Payment of Certain Out-of-Network Claims

Definitions; Methodology for Calculation of Average Contracted Rate; Reporting

Fast, Fair and Cost-Effective Dispute Resolution Mechanism

Methodology for Determining Average Contracted Rate; Default Reimbursement Rate

Claims Settlement Practices

Definitions; Balance Billing in Cases of Emergency Services; Balance Billing in Cases of Non-emergency Services Performed by Nonparticipating Providers at Certain Participating Health Care Facilities; Dispute Resolution Regarding the Fair Value of Health Care Items or Services

Findings—Intent—2019 c 427; Short title; Definitions; Dispute resolution process—Determination of commercially reasonable payment amount; Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists; Health care provider—Requirement to provide certain information on website or upon consumer request—Requirement to submit network status information to carriers; Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information; Application of chapter to self-funded group health plans that elect to participate in balance billing protection provisions—Annual notice to commissioner; Determining the adequacy of provider networks—Required considerations; Allowed amounts paid to nonparticipating providers; Application of state and federal requirements—Applicability information access—Waivers prohibited

Concerning Gag Clauses in Individual and Group Health Benefit Plans

Health-care facilities – emergency and nonemergency services – required disclosures – balance billing – rules – definitions.

Health-care providers – required disclosures – balance billing – rules – definitions