and
(5) Childhood immunizations as recommended by the United States Department of Health and Human Services, Centers for Disease Control and Prevention and the American Academy of Pediatrics;
Sec. A-3. 24-A MRSA §4303, sub-§12 is enacted to read:
Sec. A-4. 24-A MRSA §4303, sub-§13 is enacted to read:
The superintendent shall establish by rule the minimum information and standards for explanation of benefits forms used by carriers, taking into consideration any input from stakeholders and any national standards for explanation of benefits forms. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. This subsection applies to any explanation of benefits form issued on or after January 1, 2010.
Sec. A-5. 24-A MRSA §4303, sub-§14 is enacted to read:
Sec. A-6. Appropriations and allocations. The following appropriations and allocations are made.
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF
Insurance - Bureau of 0092
Initiative: Allocates funds for the one-time costs of required rule-making proceedings.
|OTHER SPECIAL REVENUE FUNDS||2009-10||2010-11|
|OTHER SPECIAL REVENUE FUNDS TOTAL||$2,100||$0|
Sec. B-1. 24-A MRSA §4301-A, sub-§16-A is enacted to read:
Sec. B-2. 24-A MRSA §4302, sub-§1, ¶J, as enacted by PL 1999, c. 742, §5, is amended to read:
Sec. B-3. 24-A MRSA §4302, sub-§1, ¶K, as enacted by PL 1999, c. 742, §5, is amended to read:
Sec. B-4. 24-A MRSA §4302, sub-§1, ¶L is enacted to read:
Sec. B-5. 24-A MRSA §4303, sub-§2, ¶E is enacted to read:
(1) Disclose to providers the methodologies, criteria, data and analysis used to evaluate provider quality, performance and cost-efficiency ratings;
(2) Create and share with providers their provider profile at least 60 days prior to using or publicly disclosing the results of the provider profiling program;
(3) Afford providers the opportunity to correct errors, submit additional information for consideration and seek review of data and performance ratings; and
(4) Afford providers due process appeal rights to challenge the profiling determination described in this subsection and by Bureau of Insurance Rule Chapter 850, Health Plan Accountability.
If a carrier has a provider profiling program that includes out-of-network providers, a carrier must meet the requirements of this paragraph with regard to an out-of-network provider as well as for a provider in a carrier's network.
Sec. C-1. 24-A MRSA §2736, sub-§1, as amended by PL 2009, c. 14, §4 and c. 244, Pt. G, §1, is repealed and the following enacted in its place:
Sec. C-2. 24-A MRSA §2736, sub-§2, as amended by PL 1997, c. 344, §8, is further amended to read:
Sec. C-3. 24-A MRSA §2736-A, first ¶, as amended by PL 2007, c. 629, Pt. M, §3, is further amended to read:
If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates not be excessive, inadequate, unfairly discriminatory or not in compliance with former section 6913 or that the filing violates any of the provisions of chapter 23, the superintendent shall cause a hearing to be held. If a filing proposes an increase in rates in an individual health plan as defined in section 2736-C, the superintendent shall cause a hearing to be held at the request of the Attorney General. In any hearing conducted under this section, the insurer has the burden of proving rates are not excessive, inadequate or unfairly discriminatory and in compliance with section 6913.
Sec. D-1. 24-A MRSA §2808-B, sub-§2-A, ¶B, as enacted by PL 2003, c. 469, Pt. E, §16, is amended to read:
Sec. D-2. 24-A MRSA §2808-B, sub-§6, ¶A, as amended by PL 2001, c. 410, Pt. A, §6, is further amended to read:
Sec. D-3. 24-A MRSA §2808-B, sub-§8-A is enacted to read:
Sec. D-4. Superintendent of Insurance report. The Superintendent of Insurance shall review possible ways to improve the availability and affordability of the State's individual health insurance market, including, but not limited to, increases in the minimum loss-ratio standards applicable to that market and consideration of an insurer's loss experience in all lines of insurance marketed by a carrier in this State when reviewing health insurance rate filings. The superintendent shall report the results of the review, including any recommendations for legislation, to the Joint Standing Committee on Insurance and Financial Services no later than February 1, 2010. The joint standing committee may report out a bill based on the report to the Second Regular Session of the 124th Legislature.
Sec. E-1. 24-A MRSA §221, sub-§5 is enacted to read:
Sec. E-2. Transition. The Superintendent of Insurance shall begin conducting the market conduct examinations required by the Maine Revised Statutes, Title 24-A, section 221, subsection 5 during calendar year 2010, and all health carriers subject to the examination requirement must be examined at least once before January 1, 2015.
Sec. F-1. 24-A MRSA §4303, sub-§7-A is enacted to read: