Maine Revised Statutes Title 24-A Sec. 4303-B – Disclosure related to provider networks
Current as of: 2023 | Check for updates
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1. Disclosure. Upon request, a carrier shall provide to a provider to which the carrier has decided not to offer the opportunity to participate or that the carrier has decided not to include as a participating provider in any of the carrier’s provider networks a written explanation of the reason for the carrier’s decision. The written explanation provided by the carrier must indicate whether the reason for not offering the provider the opportunity to contract or for not including the provider in any network was related to the provider’s performance with respect to quality, cost or cost-efficiency.
[PL 2013, c. 535, §2 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4303-B
- Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-AContract: A legal written agreement that becomes binding when signed. 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 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
2. No right of action. A provider has no right of action as the result of a disclosure made in accordance with this section.
[PL 2013, c. 535, §2 (NEW).]
SECTION HISTORY
PL 2013, c. 535, §2 (NEW).