Maine LD 251: An Act To Limit Allowable Health Care Charges in Certain Specified Situations

LD 251 (subjects: INSURANCE , HEALTH )

Official bill page at mainelegislature.org: http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=251&PID=1456&snum=127


Sponsors | Actions | Bill Text | Patterns of Support


Sponsors

Principal Sponsor: Sen. Geoffrey Gratwick of Penobscot: (D – District 9) — e-mail | Twitter | Facebook

6 Cosponsors:

Actions

Chamber

Action
2/3/2015 Senate Committee on INSURANCE AND FINANCIAL SERVICES
suggested and ordered printed
On motion by Senator MASON of Androscoggin REFERRED to the Committee on INSURANCE AND FINANCIAL SERVICES
Ordered sent down forthwith for concurrence.
2/3/2015 House Bill REFERRED to the Committee on INSURANCE AND FINANCIAL SERVICES.
In concurrence. ORDERED SENT FORTHWITH.
4/14/2015 Senate Reports READ
Senator WHITTEMORE of Somerset moved to Accept the Minority Ought Not To Pass Report
On motion by Same Senator Tabled until Later in Today’s Session, pending ACCEPTANCE of Minority Ought Not To Pass Report
Unfinished Business
4/16/2015 Senate Taken from the table by the President
Subsequently, On motion by Senator WHITTEMORE of Somerset Minority Ought Not To Pass Report ACCEPTED
Ordered sent down forthwith for concurrence.
4/21/2015 House Reports READ.
On motion of Representative BECK of Waterville, the Minority Ought Not to Pass Report was ACCEPTED.
In concurrence. ORDERED SENT FORTHWITH.
Placed in the Legislative Files. (DEAD)

Bill Text

.

An Act To Limit Allowable Health Care Charges in Certain Specified Situations

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA 4303, sub- 8-A, as enacted by PL 2011, c. 238, Pt. A, 1, is amended to read:

8-A. Protection from balance billing by providers. An enrollee’s responsibility for payment under a managed care plan must be limited as provided in this subsection.

A. The terms of a managed care plan must provide that the enrollee’s responsibility for the cost of covered health care rendered by participating providers is limited to the cost-sharing provisions expressly disclosed in the contract, such as deductibles, copayments and coinsurance, and that if the enrollee has paid the enrollee’s share of the charge as specified in the plan, the carrier shall hold the enrollee harmless from any additional amount owed to a participating provider for covered health care.
B. Every provider agreement with a participating provider must be in writing and must set forth that if the carrier fails to pay for health care services as set forth in the contract, the enrollee is not liable to the provider for any sums owed by the carrier.
C. A participating provider may not collect or attempt to collect any charge from an enrollee for covered health care beyond the amount permitted by the terms of the plan, notwithstanding the carrier’s insolvency, the carrier’s failure to pay the amount owed by the carrier, any other breach by the carrier of the provider agreement or the failure of the provider agreement to include the written hold harmless provision required by paragraph B.
D. An enrollee’s responsibility for the cost of covered health care rendered by an out-of-network provider in the hospital or other health care facility of a participating provider is limited to the cost-sharing provisions expressly disclosed in the contract for services rendered by participating providers. If the enrollee has paid the enrollee’s share of the charge as specified in the managed care plan, the carrier shall hold the enrollee harmless from any additional amount owed to an out-of-network provider for covered health care. An enrollee is not liable to any out-of-network provider working within the hospital or health care facility of a participating provider for any charge beyond the amount permitted by the terms of the cost-sharing provisions of the plan.

summary

This bill limits a health plan enrollee’s responsibility for the cost of covered health care when an enrollee receives health care services from an out-of-network provider at a participating hospital or other health care facility to the cost-sharing provisions for participating providers.

Patterns of Support

Pattern of Cosponsorship by Region:

Pattern of Cosponsorship by Gender:

Pattern of Cosponsorship by Party:

Pattern of Cosponsorship by Campaign Finance Classification:

Note: Maine Clean Elections Act (MCEA) Qualified candidates only accept a small dollar value of initial contributions early in their campaigns, pledge not to accept further campaign contributions from private sources, and receive public funding for their campaigns. MCEA Non-Qualified candidates choose not to obtain public funding and instead are free to accept campaign contributions from individuals, party committees, political action committees and business sources.


This information about LD 251 was last updated on 2016-05-12.
The Open Maine Politics website is in a beta release and results should not be taken as definitive. Please visit the official website of the Maine State Legislature for entirely verifiable information.

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