LD 1085 – Maine

Status: In Process
Year Introduced: 2023
Link: https://legislature.maine.gov/bills/getPDF.asp?paper=HP0680&item=1&snum=131

This bill makes the following changes to the law relating to the comparable health care incentive program. 1. It removes the requirement that the small group health plan design be compatible with a health savings account. 2. It requires that the incentives be equal to or greater than 25% of the difference between the price of the service from the provider selected and the statewide average for the same covered health care service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization. 3. It adds surgical procedures to the categories of health care services included in the definition of “comparable health care service.” 4. It repeals the sunset date of the comparable health care service incentive program, which is January 1, 2024. Under current law, if an enrollee covered under a health plan other than a health maintenance organization plan elects to obtain a covered comparable health care service from an out-of-network provider at a price that is the same or less than the statewide average for the same covered health care service, the carrier is required to allow the enrollee to obtain the service from the out-of-network provider at the provider’s charge and, upon request by the enrollee, to apply the payments made by the enrollee for that comparable health care service toward the enrollee’s deductible and out-of-pocket maximum as specified in the enrollee’s health plan as if the health care services had been provided by an in-network provider. This bill removes the exception that the provision does not apply to a health maintenance organization plan and the limitation defining an out-of-network provider as a provider located in Massachusetts, New Hampshire or this State that is enrolled in the MaineCare program and participates in Medicare. The bill also removes the sunset date of the provision of law regarding access to lower-priced services, which is January 1, 2024.


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