June 20, 2018
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Maine lawmakers take more time to study proposed regulation of ‘narrow band’ health insurance networks

John Clarke Russ | BDN
John Clarke Russ | BDN
Geoffrey Gratwick
By Scott Thistle, Sun Journal

AUGUSTA, Maine — A legislative panel on insurance and financial services is working on how Maine might regulate “narrow band” networks offered by health insurance providers to their customers.

The Insurance and Financial Services Committee on Thursday again tabled a pair of bills that seek to improve disclosure for patients and health care providers as well as determine limits for how far a patient must travel for health care.

So far, the committee has taken a look at how other states handle the issue and what Maine’s current law allows and prohibits.

The new insurance plans, allowed under the federal Affordable Care Act, can limit where their subscribers can seek treatment and from whom.

While several lawmakers appear poised to support some kind of change to Maine law, others said the federal Affordable Care Act, which would supersede state law, remains a “moving target.”

Sen. Geoffrey Gratwick, D-Bangor, Senate chairman of the committee and a doctor, said he wanted the law to ensure that patients would get the best care available, especially for unique conditions. But he also understood that allowing patients to seek care for any condition without restraint was unreasonable.

During Thursday’s committee work session on the bills, Gratwick said patients often want to get care from whichever doctor or specialist was most recently featured in “People” magazine. But when it came to rare or difficult to treat cases, patients should be able to go to a specialist, Gratwick said.

“I think there should be a chain by which you can refer people, I want that person to be able to get the very best care they can,” Gratwick said, “But it needs to be so we are not just talking about treatment for a sore shoulder or the snuffles.”

Before the panel are bills that would require disclosure to health insurance customers before they purchase a plan that clearly shows them which providers will be in their network and which won’t.

The measure also allows health care providers, including hospitals, to find out why they were excluded from a particular health insurance provider’s network. Other lawmakers suggested an appeal of exclusion also be allowed.

Gratwick and Rep. Joyce Fitzpatrick, R-Houlton, also suggested the state find out if it can alter the way health plans are described on the federal government’s health insurance exchange.

The lawmakers want to ensure “narrow network” plans — those that limit narrowly the health care providers a subscriber can use — disclose that up front. They want a “black box” disclosure that would clearly show a health insurance customer which providers are in the network.

Maine is one of 27 states that chose not to set up its own exchange and instead depends on one operated by the federal government under the Affordable Care Act.

While Maine law already sets standards for health care networks, that law is not as specific as some other states.

One concern from health insurance providers is that more disclosure could lead to the release of sensitive “proprietary” information that could put businesses at a competitive disadvantage.

But several other states, including Montana, already have similar disclosure laws that the committee is starting to study.

The panel also considered whether they could merge the bills into one for final consideration. One of the bills, LD 1629, looks to address disclosure issues while the other, LD 1676, is aimed at ensuring access with “any willing provider” provisions.

The committee will take the bills up again when it meets on Feb. 18.


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