SP0239
LD 648		 PUBLIC Law, Chapter 274

on - Session - 126th Maine Legislature
 
  
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An Act To Make Records of External Review Proceedings Overseen by the Bureau of Insurance Confidential

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4312, sub-§7-A  is enacted to read:

7-A.  Confidentiality.   Except as provided in this subsection, all records of the bureau or an independent review organization relating to an external review request or external review proceeding are confidential and not a public record under Title 1, chapter 13.
A.  A party to an external review may obtain from the independent review organization a transcript or recording of the external review hearing and a copy of any evidence introduced by the opposing party.
B.  The superintendent shall disseminate to the Legislature and to the public aggregate information related to external reviews conducted by independent review organizations on an annual basis, including:

(1) The number of external review requests by carrier, the number of decisions in favor of the enrollee, the number of decisions upholding the carrier's benefit determination and the number of external review requests resolved prior to the issuance of a decision; and

(2) The categories of external review requests by carrier. The categories may not include personally identifiable information or specific medical condition. The categories must include, but are not limited to, medical necessity, out-of-network referrals, inpatient care, behavioral health, prescription drugs and experimental or investigational treatment.

Effective 90 days following adjournment of the 126th Legislature, First Regular Session, unless otherwise indicated.

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