LD 1611
pg. 63
Page 62 of 73 PUBLIC Law Chapter 469 Page 64 of 73
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LR 2137
Item 1

 
health care services in accordance with standards developed by rule
by the superintendent. These standards must consider the
geographical and transportational problems in rural areas. All
managed care plans covering residents of this State must provide
reasonable access to providers consistent with the access-to-
services requirements of any applicable bureau rule.

 
A. Upon approval of the superintendent, a carrier may offer
a health plan that includes financial provisions designed to
encourage members to use designated providers in a network
if:

 
(1)__The entire network meets overall access standards
pursuant to Bureau of Insurance Rule Chapter 850;

 
(2)__The health plan is consistent with product design
guidelines for Bureau of Insurance Rule Chapter 750;

 
(3)__The health plan does not include financial
provisions designed to encourage members to use
designated providers of primary, preventive, maternity,
obstetrical, ancillary or emergency care services, as
defined in Bureau of Insurance Rule Chapter 850;

 
(4)__The financial provisions may apply to all of the
enrollees covered under the carrier's health plan;

 
(5)__The carrier establishes to the satisfaction of the
superintendent that the financial provisions permit the
provision of better quality services and the quality
improvements either significantly outweigh any
detrimental impact to covered persons forced to travel
longer distances to access services, or the carrier has
taken steps to effectively mitigate any detrimental
impact associated with requiring covered persons to
travel longer distances to access services. The
superintendent may consult with other state entities,
including the Department of Human Services, Bureau of
Health and the Maine Quality Forum established in
section 6951, to determine whether the carrier has met
the requirements of this subparagraph. The
superintendent shall provisionally adopt rules by
January 1, 2004 regarding the criteria used by the
superintendent to determine whether the carrier meets
the quality requirements of this subparagraph and
present those rules for legislative review during the
Second Regular Session of the 121st Legislature; and

 
(6)__The financial provisions may not permit travel at a distance
that exceeds the standards established in


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