24-A §2670. Short title
§2670. Short title This chapter may be cited as the “Preferred Provider Arrangement Act.” [PL 1999, c. 609, §4 (AMD).] SECTION HISTORY PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §4 (AMD).
24-A §2671. Definitions
§2671. Definitions As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings. [PL 1985, c. 704, §4 (NEW).] 1. “Administrator” means any person, other than a carrier, that administers a preferred provider arrangement. An administrator does not include a health maintenance organization licensed pursuant to chapter 56 […]
24-A §2672. Selective contracting authorized
§2672. Selective contracting authorized Carriers or administrators may enter into preferred provider arrangements with providers of their choice. In selecting preferred providers, carriers or administrators may consider, among other factors, price differences between or among providers, geographic accessibility, specialization and projected utilization by enrollees. Selective contracting does not constitute unreasonable discrimination against or among providers. […]
24-A §2673-A. Preferred provider arrangements
§2673-A. Preferred provider arrangements 1. Filing with superintendent; disapproval. A carrier or administrator who proposes to offer a preferred provider arrangement shall file with the superintendent proposed agreements, rates, geographic service areas, provider networks and other materials relevant to the proposed arrangement. The superintendent shall disapprove any preferred provider arrangement if the arrangement contains any […]
24-A §2673. Policies, agreements or arrangements with incentives or limits on reimbursement authorized (REPEALED)
§2673. Policies, agreements or arrangements with incentives or limits on reimbursement authorized (REPEALED) SECTION HISTORY PL 1985, c. 704, §4 (NEW). PL 1989, c. 588, §A49 (RPR). PL 1999, c. 609, §7 (RP).
24-A §2674-A. Requirements for administrators and carriers
§2674-A. Requirements for administrators and carriers 1. Registration fee. All administrators of a preferred provider arrangement shall register with the superintendent and pay an annual registration fee pursuant to section 601, subsection 20. The superintendent shall by rule establish criteria for the registration, including minimum solvency requirements. Rules adopted pursuant to this subsection are routine […]
24-A §2674. Requirements applicable to administrators (REPEALED)
§2674. Requirements applicable to administrators (REPEALED) SECTION HISTORY PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §9 (RP).
24-A §2675. Requirements applicable to insurers (REPEALED)
§2675. Requirements applicable to insurers (REPEALED) SECTION HISTORY PL 1985, c. 704, §4 (NEW). PL 1989, c. 588, §§A50-52 (AMD). PL 1999, c. 609, §11 (RP).
24-A §2676. Risk transfer
§2676. Risk transfer Preferred provider arrangements may include capitated payments that are limited to the health services provided by the provider. [PL 1999, c. 609, §12 (AMD).] Preferred provider arrangements may embody risk transfer between carriers and providers in accordance with the provisions of chapter 56‑A, subchapter III. Any other acceptance of insurance risk […]
24-A §2677-A. Payment for nonpreferred providers
§2677-A. Payment for nonpreferred providers 1. Nonpreferred providers. A carrier incorporating a preferred provider arrangement into a health plan shall provide for payment of covered health care services rendered by providers that are not preferred providers. [PL 1999, c. 609, §14 (NEW).] 2. Benefit level. The benefit level differential between services rendered by preferred […]
24-A §2677. Alternative health care benefits (REPEALED)
§2677. Alternative health care benefits (REPEALED) SECTION HISTORY PL 1985, c. 704, §4 (NEW). PL 1987, c. 34, §2 (AMD). PL 1989, c. 588, §A54 (RPR). PL 1993, c. 600, §B19 (AMD). PL 1999, c. 609, §13 (RP).
24-A §2678-A. Annual report (REPEALED)
§2678-A. Annual report (REPEALED) SECTION HISTORY PL 1989, c. 588, §A55 (NEW). PL 1999, c. 609, §16 (RP).
24-A §2678. Annual experience report
§2678. Annual experience report On or before April 1st of each year, an administrator or carrier who issues or administers a program, policy or contract in this State that includes incentives for the enrollee to use the services of a provider who has entered into an agreement with the carrier or administrator shall file a […]
24-A §2679. Utilization review data (REPEALED)
§2679. Utilization review data (REPEALED) SECTION HISTORY PL 1987, c. 168, §3 (NEW). PL 1999, c. 609, §17 (RP).
24-A §2680. Standardized claim form
§2680. Standardized claim form Administrators providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner or licensed hospital shall accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically. An administrator may not be […]