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G.__To distribute the costs of health care fairly and | | equitably; |
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| | | H.__To simplify the health care system for consumers, | | businesses and providers; |
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| | | I.__To ensure providers clinical freedom to treat patients | | based on health care needs and criteria; and |
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| | | J.__To ensure accountability in all aspects of the health | | care system to promote public confidence and control of | | costs. |
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| | | 2. Eligibility for Maine Health Care Plan.__In accordance with | | this subsection, residents and nonresidents are eligible to | | receive covered health care services from participating providers | | under the plan within this State if the service is necessary or | | appropriate for the prevention, diagnosis or treatment of, or | | maintenance or rehabilitation following, injury, disability or | | disease.__The agency shall adopt rules regarding payment of | | premium, application for a plan card and membership in the plan.__ | | Rules adopted pursuant to this subsection are routine technical | | rules as defined in Title 5, chapter 375, subchapter 2-A.__The | | rules must provide for at least the following. |
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| | | A.__Each resident of the State is eligible to receive health | | care under the plan and may enroll in the plan. |
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| | | B.__A nonresident of the State who maintains significant | | contact with the State, including employment or self- | | employment within the State or attendance at a college, | | university or other institution of higher education in the | | State, is eligible to receive health care under the plan.__ | | Eligibility extends to a person qualifying under this | | paragraph and to that person's spouse and dependents.__The | | agency shall adopt rules establishing criteria for | | eligibility for nonresidents and determine the premium to be | | paid by them and the method of payment. |
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| | | C.__A plan member who ceases to be eligible for the plan may | | elect, within 60 days of the event that causes ineligibility, to | | continue participation in the plan for a period of up to 18 | | months.__For the purposes of this paragraph, a plan member is | | considered to have lost eligibility due to disability if the | | member could be determined disabled under the federal Social | | Security Act, Title II or Title XVI.__The agency shall ensure | | that plan members who become ineligible for enrollment in the | | plan are promptly notified of the provisions of this paragraph.__ | | The |
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