reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 4320-L (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-L. Nondiscrimination

 §4320-L. Nondiscrimination 1.  Nondiscrimination.  An individual may not, on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied benefits of or otherwise be subjected to discrimination under any health plan offered in accordance with this Title. A carrier may not in offering, providing or administering a health plan:   A. Deny, cancel, limit or refuse to issue or renew a health plan or other health-related coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability;   [PL 2019, c. 5, Pt. C, §2 (NEW).]B. Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability in a health plan or other health-related coverage;   [PL 2019, c. 5, Pt. C, §2 (NEW).]C. Deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for any health services that are ordinarily or exclusively available to individuals of one sex to a transgender individual based on the fact that the individual's sex assigned at birth, gender identity or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available;   [PL 2019, c. 5, Pt. C, §2 (NEW).]D. Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition; or   [PL 2019, c. 5, Pt. C, §2 (NEW).]E. Otherwise deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for specific health services related to gender transition if such denial, limitation or restriction results in discrimination against a transgender individual.   [PL 2019, c. 5, Pt. C, §2 (NEW).]Nothing in this subsection is intended to determine or restrict a carrier from determining whether a particular health service is medically necessary or otherwise meets applicable coverage requirements in any individual case.   [PL 2019, c. 5, Pt. C, §2 (NEW).] 2.  Meaningful access for individuals with limited English proficiency.  A carrier shall take reasonable steps to provide meaningful access to each enrollee or prospective enrollee under a health plan who has limited proficiency in English.   [PL 2019, c. 5, Pt. C, §2 (NEW).] 3.  Effective communication for persons with disabilities.  A carrier shall take reasonable steps to ensure that communication with an enrollee or prospective enrollee in a health plan who is an individual with a disability is as effective as communication with other enrollees or prospective enrollees.   [PL 2019, c. 5, Pt. C, §2 (NEW).] SECTION HISTORY PL 2019, c. 5, Pt. C, §2 (NEW).
24-A ME Rev Stat § 4320-M (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-M. Coverage for abortion services

 §4320-M. Coverage for abortion services 1.  Required coverage.  A carrier offering a health plan in this State that provides coverage for maternity services shall provide coverage for abortion services for an enrollee in accordance with this section.   [PL 2019, c. 274, §5 (NEW).] 2.  Limits; deductible; copayment; coinsurance.  A health plan that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.   [PL 2019, c. 274, §5 (NEW).] 3.  Application.  Except for a religious employer granted an exclusion as provided in subsection 4, the requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2019, c. 274, §5 (NEW).] 4.  Exclusion for religious employer.  A religious employer may request and a carrier shall grant an exclusion under the policy or contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains an exclusion under this subsection shall provide prospective enrollees and those individuals insured under its policy written notice of the exclusion. This section may not be construed as authorizing a carrier to exclude coverage for abortion services that are necessary to preserve the life or health of a covered enrollee. For the purposes of this section, "religious employer" means an employer that is a church, a convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 United States Code, Section 3121(w)(3)(A) and that qualifies as a tax-exempt organization under 26 United States Code, Section 501(c)(3).   [PL 2019, c. 274, §5 (NEW).] 5.  Protection of federal funds.  If the superintendent determines enforcement of this section may adversely affect the allocation of federal funds to the State, the superintendent may grant an exemption from the requirements of this section, but only to the minimum extent necessary to ensure the continued receipt of federal funds.   [PL 2019, c. 274, §5 (NEW).] Revisor's Note: §4320-M. Step therapy as enacted by PL 2019, c. 295, §1 is REALLOCATED TO TITLE 24-A, SECTION 4320-N SECTION HISTORY PL 2019, c. 274, §5 (NEW).
24-A ME Rev Stat § 4320-O (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-O. Coverage for services provided by a physician assistant

 §4320-O. Coverage for services provided by a physician assistant 1.  Services provided by a physician assistant.  A carrier offering a health plan in this State shall provide coverage for health care services performed by a physician assistant licensed under Title 32, section 2594‑E or 3270-E when those services are covered services under the health plan when performed by any other health care provider and when those services are within the lawful scope of practice of the physician assistant.   [PL 2019, c. 627, Pt. A, §2 (NEW).] 2.  Limits; deductible; copayment; coinsurance.  A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided by a physician assistant as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to the same service provided by other health care providers.   [PL 2019, c. 627, Pt. A, §2 (NEW).] 3.  Network participation.  A carrier shall demonstrate that the carrier's provider network includes reasonable access, in accordance with section 4303, to all covered services that are within the lawful scope of practice of a physician assistant. A carrier may not exclude a provider from participation in the carrier's provider network solely because the provider is a physician assistant as long as the provider is willing to meet the same terms and conditions as other participating providers. This subsection does not require a carrier to contract with all physician assistants or require a carrier to provide coverage under a health plan for any service provided by a participating physician assistant that is not within the health plan's scope of coverage.   [PL 2019, c. 627, Pt. A, §2 (NEW).] 4.  Billing.  A carrier shall authorize a physician assistant to bill the carrier and receive direct payment for a medically necessary service the physician assistant provides to an enrollee and identify the physician assistant as provider in the billing and claims process for payment of the service. A carrier may not impose on a physician assistant a practice, education or collaboration requirement that is inconsistent with or more restrictive than a requirement of state law or board or agency rules.   [PL 2019, c. 627, Pt. A, §2 (NEW).] SECTION HISTORY PL 2019, c. 627, Pt. A, §2 (NEW).
24-A ME Rev Stat § 4320-Q (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-Q. Coverage for services provided by a certified registered nurse anesthetist (REALLOCATED FROM TITLE 24-A, SECTION 4320-P)

 §4320-Q. Coverage for services provided by a certified registered nurse anesthetist (REALLOCATED FROM TITLE 24-A, SECTION 4320-P)1.  Services provided by a certified registered nurse anesthetist.  A carrier offering a health plan in this State shall provide coverage for health care services performed by a certified registered nurse anesthetist licensed under Title 32, chapter 31 when those services are covered services under the health plan when performed by any other health care provider and when those services are within the lawful scope of practice of the certified registered nurse anesthetist.   [PL 2021, c. 39, §1 (NEW); RR 2021, c. 1, Pt. A, §23 (RAL).] 2.  Limits; deductible; copayment; coinsurance.  A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided by a certified registered nurse anesthetist as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to the same service provided by other health care providers.   [PL 2021, c. 39, §1 (NEW); RR 2021, c. 1, Pt. A, §23 (RAL).] 3.  Network participation.  A carrier may not prohibit a certified registered nurse anesthetist from participating in the carrier's provider network or billing the carrier directly solely because the provider is a certified registered nurse anesthetist as long as the provider is willing to meet the same terms and conditions as other participating providers. This subsection does not require a carrier to contract with all certified registered nurse anesthetists or require a carrier to provide coverage under a health plan for any service provided by a participating certified registered nurse anesthetist that is not a covered service under the plan.   [PL 2021, c. 39, §1 (NEW); RR 2021, c. 1, Pt. A, §23 (RAL).] 4.  Claim submission.  Services billed by a certified registered nurse anesthetist must be submitted using the current standardized claim form for professional services approved by the Federal Government and submitted electronically.   [PL 2021, c. 39, §1 (NEW); RR 2021, c. 1, Pt. A, §23 (RAL).] SECTION HISTORY PL 2021, c. 39, §1 (NEW). RR 2021, c. 1, Pt. A, §23 (RAL).
24-A ME Rev Stat § 4322 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 2: CONSUMER HEALTH CARE DIVISION|24-A §4322. Consumer Health Care Division Advisory Council (REPEALED)

 §4322. Consumer Health Care Division Advisory Council (REPEALED)SECTION HISTORY PL 1997, c. 792, §3 (NEW). PL 2003, c. 689, §B7 (REV). PL 2005, c. 294, §24 (RP).
24-A ME Rev Stat § 4326 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 2-A: HEALTH INSURANCE CONSUMER ASSISTANCE PROGRAM|24-A §4326. Health Insurance Consumer Assistance Program

 §4326. Health Insurance Consumer Assistance Program 1.  Establishment.  The Health Insurance Consumer Assistance Program, referred to in this section as "the consumer assistance program," is established to provide support for consumers, including prospective consumers, of health insurance, referred to in this section as "consumers," and to customer assistance programs and public and private health insurance assistance programs.   [PL 2019, c. 522, §1 (NEW).] 2.  Consumer assistance program services.  The services provided by the consumer assistance program may include:   A. Assisting consumers with filing complaints and appeals with a group health plan, health insurance carrier or independent review organization and providing information about the internal and external appeal and grievance processes of a group health plan, health insurance carrier or independent review organization;   [PL 2019, c. 522, §1 (NEW).]B. Collecting, tracking and quantifying inquiries regarding health insurance and problems encountered by consumers;   [PL 2019, c. 522, §1 (NEW).]C. Educating consumers on their rights and responsibilities with respect to health insurance coverage;   [PL 2019, c. 522, §1 (NEW).]D. Assisting consumers with obtaining health insurance coverage by providing information, referrals or other assistance;   [PL 2019, c. 522, §1 (NEW).]E. Assisting with obtaining federal health insurance premium tax credits under Section 36B of the United States Internal Revenue Code of 1986, as amended; and   [PL 2019, c. 522, §1 (NEW).]F. Providing information to the public about the services of the consumer assistance program through a comprehensive outreach program and a toll-free telephone number.   [PL 2019, c. 522, §1 (NEW).][PL 2019, c. 522, §1 (NEW).] 3.  Contract for operation.  The Attorney General shall contract with a nonprofit, independent health insurance consumer assistance entity, which may not be an insurer, to operate the consumer assistance program.   [PL 2019, c. 522, §1 (NEW).] 4.  Report.  The operator of the consumer assistance program shall report to the Attorney General, according to the requirements of the contract under subsection 1, on aggregate data relevant to the services provided by and activities of the consumer assistance program, and annually, by January 15th, the Attorney General shall report to the joint standing committee of the Legislature having jurisdiction over health insurance matters on the aggregate data.   [PL 2019, c. 522, §1 (NEW).] 5.  Funding.  The State shall provide necessary funding for the consumer assistance program.   [PL 2021, c. 206, §1 (NEW).] SECTION HISTORY PL 2019, c. 522, §1 (NEW). PL 2021, c. 206, §1 (AMD).
24-A ME Rev Stat § 4332 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 3: DOWNSTREAM RISK|24-A §4332. Safe harbor and waiver

 §4332. Safe harbor and waiver 1.  Authority for safe harbor.  Notwithstanding any other provisions of this Title or Title 24, including, without limitation, sections 4341 and 4342, an arrangement between a carrier and a downstream entity with which the carrier has contracted to provide or arrange for the provision of services that allows the downstream entity to accept a limited degree of insurance risk is permitted and such a risk arrangement is deemed not to be engaging in the business of insurance by the downstream entity if:   A. The arrangement does not involve substantial insurance risk or substantial enrollment risk as described in section 4334; and   [PL 1999, c. 609, §20 (NEW).]B. The arrangement meets the requirements of sections 4335 and 4336.   [PL 1999, c. 609, §20 (NEW).][PL 1999, c. 609, §20 (NEW).] 2.  Waiver for downstream risk arrangements that exceed risk threshold described in section 4334.  Carriers and downstream entities that wish to develop downstream risk arrangements that exceed the risk threshold described in section 4334 may jointly request that the superintendent grant a waiver that allows the downstream entity to accept a limited degree of insurance risk without being licensed as an insurer, a health maintenance organization or an insurance administrator. The joint request for a waiver must include a plan for managing financial exposure, based upon reasonable enrollment and utilization projections and upon the contracts, parties and features proposed, sufficient to quantify in dollars per quarter and per annum all elements of downstream risk to be assumed by the downstream entity. All other risk arrangements are prohibited unless the arrangements meet the appropriate licensing standards or are expressly permitted by the superintendent.   [PL 1999, c. 609, §20 (NEW).] 3.  Continuing obligation to subscribers.  A carrier contracting with a downstream entity remains obligated to its subscribers for the delivery of health care benefits consistent with existing state law. The carrier remains responsible for compliance with all applicable laws.   [PL 1999, c. 609, §20 (NEW).] 4.  Certain incentives prohibited.  A downstream risk arrangement may not contain incentives for the downstream entity or participating provider to limit or deny medically necessary care to enrollees.   [PL 1999, c. 609, §20 (NEW).] 5.  Requirements still applicable.  The application of the safe harbor provisions in subsection 1 or a waiver of licensing requirements granted pursuant to this section does not exempt the downstream entity from any other licensure or prior approval requirements applicable to activities conducted by the downstream entity, including, but not limited to, utilization review licensure, insurance administrator licensure or preferred provider arrangement registration.   [PL 1999, c. 609, §20 (NEW).] SECTION HISTORY PL 1999, c. 609, §20 (NEW).
24-A ME Rev Stat § 4333 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 3: DOWNSTREAM RISK|24-A §4333. Requirements for downstream risk arrangements

 §4333. Requirements for downstream risk arrangements 1.  Permissible downstream risk arrangements.  Downstream entities that do not exceed the risk threshold described in section 4334 may enter into downstream risk arrangements only if:   A. The requirements of section 4332, subsection 1 and sections 4335 and 4336 are met; and   [PL 1999, c. 609, §20 (NEW).]B. No specific payment is made directly or indirectly under the plan to a provider as an inducement to reduce or limit medically necessary services furnished to an enrollee.   [PL 1999, c. 609, §20 (NEW).][PL 1999, c. 609, §20 (NEW).] 2.  Prohibited downstream risk payments.  A specific payment of any kind may not be made directly or indirectly under the incentive plan to a downstream entity as an inducement to reduce or limit covered medically necessary services under the carrier's contract furnished to an enrollee. Indirect payments include offerings of monetary value such as stock options or waivers of debt measured in the present or future.   [PL 1999, c. 609, §20 (NEW).] 3.  Applicability.  This section applies to risk arrangements between carriers and downstream entities with which they contract to provide medical services to enrollees. This section also applies to subcontracting arrangements.   [PL 1999, c. 609, §20 (NEW).] SECTION HISTORY PL 1999, c. 609, §20 (NEW).
24-A ME Rev Stat § 4334 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 3: DOWNSTREAM RISK|24-A §4334. Substantial insurance risk; substantial enrollment risk

 §4334. Substantial insurance risk; substantial enrollment risk 1.  Substantial insurance risk.  Substantial insurance risk is risk based on the use or costs of referral services only, when the downstream entity is at risk for more than 25% of potential payments by the carrier to the downstream entity.   [PL 1999, c. 609, §20 (NEW).] 2.  Substantial enrollment risk.  Substantial enrollment risk exists when a carrier enters into a risk arrangement with a downstream entity involving more than 25% of the enrollees served by the carrier in the State unless the risk arrangement is a risk-sharing arrangement.   [PL 1999, c. 609, §20 (NEW).] SECTION HISTORY PL 1999, c. 609, §20 (NEW).
24-A ME Rev Stat § 4336 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 3: DOWNSTREAM RISK|24-A §4336. Disclosure requirements for organizations with downstream risk arrangements

 §4336. Disclosure requirements for organizations with downstream risk arrangements 1.  Disclosure to superintendent.  Each carrier shall provide information concerning the carrier's downstream risk arrangements as required or requested by the superintendent. The disclosure must contain the following information in sufficient detail to enable the superintendent to determine whether the risk arrangement complies with the following requirements:   A. Whether services not furnished by the downstream entity are covered by the risk arrangement. If the services furnished by the downstream entity are covered by the risk arrangement, disclosure of other aspects of the plan need not be made;   [PL 1999, c. 609, §20 (NEW).]B. The type of risk arrangement; for example, withhold, bonus, capitation;   [PL 1999, c. 609, §20 (NEW).]C. If the risk arrangement involves a withhold or bonus, the percent of the withhold or bonus;   [PL 1999, c. 609, §20 (NEW).]D. The panel size, the number of enrollees covered by the downstream entity and the total number of enrollees covered by the carrier in the State; and   [PL 1999, c. 609, §20 (NEW).]E. In the case of capitated downstream entities, capitation payments paid to primary care providers for the most recent year broken down by percent for primary care services, referral services to specialists, hospital services and other types of provider services, including, but not limited to, nursing home and home health agency services.   [PL 1999, c. 609, §20 (NEW).][PL 1999, c. 609, §20 (NEW).] 2.  Annual disclosure.  A carrier shall provide this information to the superintendent at least annually. A carrier shall provide the capitation data required under subsection 1 for the previous calendar year to the superintendent by April 1st of each year.   [PL 1999, c. 609, §20 (NEW).] 3.  Disclosure to enrollees.  A carrier shall provide the following information to any enrollee upon request:   A. Whether the prepaid plan uses a downstream risk arrangement that affects the use of referral services; and   [PL 1999, c. 609, §20 (NEW).]B. The type of risk arrangement.   [PL 1999, c. 609, §20 (NEW).][PL 1999, c. 609, §20 (NEW).] SECTION HISTORY PL 1999, c. 609, §20 (NEW).
24-A ME Rev Stat § 4337 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 3: DOWNSTREAM RISK|24-A §4337. Requirements related to subcontracting arrangements

 §4337. Requirements related to subcontracting arrangements 1.  Physician groups.  A carrier that contracts with a downstream entity that places the individual physician members at substantial financial risk for services they do not furnish shall disclose to the superintendent any incentive plan between the downstream entity and the entity's individual physicians that bases compensation to the physician on the use or cost of services furnished to enrollees. The disclosure must include the information specified in section 4336, subsection 1.   [PL 1999, c. 609, §20 (NEW).] 2.  Intermediate entities.  A carrier that contracts with a downstream entity, other than a physician group, for the provision of services to enrollees shall disclose to the superintendent any risk arrangement between the entity and a physician or physician group that bases compensation to the physician or physician group on the use or cost of services furnished to enrollees. The disclosure must include the information required to be disclosed under section 4336, subsection 1.   [PL 1999, c. 609, §20 (NEW).] 3.  Sanctions against the carrier.  The superintendent may apply intermediate sanctions if the superintendent determines that a carrier fails to comply with the requirements of this section.   [PL 1999, c. 609, §20 (NEW).] SECTION HISTORY PL 1999, c. 609, §20 (NEW).