| | | 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. |
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| | | 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. |
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| | | Sec. D-1. 24 MRSA §2321, sub-§4, ¶B, as enacted by PL 1997, c. 344, §6, | | is amended to read: |
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| | | 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% | | previous 12-month period. |
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| | | Sec. D-2. 24 MRSA §2327, as amended by PL 1985, c. 648, §2, is | | further amended to read: |
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| | | 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. |
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| | | 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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