| | | A. To the extent that payment for coverage expenses has | | been made under the Medicaid program or the Cub Care program | | for health care items or services furnished to an | | individual, the State is considered to have acquired the | | rights of the covered subscriber or family member to payment | | by the nonprofit service organization for those health care | | items or services. Upon presentation of proof that the | | Medicaid program or the Cub Care program has paid for | | covered items or services, the nonprofit service | | organization shall make payment to the Medicaid program or | | the Cub Care program according to the coverage provided in | | the contract or certificate. |
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| | | B. A nonprofit service organization may not impose | | requirements on a state agency that has been assigned the | | rights of an individual eligible for Medicaid or Cub Care | | coverage and covered by a subscriber contract that are | | different from requirements applicable to an agent or | | assignee of any other covered individual. |
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| | | Sec. 45. 24-A MRSA §2744, as amended by PL 2005, c. 121, Pt. I, §§1 | | and 2 and c. 213, §1 and affected by §3 and amended by c. 214, §1 | | and affected by §3, is repealed and the following enacted in its | | place: |
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| | | §2744.__Mental health services |
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| | | 1.__Notwithstanding any provision of a health insurance policy | | subject to this chapter, whenever the policy provides for payment | | or reimbursement for services that are within the lawful scope of | | practice of a professional listed in subsection 2-A, any person | | covered by the policy is entitled to reimbursement for these | | services if the services are performed by a physician or a | | professional listed in subsection 2-A.__Payment or reimbursement | | for services rendered by a professional listed in subsection 2-A, | | paragraph B, C, D, E or F may not be conditioned upon prior | | diagnosis or referral by a physician or other health care | | professional, except when diagnosis of the condition for which | | the services are rendered is beyond the scope of their licensure. |
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| | | 2.__Nothing in subsection 1 may be construed to require a | | health insurance policy subject to this chapter to provide for | | reimbursement of services that are within the lawful scope of | | practice of a professional listed in subsection 2-A. |
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| | | 2-A. Subsections 1 and 2 apply with respect to the following | | types of professionals: |
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| | | A. A psychologist licensed to practice in this State; |
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