Sec. 1. 24-A MRSA §4303, sub-§§3-B and 5 are enacted to read:

3-B.__Prohibition on financial incentives.__A carrier offering a managed care plan in this State may not offer or pay any type of material inducement, bonus or other financial incentive to a participating provider to deny, reduce, withhold, limit or delay specific medically necessary and appropriate health care services covered under the plan to an enrollee.

5. Independent external review of coverage decisions.__An enrollee who has exhausted all internal grievance and appeal procedures provided by a carrier offering a health plan in this State has the right to an independent external review of a health plan's decision to deny, reduce or terminate health care coverage or to deny payment for health care services.__The independent external review is subject to the following requirements.

A.__The decision to be reviewed relates to a health care service that costs at least $100.

B.__The health plan's decision is based on one of the following reasons:

(1)__The health care service is a covered benefit that the carrier has determined to be not medically necessary;

(2)__A limitation is placed on the selection of a health care provider that is claimed by the enrollee to be inconsistent with limits imposed by the health plan and any applicable laws and rules;

(3)__The health care treatment has been determined to be experimental or investigational; or

(4)__The health care service involves a medically based decision that a condition is preexisting.

C.__The independent external review must be requested in writing by the affected enrollee and the enrollee pays a filing fee of not more than $50 that reflects the administrative costs of processing a request for review under this subsection.__The filing fee may be waived or reduced based on a determination by the superintendent that the financial circumstances of the enrollee warrant a waiver or reduction.