| | |
the carrier is deemed at all times to be the agent of the State of | | Maine and the University of Maine System. The chancellor and the | carrier, acting at the direction of the State, may offer or demand | | negotiate such terms and conditions as the chancellor considers to | | be in the best interest of the university to reduce the expense of | the plan, including, but not limited to, offering or demanding | | negotiating reductions in standard hospital reimbursement rates, | | rebates and refunds and uniform terms relating to such reductions, | | rebates or refunds. The chancellor may not affect or seek to | | affect amounts paid to hospitals relating to any other customer of | | the carrier. The hospital discount rate resulting from this | | specific arrangement is not intended to affect the underlying | | premium rates for any purpose. This pooling of funds by the State | | is not intended to affect plan cost recoveries, plan cost | | structures or the university's ability to negotiate with carriers | | regarding the plan. |
|
| | | 2. The Commissioner of Human Services shall implement | | appropriate normalizing adjustments, no less than annually, to | | the public revenue component and the annual periodic interim | | payments of each hospital under subsection 1, consistent with the | requirements of Title XIX of the federal Social Security Act, to | offset the impact of any plan-related revenue reduction under | this sectionIf any payment made in accordance with this | subsection is subsequently determined to be subject to | recoupment, the State shall reimburse the hospital for all such | recoupment costs paid by the hospital. | | financial participation is denied in any payments resulting from | | adjustments made pursuant to this subsection, the State may not | | recoup any such payments from the hospitals to which they were | | made. |
|
| | | 3. Any carrier subject to this section is immune from any | | claim of or liability to any enrollee, any hospital or other | | health care provider for any action taken in furtherance of the | | authority and directives as set forth in this section. The terms | | of this section are deemed to amend the contract between the | | carrier and the University of Maine System and prevail over any | | inconsistent terms in the contract or certificates of coverage. | | A reimbursement rate, discount or rebate resulting from an | | agreement under subsection 1 may not be used by the carrier as a | | reference or base rate for any other contractual arrangement. |
|
| | | 5. Notwithstanding the provisions of the Maine Revised | | Statutes, Title 24-A, including sections 2174, 2185 and 2677-A, | | the agreement negotiated in accordance with subsection 1 may | | provide for adjustments to the amounts payable to providers on an | aggregate services basis and on a retrospective basis, and such | adjustments may not require any change to previously calculated | coinsurance amounts, deductibles, lifetime maximums, benefit |
|
|
