This bill makes the following changes to the law relating to the comparable health care service incentive program.
1. It removes the requirement that the small group health plan design be compatible with a federally authorized health savings account.
2. It requires that the incentives be equal to or greater than 25% of the difference between the price of the health care service from the provider selected and the statewide average for the same covered health care service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization.
3. It adds surgical procedures to the categories of nonemergency, outpatient health care services included in the definition of "comparable health care service." Under current law, if an enrollee covered under a health plan other than a health maintenance organization plan elects to obtain a covered comparable health care service from an out-of-network provider at a price that is the same or less than the statewide average for the same covered health care service, the carrier is required to allow the enrollee to obtain the service from the out-of-network provider at the provider's charge and, upon request by the enrollee, to apply the payments made by the enrollee for that comparable health care service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the health care services had been provided by an in-network provider. The bill removes the exception that the provision does not apply to a health maintenance organization plan. The bill also removes the limitation defining "out- of-network provider" as a provider located in Massachusetts, New Hampshire or Maine that is enrolled in the MaineCare program and participates in Medicare.

Statutes affected:
Bill Text LD 1152, HP 757: 24-A.4318