SP0180
LD 448
Session - 126th Maine Legislature
 
LR 1313
Item 1
Bill Tracking, Additional Documents Chamber Status

An Act To Authorize the State Employee Health Commission's Preferred Provider Program

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 5 MRSA §285, sub-§15  is enacted to read:

15 Preferred provider program.   The State Employee Health Commission may develop and implement a preferred provider program, health insurance program or any other program the purpose of which is to rank into tiers health care providers, including hospitals and health care organizations, to determine preferred hospital or health care provider status for the state employee health insurance program and to steer the state employee health insurance program members to be treated by or to consult with certain health care providers, including hospitals and health care organizations, based on cost and quality of health care. If the commission develops such a program, the commission shall develop a tiering methodology that rates or accounts for effectiveness, safety, patient satisfaction and comparative cost. The commission shall adopt rules to implement this subsection. Rules adopted pursuant to this subsection are major substantive rules as defined in chapter 375, subchapter 2-A.

summary

This bill authorizes the State Employee Health Commission to develop and implement a preferred provider program, health insurance program or any other program the purpose of which is to rank into tiers health care providers, including hospitals and health care organizations, to determine preferred hospital or health care provider status for the state employee health insurance program and to steer the state employee health insurance program members to be treated by or to consult with certain health care providers, including hospitals and health care organizations, based on cost and quality of health care. The commission is directed to adopt major substantive rules to develop and implement the preferred provider program.


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