S.P. 584 - L.D. 1664
An Act to Clarify Basic Health Care Services to be Offered by Maine Health Maintenance Organizations
Emergency preamble. Whereas, Acts of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, this legislation is immediately necessary to ensure that health maintenance organizations and employers are able to vary particular coverages and copayment requirements to respond to particular needs and market factors; and
Whereas, in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore,
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4202-A, sub-§1, as enacted by PL 1991, c. 709, §2, is amended to read:
1. Basic health care services. "Basic health care services" means health care services that an enrolled population might reasonably require in order to be maintained in good health, including and includes, at a minimum, emergency care, inpatient hospital care, inpatient-outpatient inpatient physician services, outpatient physician services, ancillary services such as x-ray services and laboratory services and all benefits mandated by statute and mandated by rule applicable to health maintenance organizations. The superintendent may adopt rules defining "basic health care services" to be provided by health maintenance organizations. In adopting such rules, the superintendent shall consider the coverages that have traditionally been provided by health maintenance organizations; the need for flexibility in the marketplace; and the importance of providing multiple options to employers and consumers. The superintendent may not require that all health benefit plans offered by health maintenance organizations meet or exceed each of the particular requirements of standard or basic health plans specified in Bureau of Insurance Rule, Chapter 750. The superintendent may select required services from among those set forth in Bureau of Insurance Rule, Chapter 750 and shall permit reasonable, but not excessive or unfairly discriminatory, variations in the copayment, coinsurance, deductible and other features of such coverage, except that these features must meet or exceed those required in benefits mandated by statute. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.
Sec. 2. 24-A MRSA §4204, sub-§2-A, ¶O is enacted to read:
O. Each health maintenance organization shall provide basic health care services.
Emergency clause. In view of the emergency cited in the preamble, this Act takes effect when approved.
Effective May 18, 1999.
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