Maine § 24-A §4306 Enrollee choice of primary care provider

Maine Statutes

§ 24-A §4306 — Enrollee choice of primary care provider

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

A carrier offering or renewing a managed care plan shall allow enrollees to choose their own primary care providers, as allowed under the managed care plan's rules, from among the panel of participating providers made available to enrollees under the managed care plan's rules. A carrier shall allow physicians, including, but not limited to, pediatricians and physicians who specialize in obstetrics and gynecology, and physician associates licensed pursuant to Title 32, section 2594‑E or section 3270‑E and certified nurse practitioners who have been approved by the State Board of Nursing to practice advanced practice registered nursing without the supervision of a physician pursuant to Title 32, section 2102, subsection 2‑A to serve as primary care providers for managed care plans. A carrier

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A carrier offering or renewing a managed care plan shall allow enrollees to choose their own primary care providers, as allowed under the managed care plan's rules, from among the panel of participating providers made available to enrollees under the managed care plan's rules. A carrier shall allow physicians, including, but not limited to, pediatricians and physicians who specialize in obstetrics and gynecology, and physician associates licensed pursuant to Title 32, section 2594‑E or section 3270‑E and certified nurse practitioners who have been approved by the State Board of Nursing to practice advanced practice registered nursing without the supervision of a physician pursuant to Title 32, section 2102, subsection 2‑A to serve as primary care providers for managed care plans. A carrier is not required to contract with certified nurse practitioners, physician associates or physicians as primary care providers in any manner that exceeds the access and provider network standards required in this chapter or chapter 56, or any rules adopted pursuant to those chapters. A carrier shall allow enrollees in a managed care plan to change primary care providers without good cause at least once annually and to change with good cause as necessary. When an enrollee fails to choose a primary care provider, the carrier may assign the enrollee a primary care provider located in the same geographic area in which the enrollee resides.

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Legislative History

PL 1995, c. 673, §C1 (NEW). PL 1995, c. 673, §C2 (AFF). PL 1999, c. 396, §6 (AMD). PL 1999, c. 396, §7 (AFF). PL 1999, c. 742, §15 (AMD). PL 2007, c. 199, Pt. B, §15 (AMD). PL 2011, c. 364, §28 (AMD). PL 2019, c. 627, Pt. A, §1 (AMD). PL 2019, c. 627, Pt. A, §3 (AFF). PL 2025, c. 316, §3 (REV).