Me. Stat. tit. 24-A, § 4303. Plan requirements: Health Plan Requirements – Maine
Status: EnactedYear Enacted: 1995
Year Amended: 2017
File: Download
Prescribes requirements for health plan contracts. Among other things, such as ensuring adequate access to providers, the statute prohibits certain contract provisions including (1) those which induce financial incentives to deny medically necessary services and (2) most-favored-nations clauses. Balance billing allowed but managed care providers required to provide notice of practices, disclose maximum out-of-pocket charge on request; Additional rules for participating providers.
Key Issues:
Trade Secret
Provider Payment
PHARMACEUTICALS
Most Favored Nation (MFN)
PRICE AND QUALITY TRANSPARENCY
Utilization Review
Network Adequacy
Quality Measure
Surprise Billing or Balance Billing
Rate Regulation
Prior Authorization
HEALTHCARE COSTS
Drug Formulary
Scope of Practice
Competition
Provider Network
Shared Savings or Right to Shop
Drug Pricing
Antitrust Enforcement
Cost Containment
HEALTHCARE MARKETS
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