Maine Revised Statutes Title 24 Sec. 2302-C – Penalty for noncompliance with utilization review programs
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Terms Used In Maine Revised Statutes Title 24 Sec. 2302-C
- Contract: A legal written agreement that becomes binding when signed.
- organization: means a corporation or other entity authorized by the superintendent or organized pursuant to this chapter for the purpose of providing nonprofit hospital service plans within the meaning of subsection 1, nonprofit medical service plans within the meaning of subsection 2 and any organization that provides only nonprofit health care plans within the meaning of subsection 3. See Maine Revised Statutes Title 24 Sec. 2301
A contract issued or renewed by a nonprofit service organization after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of nonprofit service organizations to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary. [PL 1995, c. 332, Pt. M, §2 (NEW).]
SECTION HISTORY
PL 1995, c. 332, §M2 (NEW).