Sec. 1. 24-A MRSA §4204, sub-§6, śC is enacted to read:

C.__This subsection does not prohibit a participating provider from seeking reimbursement from either the health maintenance organization or the subscriber or enrollee for medical services rendered in good faith when the health maintenance organization has denied coverage because the subscriber or enrollee has failed to abide by a term of the enrollment agreement between the subscriber or enrollee and the health maintenance organization.

Sec. 2. 24-A MRSA §4306-A is enacted to read:

§4306-A.__Participating provider agreements

1.__So-called "most favored nation" provisions.__The use or enforcement by a carrier in any participating provider agreement of a provision requiring that a participating provider give a carrier the benefit of any lower fee schedules or charges for services that the participating provider may subsequently agree to with other persons or entities constitutes an unfair insurance practice pursuant to chapter 23.

2.__So-called "all products" provisions.__If an agreement between a participating provider and a carrier or other entity that provides hospital, physician or other health care services to a carrier includes provisions that require a provider, as a condition of participating in one of the carrier's or other entity's panels, to participate in any other provider panel owned or operated by that carrier or other entity, the participating provider agreement must contain a provision permitting the participating provider to refuse participation in one or more other such provider panels at the time the agreement is executed without affecting the participating provider's status as a member of or for eligibility in other existing or new provider panels.

SUMMARY

The bill clarifies that "hold harmless" provisions of managed care provider agreements and the "hold harmless" clause in the Maine Insurance Code do not prohibit participating providers from seeking reimbursement from either the health plan or the enrollee when the enrollee has not adhered to the terms of the health plan. This bill makes the use or enforcement of "most favored nation" provisions in managed care provider agreements an unfair insurance practice. It allows participating providers to