An Act To Help Maine People Be Informed Medical Consumers

Sec. 1. 24-A MRSA §4306,  as amended by PL 1999, c. 742, §15, is further amended to read:

§ 4306. Enrollee choice of primary care provider

A carrier offering 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, 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 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 must 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. A carrier shall provide reimbursement under a managed care plan for an initial consultation by an enrollee with a maximum of 3 primary care providers in a 12-month period to assist an enrollee with choosing a primary care provider. 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.

summary

This bill requires health insurance carriers to provide coverage for an initial consultation with a primary care provider to assist an enrollee in selecting a primary care provider. The bill requires carriers to provide coverage for a maximum of 3 such visits for an enrollee in a 12-month period.