§ 24-A §4236 — Chiropractors in health maintenance organizations

Maine § 24-A §4236

• Jurisdiction: Maine
• Title 24-A: MAINE INSURANCE CODE
• Ch. 56: HEALTH MAINTENANCE ORGANIZATIONS

Text

Every health maintenance organization shall include in every plan for health care services chiropractic services delivered by qualified chiropractic providers in accordance with this section.
1.
Qualifications of chiropractic providers.
The health maintenance organization shall determine the qualifications of chiropractic providers using reasonable standards that are similar to and consistent with the standards applied to other providers.
2.
Benefits; discrimination.
The health maintenance organization shall provide benefits covering care by chiropractic providers at least equal to and consistent with the benefits paid to other health care providers treating similar neuro-musculoskeletal conditions. A health maintenance organization may not refuse to reimburse a chiropractic provider who participates in the health maintenance organization's provider network for providing a health care service or procedure covered by the health maintenance organization as long as the chiropractic provider is acting within the lawful scope of that provider's license in the delivery of the covered service or procedure. Consistent with reasonable medical management techniques specified under the health maintenance organization's contract with respect to the method, treatment or setting for a covered service or procedure, the health maintenance organization may not discriminate based on the chiropractic provider's license. This subsection does not require a health maintenance organization to accept all chiropractic providers into a network or govern the reimbursement paid to a chiropractic provider.
3.
Self-referrals for chiropractic care.
A health maintenance organization must provide benefits to an enrollee who utilizes the services of a chiropractic provider by self-referral under the following conditions.

Legislative History

PL 1993, c. 669, §6 (NEW). PL 1995, c. 350, §1 (AMD). PL 1997, c. 99, §1 (AMD). PL 2015, c. 111, §3 (AMD). PL 2015, c. 111, §4 (AFF).