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charged for medically necessary, emergency health care | | services obtained by a plan member from a provider who is not | | a participating provider. |
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| | | E.__Copayments or deductibles do not apply to health care | | services provided through the plan, except that, to | | encourage the use of the most appropriate and cost-effective | | mode of service, an organized delivery system may require | | reasonable payments by a plan member if payment is approved | | by the agency and does not substantially interfere with | | access to needed health care services. |
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| | | F.__Accountability to the public of the open plan and | | organized delivery systems must be ensured in order to | | promote public confidence in the health care delivery system | | and awareness of the costs of care. |
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| | | G.__Flexible enrollment and transfer processes that preserve | | plan member confidence and ensure that health care needs are | | met must be provided. |
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| | | H.__An opportunity for negotiation of fair rates of | | compensation with participating providers in the open plan | | and organized delivery systems and negotiation with | | pharmaceutical companies for similarly classified | | pharmaceuticals must be provided. |
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| | | I.__A program to expand services to underserved rural and | | low-income communities must be established. |
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| | | J.__Mechanisms must be developed to provide incentives to | | participating providers in the open plan and to organized | | delivery systems for additional savings that do not | | compromise the quality of health care. |
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| | | Rules adopted pursuant to this subsection are routine technical | | rules as defined in Title 5, chapter 375, subchapter 2-A. |
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| | | 5.__Provider requirements.__Participating providers, the open | | plan and organized delivery systems may not charge a plan member | | or a 3rd party for covered health services and may not charge | | rates in excess of the reimbursement levels set by the agency.__A | | participating provider of health care services, the open plan and | | organized delivery systems may not refuse to provide services to | | a plan member on the basis of health status, medical condition, | | previous insurance status, race, color, creed, age, national | | origin, citizenship status, gender, sexual orientation, | | disability, marital status or arrest record except as appropriate | | to the provider's professional specialization or other medically | | appropriate circumstances. |
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