Maine Legislature, Session 121, LD 0428
Committee Amendment CA_A_S354 (Senate)
Amends: 24-A MRSA §4203, 24-A MRSA §4303

(l~'"\ 
COMMITTEE AMENDMENT 
,~, to S.P. 146, L.D. 428, Bill, "An 
Act To Eliminate the Department of Professional and Financial 
Regulation, Bureau of Insurance Travel Restrictions for Obtaining 
Health Care" 
Amend the bill by striking out everything after the enacting 
clause and before the swnmary and inserting in its place the 
following: 
'Sec. I. 24-A MRSA §4203, sub-§3, lrS, as amended by PL 2003, c. 
469, Pt. E, §18, is further amended to read: 
S. 
A list of the names and addresses of all physicians and 
facilities with which the health maintenance organization 
has or will have agreements. 
If products are offered that 
pay full benefits only when providers within a subset of the 
contracted physicians or facilities are utilized, a list of 
the providers in that limited network must be included, as 
well as a list of the geographic areas where the products 
are 
offered. 
This 
paragraph 
may 
not 
be 
construed 
to 
prohibi t 
a heal th maintenance organization from offering a 
health plan that includes financial provisions designed to 
encourage members to use designated providers in a network 
iR-~~~~~~-6e€~4eR-~~~,--s~see~ieR-~7-~~r~-A 
as 
long as 
the entire network meets overall geographic 
access standards of any applicable bureau rule. 
Sec. 2. 24-A MRSA §4303, sub-§l, as amended by PL 2003, c. 
469, Pt. E, §20, is further amended to read: 
1. 
Demonstration of adequate access to providers. 
E*€e~t 
a6-~e¥4eee-~~~r~~-Ar-a b carrier offering a managed care 
plan shall provide to its members reasonable access to health 
care services in accordance with standards developed by rule by 
Page l-LR0971(2) 
COMMITTEE AMENDMENT 
'J'" 
,;;~ 
,. 
': .. :,~ 
COMMITTEE AMENDMENT "~,, to S.P. 146, L.D. 428 
the 
superintendent. 
These 
standards 
must 
consider 
the 
geographical and transportational problems in rural areas. 
All 
managed care plans covering residents of this State must provide 
reasonable 
access 
to 
providers 
consistent 
with 
the 
access-to-services requirements of any applicable bureau rule. 
This 
subsection may not be 
construed to prohibit 
a 
carrier 
offering a managed care plan from offering a plan that includes 
financial 
prov~s~ons 
designed 
to 
encourage 
members 
to 
use 
designated providers in a network as long as the entire network 
meets 
overall geographic 
access 
standards 
of 
any 
applicable 
bureau rule. 
AT--YpeR-~~~~~-~-~~~-int~r~~a~~~~-ffiay-e~~er 
a- hea,l~h- ~~--t-ha-t- ~J..ude.s- -:€-inane-1a-l- ~~'II'-j,.s-j,.e.&S- -Ele&~B:e4 -~e 
eBee~ra§e-~~-~-~se-~~~-~~e¥iae~&-4~-~-Be~werk 
i~+ 
~±t--~~~~~-Be~weF*-ffiee~s-~~~-~-S~aBQarQS 
~~rs~aB~-~e-8~rea~-e~-IBs~raBee-R~±e-bha~~er-8§QT 
~6t--~he-~~~~b&&-is-£~~4~~~~-~~~~~~~-Qesi§B 
§~iQe±iBeS-~eF-8~Fea~-e~-IBs~FaBee-R~±e-bha~~eF-+§QT 
~6t---~~-~~~--~~aB:--Qees--~---~~--~iBaBeia± 
~FeyisieBS--~~--~e--~~--ffieffiBers--~~--~se 
QeSi§Ba~eQ-~e¥4Qe£s-~-~-~1rr-~~'II'-9&~j,.'II'-9r-ffia~eFBi~YT 
eBs~e~Fiea±T-~~~~-eF-~~-eaFe-~~~,--as 
Qe~iBeQ-iB-8~Fea~-e~-IBs~FaBee-R~±e-bha~~eF-8§QT 
~4t--~~-:€-~1a-l--~FevisieBs-~~~-~e-~~-~:€--~he 
eBFe±±ees-eeVeFeQ-~BQeF-~he-eaFFieF~s-hea±~h-~±aBT 
~§t--~he-£~~~4~-~~~~~~~~-s-a~j,.s-~~j,.e.&-e~-~he 
s~~eFiBEeBQeB~-~ha~--t~~~~~~~j,.s-~-~~j,.~-Ehe 
~FeyisieB-~--ae~~et-~l-.i,.t~-~~¥4£~--aaG-~~-~~a±i~y 
iffi~FeyemeB~S---~~----si~Bi~ieaB~±y---~~---aBY 
Qe~FimeB~a±-~~~-~~-&&'II'-9~-petSeRs-~~~-~-~Faye± 
±eB§eF-Q4s~aRees-~~~~~~~-~~-~-eaFFieF-has 
~akeB--&~~&-~~-~~~~~~-~~4~€--aRy--QeEFimeB~a± 
im~ae~--a&&&eia~-~.i,.t~-~~~-~-£~~-pe£seRs--~e 
EFaye±--~~---Qis~aBees--~~--aeeess--~~~---±he 
s~~eFiB~eBQeBE-~-eeBs~±~-~~~-eEher-~~~-eBEiEiesT 
iBe±~QiB§-~~-~~a~~&~-~-~-Setv4ees7-~~-e~ 
Hea±~h--aBQ--Ehe--MaiBe--Q~a±i~y--~eF~--es~aB±isheQ--iB 
see~ieB-~~~7-~~~~~j,.&e-whe~heF-~£€-<~~~~-~s--me~ 
~he----~~j,.Feffie&~&---~-----t~~---s~~£a~£a~,----±he 
s~~eriB~eBQeB~--~~---~~¥i&~&a~~y--aQe~--~~~--BY 
JaB~aFY--~r-~-£~a~£4~~--~he-~~j,.~~j,.a-~-~--~he 
s~~eFiB~eBQeB~-~~-QeEeFmiBe-~~--~he-<~~~~--mee~s 
~he--~~a,l4~y--~~~~~-~--~~~--&~&~a~~Fa~h--aBQ 
COMMITTEE AMENDMENT 
-
,""" 
,-J 
'-
:f" 
-
COMMITTEE AMENDMENT .. ~ 
.. to S.P. 146, L.D. 428 
~FeseB~-~~-Fa~e&-~~--~~b&~~~-£e¥iew-~-~-~he 
SeeeBe-Re~QlaF-Sess~eB-e~-~he-±6±s~-be~~sla~QFeT-aBe 
ta+--~£~~~~~~~~&~~&-may-~~-~~~--~~~~-a~ 
a- -d-~~ 
- t:.hat:.- -e-~ 
- -t..fl.e.--&1:.aaGaF4& - -e&t-abJ.~-shed- - ~ B 
8QFeaQ-~--±BSQFaBee-~-~ha~~eF-~-~eF-~~~-aBe 
~Fave±-~~me-By-±QQ%T 
~h~s-~£a~£aph-~~~~~~aBaaFY-±7-~~~-~&-Fe~ea*ee 
JQ*y-h-6QQ1T' 
SUMMARY 
This amendment is the minority report of the committee. 
The 
amendment replaces the bill and repeals the changes made to the 
geographic access standards in the Dirigo Health law, Public Law 
2003, chapter 469. 
The amendment clarifies that the geographic 
access standards for managed care plans under the Maine Insurance 
Code and Bureau of Insurance Rule Chapter 850 do not prohibi t 
health 
insurers 
and 
health 
maintenance 
organizations 
from 
developing 
health 
plans 
that 
give 
financial 
incentives 
to 
enrollees who elect to use certain designated providers in a 
health plan's provider network. 
COMMITTEE AMENDMENT