nursing without the supervision of a physician pursuant to to serve as primary care providers for managed care plans. Essential Health Care (7) Benefits must be made available for outpatient health care services of ☐ Providers (Rural health certified rural health clinics. clinics) Independent Practice 24-A M.R.S.A. Coverage must be provided for dental services performed by a licensed ☐ Dental Hygienists §2847-Q independent practice dental hygienist when those services are covered services under the contract and when they are within the lawful scope of practice of the independent practice dental hygienist. Network adequacy 24-A M.R.S.A. All managed care arrangements except must be filed for ☐ MEWA’s adequacy and compliance with Rule 850 and Rule 360 access ) standards. If the policy uses a network, the network(s) need to have been (7) approved by the Bureau for adequacy and access standards (i.e. physician, hospital, and ancillary service networks). Must provide a copy of network approval. Optional coverage for 24-A M.R.S.A. Benefits must be made available for the services of optometrists if the ☐ optometric services same services would be covered if performed by a physician. Pastoral counselors Must include benefits for licensed pastoral counselors and marriage ☐ and marriage and and family therapists for mental health services to the extent that the family therapists same services would be covered if performed by a physician. Pharmacy Providers A carrier that provides coverage for prescription drugs as part of a ☐ – health plan may not refuse to contract with a pharmacy provider that is “Any Willing qualified and is willing to meet the terms and conditions of the carrier's Pharmacy” criteria for pharmacy participation as stipulated in the carrier's contractual agreement with its pharmacy providers. PPOs Payment for 24-A M.R.S.A. The benefit level differential between services rendered by preferred ☐ – Non-preferred providers and non-preferred providers may not exceed 20% of the Providers allowable charge for the service rendered. Provider directories Pursuant to 24-A M.R.S. § 4303-D: ☐ 1. Requirement. A carrier shall make available provider directories in accordance with this section.
nursing without the supervision of a physician pursuant to to serve as primary care providers for managed care plans. Essential Health Care Providers (Rural health clinics) (7) Benefits must be made available for outpatient health care services of certified rural health clinics. ☐ Independent Practice Dental Hygienists 24-A M.R.S.A. §2847-Q Coverage must be provided for dental services performed by a licensed independent practice dental hygienist when those services are covered services under the contract and when they are within the lawful scope of practice of the independent practice dental hygienist. ☐ Network adequacy 24-A M.R.S.A. ) (7) All managed care arrangements except MEWA’s must be filed for adequacy and compliance with Rule 850 and Rule 360 access standards. If the policy uses a network, the network(s) need to have been approved by the Bureau for adequacy and access standards (i.e. physician, hospital, and ancillary service networks). Must provide a copy of network approval. ☐ Optional coverage for optometric services 24-A M.R.S.A. Benefits must be made available for the services of optometrists if the same services would be covered if performed by a physician. ☐ Pastoral counselors and marriage and family therapists Must include benefits for licensed pastoral counselors and marriage and family therapists for mental health services to the extent that the same services would be covered if performed by a physician. ☐ Pharmacy Providers – “Any Willing Pharmacy” A carrier that provides coverage for prescription drugs as part of a health plan may not refuse to contract with a pharmacy provider that is qualified and is willing to meet the terms and conditions of the carrier's criteria for pharmacy participation as stipulated in the carrier's contractual agreement with its pharmacy providers. ☐ PPOs – Payment for Non-preferred Providers 24-A M.R.S.A. The benefit level differential between services rendered by preferred providers and non-preferred providers may not exceed 20% of the allowable charge for the service rendered. ☐ Provider directories Pursuant to 24-A M.R.S. § 4303-D: 1. Requirement. A carrier shall make available provider directories in accordance with this section. ☐
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