Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 855 - HEALTH INSURANCE PAYMENT REFORM PILOT PROJECTS
Section 031-855-2 - Definitions

Universal Citation: 02 ME Code Rules ยง 031-855-2

Current through 2024-13, March 27, 2024

For purposes of this rule, the following terms have the following meanings:

A. "Accountable care organization" means a group of health care providers operating under a payment agreement to provide health care services to a defined set of individuals with established benchmarks for the quality and cost of those health care services consistent with federal law and regulations.

B. "Carrier" and "health plan" have the meanings set forth in 24-A M.R.S.A. §§4301-A(3) & (7).

C. "Pilot project" means a project that allows a health insurance carrier that offers health plans in this State to implement payment reform strategies with providers through an accountable care organization to reduce costs and improve the quality of patient care, but does not include projects otherwise permitted by law.

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