Maine Revised Statutes
Subchapter 1: HEALTH PLAN REQUIREMENTS
24-A §4303-F. Reimbursement for ambulance services and participation of ambulance service providers in carrier networks

§4303-F. Reimbursement for ambulance services and participation of ambulance service providers in carrier networks
(CONTAINS TEXT WITH VARYING EFFECTIVE DATES)
1.  (TEXT EFFECTIVE UNTIL 12/31/23) (TEXT REPEALED 12/31/23) Reimbursement for ambulance services.  Until December 31, 2023, with respect to a bill for covered emergency services rendered by an ambulance service provider, a carrier shall reimburse the ambulance service provider or enrollee, as applicable, as follows.  
A. If the ambulance service provider participates in the carrier's network, the carrier shall reimburse at the ambulance service provider's rate or 200% of the Medicare rate for that service, whichever is less, plus any adjustment required by paragraph C.   [PL 2021, c. 241, §3 (NEW).]
B. If the ambulance service provider is an out-of-network provider, the carrier shall reimburse at the ambulance service provider's rate or 180% of the Medicare rate for that service, whichever is less, plus any adjustment required by paragraph C.   [PL 2021, c. 241, §3 (NEW).]
C. If the ambulance service provider is located in a rural or super rural area as designated by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services and eligible for additional Medicare reimbursement for services that were provided to a Medicare enrollee, the carrier shall increase the reimbursement to that ambulance service provider in the same amount as the additional Medicare reimbursement.   [PL 2021, c. 241, §3 (NEW).]
D. If, on the effective date of this subsection, an ambulance service provider's charge for ambulance services is below 200% of the Medicare rate for that service, the ambulance service provider may not increase the charge for that service by more than 5% annually.   [PL 2021, c. 241, §3 (NEW).]
This subsection is repealed December 31, 2023.  
[PL 2021, c. 241, §3 (NEW).]
2.  Network participation; standard contract.  A carrier shall offer a standard contract to all ambulance service providers willing to participate in the carrier's provider network with the following provisions:  
A. (TEXT EFFECTIVE UNTIL 12/31/23) (TEXT REPEALED 12/31/23) The reimbursement rate paid for ambulance services conforms to the requirements of subsection 1.  
This paragraph is repealed December 31, 2023;   [PL 2021, c. 241, §3 (NEW).]
B. The contract term is for a minimum of 24 months;   [PL 2021, c. 241, §3 (NEW).]
C. The contract may be terminated as long as the party seeking to terminate the contract provides at least 180 days' prior notice; and   [PL 2021, c. 241, §3 (NEW).]
D. The contract provides that an ambulance service provider has a minimum of 120 days to submit a claim.   [PL 2021, c. 241, §3 (NEW).]
[PL 2021, c. 241, §3 (NEW).]
3.  Exemption.  This section does not apply to air ambulance services.  
[PL 2021, c. 241, §3 (NEW).]
SECTION HISTORY
PL 2021, c. 241, §3 (NEW).

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