HP0425, LD 609, item 1, An Act To Prohibit Insurance Carriers That Are Not Health Insurance Carriers from Operating as Managed Care Organizations

An Act To Prohibit Insurance Carriers That Are Not Health Insurance Carriers from Operating as Managed Care Organizations

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

Sec. 1. 24-A MRSA §2185-A is enacted to read:

§ 2185-A. Acting as managed care organization prohibited

It is an unfair trade practice under this chapter for an insurer authorized to transact insurance in this State to act as a managed care organization or impose principles of managed care under a contract with a health care provider except as provided in this section.

1. Fee schedule. An insurer may not impose a fee schedule used by an affiliated health insurer, health maintenance organization or other managed care organization under a separate contract with a health care provider for any claim under any automobile insurance liability policy or workers' compensation policy without the express prior written consent of the health care provider.

2. Reduction of reimbursement or imposition of limits. An insurer may not reduce reimbursement or impose limits on the type or frequency of covered services of a health care provider under any automobile insurance liability policy or workers' compensation policy based on the terms and conditions of the health care provider's separate contract with the insurer's affiliated health insurer, health maintenance organization or other managed care organization without the express prior written consent of the health care provider.

summary

This bill prohibits an insurer from imposing a fee schedule, reducing reimbursement or imposing limits on the type or frequency of health care services covered under any automobile insurance liability policy or workers' compensation policy based on the terms and conditions of a health care provider's separate contract with the insurer's affiliated health insurer, health maintenance organization or other managed care organization without the express prior written consent of the health care provider.

HP0425 LD 609	Session - 128th Maine Legislature		LR 950 Item 1
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