Legislation


LD 46 – Maine

Status: Enacted
Year Introduced: 2021
Year Enacted: 2021
Link: http://legislature.maine.gov/legis/bills/display_ps.asp?LD=46&snum=130

This bill provides that information on provider charges as reported by the Maine Health Data Organization or, if Maine Health Data Organization claims data is insufficient or otherwise inapplicable, another independent medical claims database specified by the Superintendent of Insurance must be used to determine the amount a carrier must reimburse an out-of-network provider under certain circumstances. It removes the requirement that a benchmarking database be maintained by a nonprofit organization that is not affiliated with and does not receive funding from a carrier. It bases the amount a carrier must reimburse an out-of-network provider or enrollee on the rate paid for a health care service in the geographic area where the service is provided rather than on the rate paid for a health care service in an enrollee’s geographic area.


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