LD 1619
pg. 9
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LR 251
Item 1

 
A.__If the enrollee has entered the 2nd trimester of pregnancy
at the time of the provider's termination and the provider has
been treating the enrollee during the pregnancy, the
transitional period must extend through the provision of
postpartum care directly related to the pregnancy.

 
B.__The transitional period for institutional or inpatient
care must extend until the discharge or termination of the
period of institutionalization and also include
institutional care provided within a reasonable time of the
date of termination of the provider if the care was
scheduled before the date of the notice of termination or if
the enrollee was on an established waiting list or otherwise
scheduled to have such care on the date of notice of
termination.

 
C.__If an enrollee was terminally ill at the time of
termination of the provider and the provider was treating
the terminal illness before the date of termination, the
transitional period must extend for the remainder of the
enrollee's life for care directly related to the treatment
of the terminal illness.

 
3.__Terms and conditions of continuity of care.__A carrier may
condition coverage of continued treatment by a provider under
subsection 1 upon the provider agreeing to the following terms
and conditions.

 
A.__The provider agrees to accept reimbursement from the
carrier at the rates applicable prior to the start of the
transitional period as payment in full and not to impose
cost sharing with respect to the enrollee in an amount that
would exceed the cost sharing that could have been imposed
if the contract between the carrier and the provider had not
been terminated.

 
B.__The provider agrees to adhere to the quality assurance
standards of the carrier responsible for payment and to
provide the carrier necessary medical information related to
the care provided.

 
C. The provider agrees otherwise to adhere to the carrier's
policies and procedures, including procedures regarding
referrals, obtaining prior authorization and providing
services pursuant to any treatment plan approved by the
carrier.

 
Sec. 9. 24-A MRSA §4323 is enacted to read:


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