Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 850 - HEALTH PLAN ACCOUNTABILITY
Section 031-850-1 - Purpose

This rule establishes standards applicable to health maintenance organizations (HMOs), as defined by Chapter 56 of the Insurance Code, utilization review entities, as defined by Chapter 34 of the Insurance Code, and carriers as defined by Chapter 56-A of the Insurance Code. In the interest of consolidating standards applicable to carriers and adopting current National Association of Insurance Commissioners (NAIC) health plan accountability models, it repeals and replaces old Bureau of Insurance Rule Chapter 520, Medical Utilization Review Entities, and incorporates provisions of the NAIC Utilization Review Model Act, Health Carrier Grievance Procedure Model Act and Health Care Professional Credentialing Verification Model Act. The 2002 Amendments to Revised Rule Chapter 850 reflect amendments to the Health Plan Improvement Act, Title 24-A, Chapter 56-A M.R.S.A. (§§4301 et seq. ), enacted by Public Law 1999, Chapter 742, An Act to Establish a Patient's Bill of Rights. The 2003 Amendments reflect amendments to 24-A M.R.S.A. §4303, enacted by Public Law 2003, Chapters 108 and 469. The 2007 Amendments to the access requirements in section 7 are Major Substantive Amendments proposed by the Superintendent pursuant to a consensus-based rule development process governed by 5 M.R.S.A. §8051-B. The 2012 Amendments, which include Major Substantive Amendments to the access requirements in section 7, are adopted to reflect amendments to the Maine Health Plan Improvement Act enacted by Public Law 2011, Chapters 90 and 364, and to bring the appeal and grievance procedures in sections 8 through 10 into compliance with the requirements of the federal Affordable Care Act. The 2020 Amendments are Routine Technical Amendments adopted to reflect amendments to the Maine Health Plan Improvement Act enacted by Public Law 2019, Chapters 171, 238, and 273.