LD 1611
pg. 38
Page 37 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 39 of 47
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LR 2137
Item 1

 
shall develop these reports on the 15 most common services
provided by health care facilities and health care practitioners,
excluding emergency services. The board shall specify the data
elements to be included in the price reports, including, but not
limited to, average paid price per service per facility and total
number of services per facility, organized__by payor type such as
Medicare, Medicaid, aggregated commercial insurers, aggregated
3rd-party administrators and self-pay or uninsured.

 
2.__Comparison report of diagnosis-related groups and
outpatient procedures.__At a minimum, the organization shall
develop a report that compares the 15 most common diagnosis-
related groups and the 15 most common outpatient procedures for
all hospitals and the 15 most common procedures for nonhospital
health care facilities in the State to similar data for medical
care rendered in other states, when such data are available.

 
PART D

 
Sec. D-1. 24 MRSA §2321, sub-§4, ¶B, as enacted by PL 1997, c. 344, §6,
is amended to read:

 
B. The nonprofit hospital and medical service organization
must demonstrate in accordance with generally accepted
actuarial principles and practices consistently applied
that, as of a date no more than 210 days prior to the
filing, the ratios of benefits incurred to premiums earned
for said products average no less than 80% 87.5% for the
previous 12-month period.

 
Sec. D-2. 24 MRSA §2327, as amended by PL 1985, c. 648, §2, is
further amended to read:

 
§2327. Group rates

 
No group health care contract may be issued by a nonprofit
hospital or medical service organization in this State until a
copy of the group manual rates to be used in calculating the
rates for these contracts has been filed for informational
purposes with the superintendent. Notwithstanding this section,
rates for group Medicare supplement, nursing home care or long-
term care contracts must be filed in accordance with section 2321
and rates for small group health plans as defined by Title 24-A,
section 2808-B must be filed in accordance with that section.

 
Sec. D-3. 24 MRSA §2332-E, as enacted by PL 1993, c. 477, Pt. D, §5
and affected by Pt. F, §1, is amended to read:


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