HP0480, LD 704, item 1, An Act Regarding Notice Provided by Insurance Carriers to Health Care Providers

An Act Regarding Notice Provided by Insurance Carriers to Health Care Providers

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4320-J is enacted to read:

§ 4320-J. Notice of grace period

If an enrollee is covered by an insurance product purchased through the American Health Benefit Exchange pursuant to the federal Affordable Care Act and is in the 3-month grace period under 45 Code of Federal Regulations, Section 156.270(d)(2015) and a provider, or a representative of a provider, requests information from a carrier regarding the enrollee's eligibility, coverage or health plan benefits or the status of a claim or claims for services provided to the enrollee and the information requested is regarding the enrollee's eligibility, coverage or health plan benefits or a claim for services provided on a date within the 2nd or 3rd month of the 3-month grace period, the carrier shall inform the provider that the enrollee is in the 3-month grace period.

1. Information provided. The carrier shall provide the information required under this section through the same medium through which the provider or representative of the provider sought the information. The information to be provided by the carrier must include:

A. The purpose of the notice;

B. The enrollee's name and any unique identification numbers;

C. The name of the carrier and the carrier's unique health plan identifier;

D. The specific date upon which the grace period for the enrollee began and the specific date it expires; and

E. A clear statement regarding whether the carrier intends to exercise its right under the federal Affordable Care Act to pend claims for the enrollee and subsequently not pay claims for care provided to the enrollee during the grace period if the enrollee fails to make premium payments or whether the carrier intends on recouping claims payments for services rendered during the grace period.

2. Failure to provide information. If a carrier does not provide information required by this section, the carrier must pay for all claims for services provided by a provider to the relevant enrollee during the time the enrollee was in the grace period.

3. Waiver. The notice required by this section may not be waived by contract, and contract provisions in conflict with this section are void and of no effect.

4. Effective date. This section takes effect January 1, 2016.

summary

This bill requires insurance carriers, beginning January 1, 2016, to give health care providers notice that an enrollee covered by an insurance product purchased through the American Health Benefit Exchange is in the 3-month grace period under 45 Code of Federal Regulations, Section 156.270(d)(2015).

HP0480 LD 704	Session - 127th Maine Legislature		LR 958 Item 1
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