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Title 24-A, Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT
Subchapter 1: HEALTH PLAN REQUIREMENTS
24-A §4301. Definitions (REPEALED)
24-A §4301-A. Definitions
24-A §4302. Reporting requirements
24-A §4303. Plan requirements
24-A §4303-A. Provider profiling programs
24-A §4303-B. Disclosure related to provider networks
24-A §4303-C. Protection from surprise bills and bills for out-of-network emergency services
24-A §4303-D. Provider directories
24-A §4303-E. Dispute resolution process for surprise bills and bills for out-of-network emergency services
24-A §4303-F. Reimbursement for ambulance services and participation of ambulance service providers in carrier networks
24-A §4303-G. Provider maintenance of certification requirements (WHOLE SECTION TEXT EFFECTIVE UNTIL 4/1/29) (WHOLE SECTION TEXT REPEALED 4/1/29)
24-A §4304. Utilization review
24-A §4304-A. Prior authorization for rehabilitative or habilitative services
24-A §4305. Quality of care
24-A §4306. Enrollee choice of primary care provider
24-A §4306-A. Patient access to obstetrical and gynecological care
24-A §4307. Construction
24-A §4308. Indemnification
24-A §4309. Adoption of rules
24-A §4309-A. Compliance with the Affordable Care Act
24-A §4310. Access to clinical trials
24-A §4311. Access to prescription drugs
24-A §4311-A. Access to pain management services
24-A §4312. Independent external review
24-A §4313. Carrier liability; cause of action
24-A §4314. Access to eye care providers
24-A §4314-A. Coverage for early refills of prescription eye drops
24-A §4315. Coverage of prosthetic devices
24-A §4316. Coverage for telehealth services
24-A §4317. Pharmacy providers
24-A §4317-A. Prescription drug coverage; out-of-pocket expenses for coinsurance
24-A §4317-B. Orally administered cancer therapy
24-A §4317-C. Coverage for prescription insulin drugs; limit on out-of-pocket costs
24-A §4317-D. Coverage of HIV prevention drugs
24-A §4317-E. Coverage for emergency supply of chronic maintenance drugs
24-A §4318. Prohibition against maximum aggregate benefit provisions (REALLOCATED FROM TITLE 24-A, SECTION 4317) (REPEALED)
24-A §4318-A. Comparable health care service incentive program
24-A §4318-B. Access to lower-priced services
24-A §4319. Rebates
24-A §4319-A. Guaranteed issue
24-A §4319-B. Medical loss ratio reporting for dental insurance plans
24-A §4320. No lifetime or annual limits on health plans
24-A §4320-A. Coverage of preventive and primary health services
24-A §4320-B. Extension of dependent coverage
24-A §4320-C. Emergency services
24-A §4320-D. Comprehensive health coverage
24-A §4320-E. Reinsurance, risk corridors and risk adjustment
24-A §4320-F. Oversight of plans offered on the American Health Benefit Exchange and the SHOP Exchange
24-A §4320-G. Applicability to health plans grandfathered under the Affordable Care Act
24-A §4320-H. Payment reform pilot projects (REALLOCATED FROM TITLE 24-A, SECTION 4320)
24-A §4320-I. Coverage for the cost of testing for bone marrow donation suitability
24-A §4320-J. Coverage for abuse-deterrent opioid analgesic drug products
24-A §4320-K. Coverage for services provided by a naturopathic doctor
24-A §4320-L. Nondiscrimination
24-A §4320-M. Coverage for abortion services
24-A §4320-N. Step therapy (REALLOCATED FROM TITLE 24-A, SECTION 4320-M)
24-A §4320-O. Coverage for services provided by a physician assistant
24-A §4320-P. Coverage for health care services for COVID-19
24-A §4320-Q. Coverage for services provided by a certified registered nurse anesthetist (REALLOCATED FROM TITLE 24-A, SECTION 4320-P)
24-A §4320-R. Mandatory offer of coverage for certain adults with disabilities
24-A §4320-S. Coverage for dental services for cancer patients
24-A §4320-T. Implementation of federal mental health parity laws (WHOLE SECTION TEXT EFFECTIVE UNTIL 4/30/28) (WHOLE SECTION TEXT REPEALED 4/30/28) (REALLOCATED FROM TITLE 24-A, SECTION 4320-R)
24-A §4320-U. Coverage for fertility services (REALLOCATED FROM TITLE 24-A, SECTION 4320-S)
24-A §4320-V. Coverage for donor breast milk
Subchapter 2: CONSUMER HEALTH CARE DIVISION
24-A §4321. Consumer Health Care Division
24-A §4322. Consumer Health Care Division Advisory Council (REPEALED)
Subchapter 2-A: HEALTH INSURANCE CONSUMER ASSISTANCE PROGRAM
24-A §4326. Health Insurance Consumer Assistance Program
Subchapter 2-B: INDEPENDENT HEALTH CARE PROVIDER ASSISTANCE
24-A §4329. Independent health care provider assistance
Subchapter 3: DOWNSTREAM RISK
24-A §4331. Definitions
24-A §4332. Safe harbor and waiver
24-A §4333. Requirements for downstream risk arrangements
24-A §4334. Substantial insurance risk; substantial enrollment risk
24-A §4335. Contractual provisions
24-A §4336. Disclosure requirements for organizations with downstream risk arrangements
24-A §4337. Requirements related to subcontracting arrangements
24-A §4338. Downstream risk arrangements that exceed risk threshold described in section 4334
24-A §4339. Contractual provisions to demonstrate financial viability
24-A §4340. Financial viability
24-A §4341. Limitations on premium transfer
24-A §4342. Related provisions
24-A §4343. Rules
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