Sec. 1. 24-A MRSA §4301, sub-§5, as enacted by PL 1995, c. 673, Pt. C, §1 and affected by §2, is amended to read:

5. Participating provider. "Participating provider" means a licensed or certified provider of health care services, including mental health services, or health care supplies that has entered into an agreement with a carrier to provide those health care services or supplies to an individual enrolled in a managed care plan.

Sec. 2. 24-A MRSA §4301, sub-§7 is enacted to read:

7.__Provider.__"Provider" means an individual or entity licensed or certified to provide health care services or health care supplies.

Sec. 3. 24-A MRSA §4307, sub-§§1 and 2, as enacted by PL 1995, c. 673, Pt. C, §1 and affected by §2, are amended to read:

1. Purchase services with own funds. Prohibit an individual from purchasing any health care services with that individual's own funds, whether these services are covered within the individual's benefit package or from another health care provider or plan, except as otherwise provided by federal or state law; or

2. Additional benefits. Prohibit any plan sponsor from providing additional coverage for benefits, rights or protections not set out in this chapter; or.

Sec. 4. 24-A MRSA §4307, sub-§3, as enacted by PL 1995, c. 673, Pt. C, §1 and affected by §2, is repealed.

Sec. 5. 24-A MRSA §4311 is enacted to read:

§4311.__Choice of health care providers

A carrier offering a managed care plan may not deny the right to become a participating provider in the plan to any provider who provides health care services or supplies within the geographic coverage area of the plan and is willing to meet the terms and conditions of the managed care plan.

SUMMARY

This bill prohibits nonprofit hospital and medical service organizations, preferred provider organizations, health insurers