Maine § 24-A §4303-E Dispute resolution process for surprise bills and bills for out-of-network emergency services

Maine Statutes

§ 24-A §4303-E — Dispute resolution process for surprise bills and bills for out-of-network emergency services

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 56-A HEALTH PLAN IMPROVEMENT ACT

1.Independent dispute resolution process. The superintendent shall establish an independent dispute resolution process by which a dispute for a surprise bill for emergency services or a bill for covered emergency services rendered by an out-of-network provider in accordance with section 4303‑C, subsection 2 may be resolved as provided in this subsection beginning no later than October 1, 2020.

2.Self-insured health benefit plans. An entity providing or administering a self-insured health benefit plan exempted from the applicability of this section under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) may elect to be subject to the provisions of this section to resolve disputes with respect to a surprise bill for emergency s

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1.
Independent dispute resolution process.
The superintendent shall establish an independent dispute resolution process by which a dispute for a surprise bill for emergency services or a bill for covered emergency services rendered by an out-of-network provider in accordance with section 4303‑C, subsection 2 may be resolved as provided in this subsection beginning no later than October 1, 2020.
2.
Self-insured health benefit plans.
An entity providing or administering a self-insured health benefit plan exempted from the applicability of this section under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) may elect to be subject to the provisions of this section to resolve disputes with respect to a surprise bill for emergency services or a bill for covered emergency services from an out-of-network provider. In the event an entity providing or administering a self-insured health benefit plan elects to be subject to the provisions of this section, the provisions of this section apply to a self-insured health benefit plan and its members in the same manner as the provisions of this section apply to a carrier and its enrollees. To elect to be subject to the provisions of this section, the entity shall provide notice, on an annual basis, to the superintendent, on a form and in a manner prescribed by the superintendent, attesting to the entity's participation and agreeing to be bound by the provisions of this section. The entity shall amend the health benefit plan, coverage policies, contracts and any other plan documents to reflect that the provisions of this section apply to the plan's members.
3.
Information required from carriers.
As part of the carrier's annual public regulatory filings made to the superintendent, a carrier shall submit in a form and manner determined by the superintendent information related to:
4.
Report from superintendent.
On or before January 31st annually, beginning January 1, 2022, the superintendent shall report the following information received from all carriers in the aggregate:
5.
Confidentiality.
Except as provided in this subsection, all records of the bureau or an independent dispute resolution entity relating to an independent dispute resolution request or proceeding are confidential and not a public record under Title 1, chapter 13.

Maine § 24-A §4303-E (Dispute resolution process for surprise bills and bills for out-of-network emergency services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.