Maine Revised Statutes Title 24-A Sec. 1953 – Powers
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In addition to the powers granted in Title 13?B or Title 13?C, an alliance may do any of the following: [RR 2001, c. 2, Pt. B, §43 (COR); RR 2001, c. 2, Pt. B, §58 (AFF).]
1. Membership fees. Set reasonable fees for membership in the alliance for financing reasonable and necessary costs incurred in administering the alliance;
[PL 1995, c. 673, Pt. A, §3 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 1953
- alliance: means a corporation established under former Title 13?A, Title 13?B or Title 13?C to provide health insurance to its members through one or more participating carriers. See Maine Revised Statutes Title 24-A Sec. 1951
- Carrier: means any insurance company, nonprofit hospital and medical service organization or health maintenance organization authorized to issue health plans in this State. See Maine Revised Statutes Title 24-A Sec. 1951
2. Premium collection. Provide premium collection services for health benefit plans offered through the alliance if the insurer or health maintenance organization offering the plan gives express written authorization to the alliance or any other person or entity acting on behalf of the alliance to act as the insurer’s or the health maintenance organization’s agent for that purpose;
[PL 1995, c. 673, Pt. A, §3 (NEW).]
3. Contracts. Contract with qualified independent 3rd parties for any service necessary to carry out the powers and duties authorized or required by this chapter;
[PL 1995, c. 673, Pt. A, §3 (NEW).]
4. Standards. Exclude a carrier or freeze enrollment in a carrier for failure to achieve established quality, access or information reporting standards of the alliance;
[PL 1995, c. 673, Pt. A, §3 (NEW).]
5. Data collection. Develop uniform standards for data to be provided by participating carriers and providers. The alliance may collect data necessary for evaluation of the performance of participating carriers and their provider networks by consumers, providers, employers and the superintendent;
[PL 1995, c. 673, Pt. A, §3 (NEW).]
6. Negotiation. Negotiate with participating carriers the premium rates charged for coverage offered through the alliance, consistent with rules adopted by the superintendent; or
[PL 1995, c. 673, Pt. A, §3 (NEW).]
7. Risk adjustment. Establish procedures, subject to approval by the superintendent, for adjusting payments within each risk pool to participating carriers if the alliance finds that some carriers have a significantly disproportionate share of high-risk or low-risk enrollees.
[PL 1995, c. 673, Pt. A, §3 (NEW).]
SECTION HISTORY
PL 1995, c. 673, §A3 (NEW). PL 1997, c. 616, §2 (AMD). RR 2001, c. 2, §B43 (COR). RR 2001, c. 2, §B58 (AFF).