LD 32
pg. 4
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LR 139
Item 1

 
not medically necessary. Covered health care must
include all services and providers for which coverage is
mandated under the Maine Revised Statutes, Title 24-A and
must include all coverage offered by the MaineCare
program;

 
(3) A system for the delivery of health care services
throughout the State. Covered health care services must
be provided to plan enrollees by participating
providers who are located within the State and who are
chosen by plan enrollees. The plan must pay for health
care services provided to a plan enrollee while the
enrollee is temporarily outside the State. The maximum
period of time a plan enrollee may be covered while out
of state is 90 days per year. A plan enrollee may
qualify to begin services out of state but, in order to
receive continued treatment, may be required to receive
treatment within the State. Reimbursement for services
rendered out of state must be at rates set by the
board. A participating provider may not charge plan
enrollees or 3rd parties for covered health care
services in excess of the amount reimbursed to that
provider by the plan. A participating provider may not
refuse to provide services to a plan enrollee on the
basis of health status, medical condition, previous
insurance status, race, color, creed, age, national
origin, citizenship status, gender, sexual orientation,
disability or marital status;

 
(4) The role of other health care programs, including,
but not limited to, the following programs: the
Medicare program of the federal Social Security Act,
Title XVIII; the Medicaid program of the federal Social
Security Act, Title XIX; the civilian health and
medical program as referred to in 10 United States
Code, Sections 1071 to 1106; the federal Indian Health
Care Improvement Act, 25 United States Code, Sections
1601 to 1682; the statewide plan provided through
Dirigo Health; other 3rd party payers who may be
billable for health care services; and any state and
local health programs, including, but not limited to,
workers' compensation and employers' liability
insurance pursuant to the Maine Revised Statutes, Title
39-A; and

 
(5) Other issues such as: promoting the purposes of the plan;
setting reimbursement rates for participating providers; rules
necessary to implement the plan; systems for enrollment,
registration of providers for participation, rate setting and
contracts with


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