§2302-C. Penalty for noncompliance with utilization review programs
A contract issued or renewed by a nonprofit service organization after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of nonprofit service organizations to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary. [PL 1995, c. 332, Pt. M, §2 (NEW).]
SECTION HISTORY
PL 1995, c. 332, §M2 (NEW).
Structure Maine Revised Statutes
Chapter 19: NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGANIZATIONS
Subchapter 1: GENERAL PROVISIONS
24 §2301-A. Continuity of licensure; business combinations
24 §2302-A. Utilization review data
24 §2302-B. Penalty for failure to notify of hospitalization
24 §2302-C. Penalty for noncompliance with utilization review programs
24 §2303. Mental health services
24 §2303-A. Dentist included in definition of physician (REPEALED)
24 §2303-B. Optional coverage for chiropractic services (REPEALED)
24 §2303-C. Coverage for chiropractic services (REPEALED)
24 §2305-A. Conditions of certificate of authority
24 §2307-B. Loss information (REPEALED)
24 §2308. Investments (REPEALED)
24 §2308-A. Health insurance affiliates
24 §2313. Licenses; fees (REPEALED)
24 §2314. Suspension or revocation of certificate of authority
24 §2316. Certificates or contracts; approval by superintendent
24 §2317. Other provisions applicable
24 §2317-A. Explanation and notice to parent of minor (REPEALED)
24 §2317-B. Applicability of provisions
24 §2318. Maternity benefits and dependent coverage
24 §2318-A. Maternity and routine newborn care
24 §2319. Newborn children coverage
24 §2319-A. Mandated offer of domestic partner benefits
24 §2320. Home health care coverage
24 §2320-A. Screening mammograms
24 §2320-B. Acupuncture services
24 §2320-C. Coverage for breast cancer treatment
24 §2320-D. Medical food coverage for inborn error of metabolism
24 §2320-E. Coverage for Pap tests
24 §2320-F. Off-label use of prescription drugs for cancer
24 §2320-G. Off-label use of prescription drugs for HIV or AIDS
24 §2321. Rate filings on individual subscriber and membership contracts
24 §2321-A. Standards for when filings are inadequate
24 §2321-B. Appropriate level of subscriber reserves
24 §2324. Certified ambulatory health care center outpatient coverage
24 §2325. Community health services coverage (REPEALED)
24 §2325-A. Mental health services coverage
24 §2325-B. Mandated Benefits Advisory Commission (REPEALED)
24 §2325-C. Coverage for prostate cancer screening
24 §2326. Appeals from order or decision of the superintendent
24 §2327-A. Applicability (REPEALED)
24 §2327-B. Rating practices in individual insurance (REPEALED)
24 §2327-C. Continuity of health insurance coverage (REPEALED)
24 §2329. Equitable health care for substance use disorder treatment
24 §2330. Conversion on termination of contracts or eligibility (REPEALED)
24 §2331. Optional coverage for optometric services
24 §2332-A. Coordination of benefits
24 §2332-B. Acquired Immune Deficiency Syndrome
24 §2332-C. Assessment of mandated benefits proposals (REPEALED)
24 §2332-E. Standardized claim forms
24 §2332-F. Coverage for diabetes supplies
24 §2332-G. Gynecological and obstetrical services (REALLOCATED FROM TITLE 24, SECTION 2332-F)
24 §2332-H. Assignment of benefits
24 §2332-I. Effective date of cancellation
24 §2332-J. Coverage for contraceptives
24 §2332-M. Coverage for general anesthesia for dentistry
24 §2332-N. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery