LD 1890
pg. 4
Page 3 of 16 An Act to Establish a Patients' Bill of Rights for Managed Care Page 5 of 16
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LR 1804
Item 1

 
if any; a description of the formulary and any formulary
exceptions consistent with section 4313; and a description of
the extent to which an enrollee will be reimbursed for the
cost of a drug that is not on a plan list or plan formulary or
an exception under section 4313. Enrollees may request
additional information related to specific drugs that are not
on the drug formulary; and

 
Sec. 10. 24-A MRSA §4302, sub-§2, ¶F, as enacted by PL 1995, c. 673,
Pt. C, §1 and affected by §2, is amended to read:

 
F. Enrollee satisfaction statistics and demographic
information, including demographic characteristics of
enrollees, disease-specific and age-specific mortality
rates, provider-to-enrollee ratio by geographic region and
medical specialty and a report on what actions, if any, the
carrier has taken to improve complaint handling and
eliminate the causes of valid complaints.

 
Sec. 11. 24-A MRSA §4303, sub-§1, as enacted by PL 1995, c. 673, Pt.
C, §1 and affected by §2, is amended to read:

 
1. Demonstration of adequate access to providers. A carrier
offering a managed care plan shall provide to its members
reasonable access to health care services in accordance with
standards developed by rule by the superintendent before January
1, 1997. These standards must consider the geographical and
transportational problems in rural areas. Bureau of Insurance
Rule, Chapter 850, section 7, applies to all carriers offering or
administering a managed care plan.

 
Sec. 12. 24-A MRSA §4303, sub-§2, ¶D is enacted to read:

 
D.__The credentialling process:

 
(1)__Must include verification of a health care
provider's license and a history of suspension or
revocation of a health care provider's license;

 
(2)__May not use a high-risk patient base or location
of a provider in an area with residents with poorer
health status as a basis for excluding providers from
participation; or

 
(3) May not discriminate in selection of a health care
professional to be a participating health care provider or with
respect to the terms and conditions of that participation based
on the professional's race, color, religion, sex, national
origin, age, sexual orientation


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