An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans
Maine Legislature, Session 126, LD 1676
Committee Amendment CA_A_H718 (House)
Amends: 24-A MRSA §4303, 24-A MRSA §4303-B

COMMITTEE AMENDMENT "A" to H.P. 1199, L.D. 1676, Bill, "An Act To 
Strengthen Access Requirements and Review Standards for Health Insurance Plans" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Strengthen Disclosure about Provider Networks in Health Insurance 
Plans to Consumers and Providers' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §4303, sub-§19 is enacted to read: 
19. Information about provider networks. A carrier offering a managed care plan 
shall prominently disclose to applicants, prospective enrollees and enrollees information 
about the carrier's provider network for the applicable managed care plan, including 
whether there are hospitals, health care facilities, physicians or other providers not 
included in the plan's network and any differences in an enrollee's financial 
responsibilities for payment of covered services to a participating provider and to a 
provider not included in a provider network. The superintendent may adopt rules that set 
forth the manner, content and required disclosure of the information in accordance with 
this subsection. Rules adopted pursuant to this subsection are routine technical rules as 
defined in Title 5,. chapter 375, subchapter 2-A. 
Sec. 2. 24-A MRSA §4303-B is enacted to read: 
§4303-B. Disclosure related to provider networks 
1. Disclosure. Upon request. a carrier shall provide to a provider to which the 
carrier has decided not to offer the opportunity to participate or that the carrier has 
decided not to include as a participating provider in any of the carrier's provider networks 
a written explanation of the reason for the carrier's decision. The written explanation 
provided by the carrier must indicate whether the reason for not offering the provider the 
opportunity to contract or for not including the provider in any network was related to the 
provider's performance with respect to quality, cost or cost-efficiency. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'A" to H.P. 1199, L.D. 1676 
2. No right of action. A provider has no right of action as the result of a disclosure 
made in accordance with this section.' 
SUMMARY 
This amendment is the majority report of the committee and replaces the bill. The 
amendment requires a health insurance carrier to disclose information about its provider 
networks, including whether there are any hospitals, health care facilities, physicians or 
other providers not included in the provider's network and any differences in an enrollee's 
financial responsibilities for payment of covered services to a participating provider and 
to a provider not included in a provider network. 
The amendment authorizes the 
Superintendent of Insurance to adopt rules setting forth the manner, content and required 
disclosure of the information and specifies that those rules are routine technical rules. 
The amendment also requires a health insurance carrier to disclose upon request from 
a provider the reason for the carrier's decision not to offer the provider the opportunity to 
participate or to include the provider in any provider network of the carrier. 
The 
amendment requires that the written explanation indicate whether the reason was related 
to the provider'S performance with respect to quality, cost or cost-efficiency. 
The amendment stipulates that a provider has no right of action as the result of such a 
disclosure. 
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(See attached) 
COMMITTEE AMENDMENT 
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Approved: 03/13/14 frac.. 
LD 1676 
LR 2395(02) 
An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans 
Fiscal Note for Bill as Amended by Committee Amendment A' (H -11 1(') 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor cost increase - Other Special Revenue Funds 
Fiscal Detail and Notes 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation or to the 
State Employee Health Insurance Program are expected to be minor and can be absorbed within existing budgeted 
resources. 
LR2395(02) - Fiscal Note - Page 1 of 1