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charged for medically necessary, emergency health care | services obtained by a plan member from a provider who is not | a participating provider. |
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| E.__Copayments or deductibles do not apply to health care | services provided through the plan, except that, to | encourage the use of the most appropriate and cost-effective | mode of service, an organized delivery system may require | reasonable payments by a plan member if payment is approved | by the agency and does not substantially interfere with | access to needed health care services. |
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| F.__Accountability to the public of the open plan and | organized delivery systems must be ensured in order to | promote public confidence in the health care delivery system | and awareness of the costs of care. |
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| G.__Flexible enrollment and transfer processes that preserve | plan member confidence and ensure that health care needs are | met must be provided. |
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| H.__An opportunity for negotiation of fair rates of | compensation with participating providers in the open plan | and organized delivery systems and negotiation with | pharmaceutical companies for similarly classified | pharmaceuticals must be provided. |
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| I.__A program to expand services to underserved rural and | low-income communities must be established. |
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| J.__Mechanisms must be developed to provide incentives to | participating providers in the open plan and to organized | delivery systems for additional savings that do not | compromise the quality of health care. |
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| Rules adopted pursuant to this subsection are routine technical | rules as defined in Title 5, chapter 375, subchapter 2-A. |
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| | 5.__Provider requirements.__Participating providers, the open | plan and organized delivery systems may not charge a plan member | or a 3rd party for covered health services and may not charge | rates in excess of the reimbursement levels set by the agency.__A | participating provider of health care services, the open plan and | organized delivery systems may not refuse to provide services to | a plan member on the basis of health status, medical condition, | previous insurance status, race, color, creed, age, national | origin, citizenship status, gender, sexual orientation, | disability, marital status or arrest record except as appropriate | to the provider's professional specialization or other medically | appropriate circumstances. |
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