Maine Code § 24-A-4245

NCQA accreditation survey report
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1. Access and confidentiality. The superintendent or the Commissioner of Health and Human
Services may require a health maintenance organization to submit its NCQA accreditation survey
report. An NCQA accreditation survey report obtained by or submitted to the superintendent or the
Commissioner of Health and Human Services is confidential, is not subject to subpoena and may not
be made public by the superintendent or the Commissioner of Health and Human Services except as
otherwise provided in this section.
[PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
2. Use in examination. In conducting an examination of a health maintenance organization
pursuant to section 4215, the superintendent or the Commissioner of Health and Human Services has
the discretion to adopt relevant findings in the NCQA accreditation survey report in whole or in part as
the examiner's conclusions, if the examiner determines that the NCQA survey, by itself or in
combination with the examiner's own findings, sufficiently demonstrates that the health maintenance
organization has satisfied the pertinent requirements of this chapter. If the NCQA accreditation survey
report indicates that the health maintenance organization may not be in compliance with one or more
requirements of this chapter, the examiner may investigate and make independent findings.
[PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
3. Examination report. The information from the NCQA accreditation survey report that
sufficiently demonstrates that the health maintenance organization has satisfied the pertinent
requirements of this section as adopted by the superintendent or the Commissioner of Health and
Human Services pursuant to subsection 2 may be incorporated into an examination report, which is a
public record except for any information relating to an individual applicant or enrollee.
[PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
4. Use of information for regulatory purposes. The confidentiality of the NCQA accreditation
survey report does not prohibit its use by the superintendent or the Commissioner of Health and Human
Services for regulatory or law enforcement purposes subject to the restrictions of section 216,
subsection 5 and section 226, subsection 7.
[PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
REVISOR'S NOTE: §4245. Coverage for contraceptives (As enacted by PL 1999, c. 341, §4 and
affected by §5 is REALLOCATED TO TITLE 24-A, SECTION 4247)
REVISOR'S NOTE: §4245. Coverage for services of certified nurse practitioners; certified nurse
midwives (As enacted by PL 1999, c. 396, §4 and affected by §7 is REALLOCATED TO TITLE 24-
A, SECTION 4248)

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