Maine Revised Statutes Title 24-A Sec. 4320-O – Coverage for services provided by a physician assistant
Current as of: 2023 | Check for updates
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1. Services provided by a physician assistant. A carrier offering a health plan in this State shall provide coverage for health care services performed by a physician assistant licensed under Title 32, section 2594?E or 3270?E when those services are covered services under the health plan when performed by any other health care provider and when those services are within the lawful scope of practice of the physician assistant.
[PL 2019, c. 627, Pt. A, §2 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4320-O
- Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-AContract: A legal written agreement that becomes binding when signed. 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 Health 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, other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage not subject to the requirements of the federal Affordable Care Act. 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. Limits; deductible; copayment; coinsurance. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided by a physician assistant as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to the same service provided by other health care providers.
[PL 2019, c. 627, Pt. A, §2 (NEW).]
3. Network participation. A carrier shall demonstrate that the carrier’s provider network includes reasonable access, in accordance with section 4303, to all covered services that are within the lawful scope of practice of a physician assistant. A carrier may not exclude a provider from participation in the carrier’s provider network solely because the provider is a physician assistant as long as the provider is willing to meet the same terms and conditions as other participating providers. This subsection does not require a carrier to contract with all physician assistants or require a carrier to provide coverage under a health plan for any service provided by a participating physician assistant that is not within the health plan’s scope of coverage.
[PL 2019, c. 627, Pt. A, §2 (NEW).]
4. Billing. A carrier shall authorize a physician assistant to bill the carrier and receive direct payment for a medically necessary service the physician assistant provides to an enrollee and identify the physician assistant as provider in the billing and claims process for payment of the service. A carrier may not impose on a physician assistant a practice, education or collaboration requirement that is inconsistent with or more restrictive than a requirement of state law or board or agency rules.
[PL 2019, c. 627, Pt. A, §2 (NEW).]
SECTION HISTORY
PL 2019, c. 627, Pt. A, §2 (NEW).