HARRY HUGHES, Governor

3373

(5) (3) IF A PREFERRED PROVIDER POLICY OR PREFERRED
PROVIDER CONTRACT PROVIDES FOR REIMBURSEMENT FOR ANY SERVICE THAT
IS WITHIN THE LAWFUL SCOPE OF PRACTICE OF A HEALTH CARE PROVIDER
LICENSED UNDER THE HEALTH OCCUPATIONS ARTICLE, ANY PARTICIPANT,
BENEFICIARY, OR OTHER PERSON COVERED BY THE INSURANCE POLICY OR
INSURANCE CONTRACT SHALL BE ENTITLED TO REIMBURSEMENT FOR THAT
SERVICE.

(6) (4) PREFERRED PROVIDER POLICIES OR PREFERRED
PROVIDER CONTRACTS OFFERED UNDER THIS SECTION SHALL PROVIDE FOR
PAYMENT OF SERVICES RENDERED BY NONPREFERRED PROVIDERS UNLESS THE
INSURER DEMONSTRATES TO THE SATISFACTION OF THE INSURANCE
COMMISSIONER THAT AN ALTERNATIVE LEVEL OF PAYMENT IS MORE
APPROPRIATE UNDER THE CIRCUMSTANCES, ANY PAYMENT MADE UNDER THIS
PARAGRAPH MAY NOT BE LESS THAN 80% OF THE AVERAGE PAYMENTS AMOUNT
THAT WOULD HAVE BEEN PAID TO PREFERRED PROVIDERS FOR SIMILAR
SERVICES IN THE SAME GEOGRAPHIC AREA.

(C) IF THE RATES FOR EACH INSTITUTIONAL PROVIDER UNDER A
PREFERRED PROVIDER POLICY OR PREFERRED PROVIDER CONTRACT VARY
BASED UPON INDIVIDUAL NEGOTIATIONS, GEOGRAPHIC DIFFERENCES, OR
MARKET CONDITIONS AND ARE APPROVED BY THE HEALTH SERVICES COST
REVIEW COMMISSION, THE RATES MAY NOT BE DEEMED TO CONSTITUTE
UNFAIR DISCRIMINATION UNDER THIS ARTICLE.

(D) THIS SECTION DOES NOT APPLY TO ANY EMPLOYEE BENEFIT
PLAN REGULATED BY FEDERAL LAW OR BY THE EMPLOYEE RETIREMENT
INCOME SECURITY ACT OF 1974 (ERISA).

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall
take effect July 1, 1985.

Approved May 28, 1985.

CHAPTER 727

(Senate Bill 300)

AN ACT concerning

Regulatory Review and Evaluation Act

FOR the purpose of creating the Regulatory Review and Evaluation
Act to provide for periodic joint executive and legislative
review and evaluation of existing regulations; defining
certain terms; making certain findings and stating the

purposes of this Act; requiring the Governor, after

consultation with the Joint Committee on Administrative,
Executive, and Legislative Review, to provide by Executive
Order for the review and evaluation of existing regulations;