Why all eyes should be on Maine if you are in Private practice

I have long said that what therapists in different states have in common far outweighs each state’s differences.  Now, Maine may make me sing a different tune, and for a very good reason. The Maine legislature recently passed and enacted on October 8th, 2013 Public Law 399 (LD 1466).  This gives physical and occupational therapists, along with other healthcare providers addition protections when they enter into contracts as a preferred provider for health insurers.  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.

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contract, such as an exhibit or amendment, and prohibits the terms of existing preferred provider contracts from being superseded by a carrier’s subsequent contract with a health plan payer.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.”

I have worked with too many therapists from too many states who sign one sided contracts with insurance companies to be participating providers.  Many find out after the fact that fee schedules have been reduced, bundled, and in some circumstances abandoned in favor of low flat fee methodology. Many have active contracts that suddenly get superseded by new contracts at less favorable terms. Some therapists are even subjected to bills not being honored at the previously mutually agreed upon rate. The state motto of Maine is “Dirigo” (Latin for “I Direct”). I can only hope that this proves true and that as Maine has directed, the rest of the states will follow and enact such necessary legislation so that therapists can informed decisions about which insurance companies to participate in.

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