PUBLIC Law Chapter 469

organized under Title 13-B and authorized pursuant to Title 24,

chapter 19 or by proposing the expansion of an existing public

plan. If the board proposes the establishment of a nonprofit health

care plan or the expansion of an existing public plan, the board

shall submit its proposal, including, but not limited to, a funding

mechanism to capitalize a nonprofit health care plan and any

recommended legislation to the joint standing committee of the

Legislature having jurisdiction over health insurance matters.

Dirigo Health may not provide access to health insurance by

establishing a nonprofit health care plan or through an existing

public plan without specific legislative approval.

3. Carrier participation requirements. To qualify as a carrier
of Dirigo Health Insurance, a health insurance carrier must:

A.__Provide the comprehensive health services and benefits
as determined by the board, including a standard benefit
package that meets the requirements for mandated coverage
for specific health services, specific diseases and for
certain providers of health services under Title 24 and this
Title and any supplemental benefits the board wishes to make
available; and

B.__Ensure that:

(1)__Providers contracting with a carrier contracted to
provide coverage to plan enrollees do not charge plan
enrollees or 3rd parties for covered health care
services in excess of the amount allowed by the carrier
the provider has contracted with, except for applicable
copayments, deductibles or coinsurance or as provided
in section 4204, subsection 6;

(2)__Providers contracting with a carrier contracted to
provide coverage to plan enrollees do not refuse to
provide services to a plan enrollee on the basis of
health status, medical condition, previous insurance
status, race, color, creed, age, national origin,
citizenship status, gender, sexual orientation,
disability or marital status.__This subparagraph may
not be construed to require a provider to furnish
medical services that are not within the scope of that
provider's license; and

(3)__Providers contracting with a carrier contracted to
provide coverage to plan enrollees are reimbursed at
the negotiated reimbursement rates between the carrier
and its provider network.

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