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Maine Law Further Protects Health Care Providers in Preferred Provider Arrangements
Date:7/30/2013

Alexandria, VA (PRWEB) July 30, 2013

A new Maine law will give physical therapists and other health care providers additional protections when they enter into contracts for preferred provider arrangements. Public Law 399 (LD 1466) will require health plans to disclose certain information and materials to providers at the time a preferred provider arrangement contract is offered. The legislation will prohibit contracts that allow health insurance companies to make changes to key terms, such as reimbursement rates, without the provider’s written consent after the agreement has been entered. The new provisions will take effect October 8.

LD 1466 requires organizations entering into a preferred provider agreement to allow health care providers the opportunity to review certain information, including the fee schedule or terms of payment if there is no fee schedule; policies and procedures to which the provider will be bound; and the identity of carriers for which the provider is agreeing to provide services. It also requires written consent from the provider for any payer requirements or fee schedules that materially differ from the contract, unless those terms are set out in a separate section of the contract, such as an exhibit or amendment, and prohibits the terms of existing preferred provider contracts from being superseded by a carrier’s subsequent contract with a health plan payer.

“This legislation levels the playing field for providers by granting greater access to the information they need to make informed decisions before entering into these preferred provider arrangements, and it will prevent changes to the terms of service or rates of reimbursement after a provider has entered into a contract,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. “Patients benefit when the marketplace provides a variety of choices for the physical therapist services they need.”

LD 1466 was sponsored by Maine Senate
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