Proposed Amendments to Bureau of Insurance Rule Chapter 850
Health Plan Accountability
Primary Sources of Information and
Small Business Impact Statement
Primary sources of information relied upon by the Bureau of Insurance in developing amendments to Section 7 of the proposed rule include the network adequacy standards of the 2012 Standards and Guidelines for the Accreditation of Health Plans, by the National Committee for Quality Assurance (NCQA), a private, national not-for-profit accrediting organization. Primary sources of information for Sections 8 and 9 of the proposed amendments are based on the requirements of the U.S. Public Health Service Act Sec. 2719, interim final Internal Claims and Appeals and External Review Processes regulations (45 CFR 147.136) and 29 CFR 2560.503-1. Professional judgment is also noted as a source for the proposal.
Section F-7 of 2011 Public Law Ch. 90 repeals and replaces prior Maine law with the requirement that health carriers offering or renewing managed care plans provide their members with “reasonable access” to health care services. The proposal implements the “reasonable access” standard through repeal of the “time and distance” standards of the current rule and addition of reference to network adequacy standards substantially based on those of the NCQA.
In general, the enacted statutory and proposed changes to Section 7 of the Rule are intended to benefit Maine health insurance purchasers by promoting a more competitive health insurance environment in Maine with lower rates and more benefit options for small businesses and their employees.
The Bureau does not anticipate that the proposed amendments to Sections 8 and 9 of the Rule will have an effect on small business.
