Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS
Section 031-870-4 - Certification of Exempt Practitioner-Owned Facilities

1. There is no other facility of reasonable quality that provides appropriate service to the community;

2. The use of other facilities is onerous or creates too great a hardship for patients; or

3. The facility is formed to own or lease medical equipment that replaces obsolete or otherwise inadequate equipment in or under the control of a hospital located in a federally designated health manpower shortage area; or

4. The fees charged by the facility for the health care service are competitive with the fees charged outside the community.

1. Investment nondiscrimination. Individuals who are not in a position to self-refer patients to the facility must be given a bona fide opportunity to invest in that facility on the same terms as those offered a referring health care practitioner.

2. Clinical freedom. A health care practitioner who invests may not be required or encouraged to make referrals to the facility or otherwise generate business as a condition of becoming or remaining an investor.

3. Price nondiscrimination. The facility must market or furnish its services to investors who are referring health care practitioners and to other investors on equal terms.

4. No lending to practitioners. The facility may not loan funds or guarantee loans for health care practitioners who are in a position to self-refer patients to the facility.

5. No compensation for referrals. The income on the health care practitioner's investment must be tied to the practitioner's equity in the facility rather than to the volume of referrals made.

6. Nonexclusivity. An investment contract between the facility and the health care practitioner may not include a covenant or noncompetition clause that prevents a health care practitioner from investing in other facilities.

7. Disclosure to patients. When making a referral, the practitioner shall disclose his or her investment interest in the facility to the patient. The practitioner shall inform the patient that the patient will not be treated differently by the practitioner if the patient chooses to use another facility, and shall provide the patient with a list of any alternative facilities that are reasonably available.

8. Disclosure to third-party payors. Upon request, the practitioner must disclose the nature and extent of his or her investment interest in the facility to any third-party payor that provides coverage to clients of the practitioner or the facility.

9. Utilization review. The facility must have an internal utilization review program.

10. Conflict of interest. If a health care practitioner's financial interest in a facility is incompatible with a referred patient's interest; the health care practitioner shall make alternative arrangements for that patient's care.