LD 1629
Session - 126th Maine Legislature
LR 2423
Item 1
Bill Tracking, Additional Documents Chamber Status

An Act To Amend the Laws Governing the Provider Profiling Program

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

Sec. 1. 24-A MRSA §2694-A, sub-§1,  as amended by PL 2013, c. 383, §2, is further amended to read:

1. Performance measurement, reporting and tiering programs.   An insurer delivering or issuing for delivery within the State any individual health insurance policy or group health insurance policy or certificate shall annually file with the superintendent on or before October 1, 2010 and annually by October 1st in subsequent years a full and true statement of its criteria, standards, practices, procedures and programs that measure or tier , or establish narrow networks of, health care provider performance with respect to quality, cost or cost-efficiency. The statement must be on a form prepared by the superintendent and may be supplemented by additional information required by the superintendent. The statement must be verified by the oath of the insurer's president or vice-president, and secretary or chief medical officer. A filing and supporting information are public records notwithstanding Title 1, section 402, subsection 3, paragraph B.

Sec. 2. 24-A MRSA §4301-A, sub-§16-A,  as amended by PL 2013, c. 383, §3, is further amended to read:

16-A. Provider profiling program.  "Provider profiling program" means a program that uses provider data in order to rate or rank provider quality, cost or efficiency of care by the use of a grade, star, tier, rating or any other form of designation , including the establishment of a narrow network, that provides an enrollee with an incentive to use a designated provider based on quality, cost or efficiency of care.


This bill amends the law governing the health insurance provider profiling program to ensure that its requirements also apply to the establishment of narrow networks of health care providers.

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