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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 |
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| | 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: |
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| 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. |
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| | 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: |
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| | 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. |
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| | Sec. 12. 24-A MRSA §4303, sub-§2, ¶D is enacted to read: |
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| D.__The credentialling process: |
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| (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; |
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| (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 |
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| (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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