Nothing in this chapter may be construed to: [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).]
1. Purchase services with own funds. Prohibit an individual from purchasing any health care services with that individual’s own funds, whether these services are covered within the individual’s benefit package or from another health care provider or plan, except as otherwise provided by federal or state law;

[PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).]

Terms Used In Maine Revised Statutes Title 24-A Sec. 4307

  • Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Enrollee: means an individual who is enrolled in a health plan or a managed care plan. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Managed care plan: means a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan through:
    • A. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Participating provider: means a licensed or certified provider of health care services, including mental health services, or health care supplies that has entered into an agreement with a carrier to provide those services or supplies to an individual enrolled in a managed care plan. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Plan sponsor: means an employer, association, public agency or any other entity providing a health plan. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Provider: means a practitioner or facility licensed, accredited or certified to perform specified health care services consistent with state law. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Religious nonmedical provider: means a provider who provides only religious nonmedical treatment or religious nonmedical nursing care. See Maine Revised Statutes Title 24-A Sec. 4301-A
    • 2. Additional benefits. Prohibit any plan sponsor from providing additional coverage for benefits, rights or protections not set out in this chapter;

    [PL 1999, c. 742, §16 (AMD).]

    3. Provider participation. Require a carrier to admit to a managed care plan a provider willing to abide by the terms and conditions of the managed care plan; or

    [PL 1999, c. 742, §16 (AMD).]

    4. Treatment by religious nonmedical providers. With respect to coverage of treatment by religious nonmedical providers:
    A. Restrict or limit the right of a carrier to include a religious nonmedical provider as a participating provider in a managed care plan; [PL 1999, c. 742, §17 (NEW).]
    B. Require a carrier to:

    (1) Utilize medically based eligibility standards or criteria in deciding provider status of religious nonmedical providers;
    (2) Use medical professionals or criteria to decide enrollee access to religious nonmedical providers;
    (3) Utilize medical professionals or criteria in making decisions in internal or external appeals regarding coverage for care by religious nonmedical providers; or
    (4) Compel an enrollee to undergo a medical examination or test as a condition of receiving coverage for treatment by a religious nonmedical provider; or [PL 1999, c. 742, §17 (NEW).]
    C. Require a carrier to exclude religious nonmedical providers because the providers do not provide medical or other required data, if such data is inconsistent with the religious nonmedical treatment or nursing care provided by the provider. [PL 1999, c. 742, §17 (NEW).]

    [PL 1999, c. 742, §17 (NEW).]

    SECTION HISTORY

    PL 1995, c. 673, §C1 (NEW). PL 1995, c. 673, §C2 (AFF). PL 1999, c. 742, §§16,17 (AMD).
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