What is a Maine patient's "right to shop?"
Maine Medical Association Compliance “toolkit” for Maine’s “Right to Shop” law,
An Act to Encourage Maine Consumers to Comparison-shop for Certain Health Care Procedures and to Lower Health Care Costs, P.L. 2017, Chapter 232
Compliance Date: January 1, 2018
“Toolkit” effective Date: November 2, 2018
What is a Maine patient’s “right to shop?”
- Background: Maine’s legislature has taken a keen interest in health care price transparency since the Dirigo Health Program legislation in 2003. Institutional health care providers and individual health care practitioners all have been governed by a price disclosure law since that time. MMA has prepared a “toolkit” on the price disclosure laws which is available on the MMA web site. More recently, the legislature has sought to incentivize patients to comparison shop for certain health care services as part of its cost containment efforts. Senator Rod Whittemore (R-Somerset), Senate Chair of the Insurance & Financial Services Committee (125th through 128th Maine Legislatures), has been the leading advocate of this initiative as the prime sponsor of L.D. 1305 in the 127th Maine Legislature (did not pass), and L.D. 445 in the 128th Maine Legislature which was enacted and signed by Governor LePage as P.L. 2017, Chapter 232 (“Chapter 232”).
- Chapter 232 creates the Comparable Health Care Service Incentive Program that imposes certain obligations on health care providers and health insurance carriers.
“Comparable health care service” means non-emergency, outpatient health care services in the following categories:
- Physical and occupational therapy services;
- Radiology and imaging services;
- Laboratory services; and
- Infusion therapy services.
Health care provider’s obligation to provide “written notice.” Chapter 232 requires a health care provider to provide a “written notice” to a patient as follows:
- At the time of referral or recommendation;
- For a “comparable health care service” described in plain language or by CPT code;
- During an in-person visit;
- For a patient who has private health insurance coverage;
- That the patient has a right to obtain those services from a different provider;
- That before choosing a provider, the patient may review his or her carrier’s price transparency tool or may contact the carrier by a toll-free telephone number;
- To determine the best value service provider and that the carrier may provide some financial incentive for such “comparison shopping.”
Health insurance carriers’ obligation to provide price transparency tools and plan design with financial incentives to “comparison shop.”
- For a small group (2-50 enrollees) health plan compatible with a health savings account (HAS);
- Develop a plan design that directly incentivizes enrollees to shop for low-cost, high-quality participating providers for comparable health care services;
- The incentives may include cash payments, gift cards, or credits or reductions of premiums, copayments, or deductibles;
- Develop a web site and a toll-free telephone number that enable enrollees to obtain information on the estimated costs of comparable health care services from network providers, as well as quality data to the extent available;
- A carrier may direct enrollees to the Maine Health Data Organization’s (MHDO’s) www.comparemaine.org web site.
- MMA’s model Notice to Our Patients: Comparable Health Care Service Incentive Program is attached. This may be handed to patients during an office visit when a referral or recommendation is made or may be posted in each exam room.
- If you have compliance questions, please contact Andrew MacLean, MMA Deputy EVP & General Counsel, email@example.com, or by phone at 207-622-3374, ext. 214 (O) or 207-215-7462 (C).
[PRACTICE NAME OR LETTERHEAD]
NOTICE TO OUR PATIENTS:
COMPARABLE HEALTH CARE SERVICE INCENTIVE PROGRAM
Prices for some health care services can be very different, even if the service is the same. Because of a Maine law, your insurance company may reward you for using some less expensive health care services. The law calls this “comparison shopping.” If you have private insurance, you may get cash, a gift card, or a credit for saving money. The services include:
- Physical therapy (PT)
- Occupational therapy (OT)
- Radiology and imaging (such as X-rays, CT scans, MRI scans, ultrasounds, and mammograms)
- Laboratory tests (blood tests and other lab tests)
- Infusion (IV) therapy
If you are referred for any of these services at your visit with us today, you do not have to get those services from our practice. You can “shop around.”
The Maine Health Data Organization (MHDO) has information on the costs of a lot of services. You can look up and compare costs using their web site: www.comparemaine.org.
You can also call your health insurance carrier or use their web site. They have information comparing prices for many tests and services.
- Anthem Blue Cross Blue Shield in Maine: www.anthem.com; 800-331-1476
- Aetna: www.aetna.com; 800-872-3862
- Harvard Pilgrim Health Care: www.harvardpilgrim.org; 888-888-4742
- Community Health Options: www.healthoptions.org; 855-624-6463
If you have any questions about this notice, please ask your provider or contact [Practice Administrator] __________________ at _______________________.