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An Act To Promote Patient Choice and Access to Health Care
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4303, sub-§20  is enacted to read:
 
20.  Reimbursement of a provider.     A carrier may not refuse to reimburse a provider for providing a health care service or procedure covered under a health plan as long as the provider is acting within the lawful scope of that provider's license, registration or certification in the delivery of the covered service or procedure. A carrier may not circumvent the requirements of this subsection:
 
A.  By creating or using a provider-specific billing code or policy not listed in a nationally recognized coding system otherwise used by the carrier; or
 
B.  By discriminating through benefit design or implementation of its benefit design in any manner to discourage enrollment in a health plan or to shift greater costs to an enrollee when an enrollee seeks treatment from a licensed, registered or certified provider.
 
SUMMARY
This bill prohibits a health insurance carrier from refusing to reimburse a provider for providing a health care service or procedure covered under a health plan as long as the provider is acting within the lawful scope of that provider's license, registration or certification in the delivery of the covered service or procedure. The bill also prohibits a carrier from creating or using a provider-specific billing code or policy not listed in a nationally recognized coding system or from discriminating in its benefit design to circumvent the requirement.