Maine § 24 §2343 Minimum standards

Maine Statutes

§ 24 §2343 — Minimum standards

Maine § 24 §2343

Title 24INSURANCE

Ch. 19NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGANIZATIONS

This text of Maine § 24 §2343 (Minimum standards) is published on Counsel Stack Legal Research, covering Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Me. Rev. Stat. tit. 24, § 24 §2343 (2026).

Text

A utilization review program of the applicant must meet the following minimum standards.

1.Notification of adverse decisions. Notification of an adverse decision by the utilization review agent must be provided to the insured or other party designated by the insured within a time period to be determined by the superintendent through rulemaking.

2.Reconsideration of determination. All licensees shall maintain a procedure by which insureds, patients or providers may seek reconsideration of determinations of the licensee.

3.Accessibility of representatives. A representative of the licensee must be accessible by telephone to insureds, patients or providers and the superintendent may adopt standards of accessibility by rule.

4.Information materials; confidentiality. A copy of the materials

Free access — add to your briefcase to read the full text and ask questions with AI

A utilization review program of the applicant must meet the following minimum standards.
1.
Notification of adverse decisions.
Notification of an adverse decision by the utilization review agent must be provided to the insured or other party designated by the insured within a time period to be determined by the superintendent through rulemaking.
2.
Reconsideration of determination.
All licensees shall maintain a procedure by which insureds, patients or providers may seek reconsideration of determinations of the licensee.
3.
Accessibility of representatives.
A representative of the licensee must be accessible by telephone to insureds, patients or providers and the superintendent may adopt standards of accessibility by rule.
4.
Information materials; confidentiality.
A copy of the materials designed to inform applicable patients of the requirements of the utilization plan and the responsibilities and rights of patients under the plan and an acknowledgment that all applicable state and federal laws to protect the confidentiality of individual medical records are followed must be filed with the bureau.
5.
Prohibited activities.
A medical utilization review entity shall ensure that an employee does not perform medical utilization review services involving a health care provider or facility in which that employee has a financial interest.