WILLIAM DONALD SCHAEFER, Governor                            Ch. 537

BENEFITS ON AN EXPENSE-INCURRED BASIS SHALL PAY THE HOME MEDICAL
EQUIPMENT PROVIDER DIRECTLY IF PAYMENT IS PROVIDED FOR IN THE
CONTRACT, POLICY, OR CERTIFICATE OF INSURANCE WITH THE NONPROFIT
HEALTH SERVICE PLAN.

(2)      IF THE CONTRACT, POLICY, OR CERTIFICATE OF INSURANCE WITH
THE NONPROFIT HEALTH SERVICE PLAN DOES NOT REQUIRE DIRECT PAYMENT,
THE NONPROFIT HEALTH SERVICE PLAN MAY PAY THE PROVIDER OR THE
SUBSCRIBER RECEIVING THE HOME MEDICAL EQUIPMENT. AND

(3)      THE NONPROFIT HEALTH SERVICE PLAN MAY NOT REQUIRE THE
PROVIDER TO ACCEPT LESS THAN THE FULL AGREED UPON MONTHLY RENTAL
AMOUNT FOR EACH MONTH THAT USE OF THE EQUIPMENT IS AUTHORIZED BY THE
NONPROFIT HEALTH SERVICE PLAN.

(B)      AUTHORIZATION MAY NOT BE TERMINATED UNTIL BOTH THE PROVIDER
AND BENEFICIARY OF THE SERVICES EQUIPMENT HAVE BEEN NOTIFIED IN WRITING
THAT AUTHORIZATION IS TERMINATED.

(C)      A PURCHASE OF THE RENTED EQUIPMENT AND SERVICES MAY BE MADE
ONLY ON WRITTEN WITH THE CONSENT OF THE PROVIDER AND THE NONPROFIT
HEALTH SERVICE PLAN IN ACCORDANCE WITH THE BENEFITS AVAILABLE UNDER
THE APPLICABLE HEALTH BENEFITS POLICY OR CERTIFICATE.

470CC.

(A)     AN INSURER UNDER A CONTRACT, AGREEMENT, OR ASSIGNMENT IN
WHICH AN INDIVIDUAL RECEIVES HOME MEDICAL EQUIPMENT UNDER A HEALTH
INSURANCE POLICY OR CERTIFICATE DELIVERED OR ISSUED FOR DELIVERY IN THE
STATE THAT PROVIDES BENEFITS ON AN EXPENSE-INCURRED BASIS SHALL PAY THE
HOME MEDICAL EQUIPMENT PROVIDER DIRECTLY AND IF THE INSURED HAS
EXECUTED AN ASSIGNMENT OF BENEFITS AND, SUBJECT TO THE COPAYMENT AND
DEDUCTIBLE PROVISIONS IN THE CONTRACT, MAY NOT REQUIRE THE PROVIDER TO
ACCEPT LESS THAN THE FULL AGREED UPON MONTHLY RENTAL AMOUNT FOR
EACH MONTH THAT USE OF THE EQUIPMENT IS AUTHORIZED BY THE INSURER IN
WHICH BENEFITS ARE PAYABLE UNDER THE INSURANCE CONTRACT.

(B)      AUTHORIZATION MAY NOT BE TERMINATED UNTIL BOTH THE PROVIDER
AND BENEFICIARY OF THE SERVICES EQUIPMENT HAVE BEEN NOTIFIED IN WRITING
THAT AUTHORIZATION IS TERMINATED.

(C)      A PURCHASE OF THE RENTED EQUIPMENT AND SERVICES MAY BE MADE
ONLY ON WRITTEN WITH THE CONSENT OF THE PROVIDER AND THE INSURER
PROVIDED THAT THE PURCHASE PRICE AND THE RENTAL PRICE OF THE EQUIPMENT
WERE DISCLOSED TO THE INSURER, UPON THE INSURER'S REQUEST, EITHER PRIOR TO
THE INITIAL ELECTION TO RENT THE EQUIPMENT OR UPON THE INSURER RECEIVING
THE INITIAL CLAIM FROM THE PROVIDER AND THERE IS NO MATERIAL CHANGE IN THE
MEDICAL CONDITION OF THE INSURED, AS CERTIFIED BY THE ATTENDING PHYSICIAN.

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