Maine § 24-A §4303-F Reimbursement for ambulance services and participation of ambulance service providers in carrier networks

Maine Statutes

§ 24-A §4303-F — Reimbursement for ambulance services and participation of ambulance service providers in carrier networks

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

1.Reimbursement for ambulance services. With respect to a bill for covered services rendered by an ambulance service provider, a carrier shall reimburse the ambulance service provider or enrollee, as applicable, as follows. 1-A. Reimbursement for nontransport services. With respect to a health plan with an effective date on or after January 1, 2024, when an ambulance service provider responds to a call for emergency services and an enrollee refuses transport to a hospital, a carrier shall reimburse that ambulance service provider for any services other than transport provided to the enrollee as follows.

2.Network participation; standard contract. A carrier shall offer a standard contract to all ambulance service providers willing to participate in the carrier's provider network with the

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1.
Reimbursement for ambulance services.
With respect to a bill for covered services rendered by an ambulance service provider, a carrier shall reimburse the ambulance service provider or enrollee, as applicable, as follows.
1-A.
Reimbursement for nontransport services.
With respect to a health plan with an effective date on or after January 1, 2024, when an ambulance service provider responds to a call for emergency services and an enrollee refuses transport to a hospital, a carrier shall reimburse that ambulance service provider for any services other than transport provided to the enrollee as follows.
2.
Network participation; standard contract.
A carrier shall offer a standard contract to all ambulance service providers willing to participate in the carrier's provider network with the following provisions:
3.
Exemption.
Except as provided in subsection 1, paragraph E, this section does not apply to air ambulance services.
4.
Medical necessity.
A carrier shall consider the requirements of the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services related to medical necessity of ambulance services when establishing the carrier's own policies and guidelines related to the medical necessity and reasonableness of covered services provided by ambulance service providers.

Maine § 24-A §4303-F (Reimbursement for ambulance services and participation of ambulance service providers in carrier networks) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.