2/13/2024
LIST OF KEY BILLS WE ARE FOLLOWING:
Note: all of these bills were introduced last year and are carried over into the second year of the session. We will update each bill as it comes up for consideration. The updated information will be in RED.
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LD 227: An Act Regarding Health Care in the State - Rep. Perry
This bill is still a concept draft.
LD 1165: An Act to Enhance Cost Savings to Consumers of Prescription Drugs - Rep Craven This bill removes a provision that requires that compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler to a pharmacy benefits manager be remitted to the carrier if it is not remitted to the covered person. It retains the provision that requires that the compensation be remitted to the covered person to reduce the out of pocket costs associated with a prescription drug. It requires pharmacy benefits managers to annually report compliance with this requirement to the Superintendent of Insurance. It authorizes the superintendent to impose civil penalties and take enforcement action for noncompliance by a carrier or pharmacy benefits manager. It designates the information provided as confidential.
This bill was voted out of committee on a divided vote, with the majority voting ONTP, 9-4. It was not a party line vote
LD 1407: An Act to Amend the Maine Insurance Code Regarding Payments by Health Insurance Carriers to Providers - Rep Mastraccio
This bill amends the Maine Insurance Code in the following ways.
1. It allows a health care provider to object to a health insurance carrier's material change to a provider agreement within 60 days of receiving notice of the change and extends the date on which a change to a provider agreement takes effect based on that objection.
2. It requires a health insurance carrier to include an estimate of any adverse financial impact on a provider as part of a notice of an amendment to a provider agreement.
3. It clarifies that the requirement for interest to be paid on overdue insurance claims payments also applies to 3rd-party administrators that furnish provider networks to carriers.
4. It restricts the authority of a health insurance carrier to retroactively deny a previously paid claim to no later than 24 months from the date of the claims payment.
This bill was voted out of Committee on 1/16/24 as OTP-AM
LD 1577: An Act to Require Health Insurance Coverage for Biomarker Testing - Rep Zager
This bill requires insurance coverage, including coverage in the MaineCare program for biomarker testing.
This bill was voted out of Committee on a divided vote, 11-2, as OTP-AM
LD 1740: An Act to Support an Insured Patient's Access to Affordable Health Care with Timely Access to Health Care Prices - Rep Arford
New title from Amendment as of 1/30/2024
An Act to Protect a Patient's Access to Affordable Health Care with Timely Access to Health Care Prices
Under current law, health care entities are required to provide an estimate of the total price of medical services to be rendered directly by that health care entity during a single medical encounter within a reasonable time of a request from an uninsured patient. This bill requires health care entities to provide a good faith estimate of the allowed amount under an insured patient's health insurance coverage to be paid by an insurer for the medical services to be rendered directly by that health care entity during a single medical encounter. This bill requires the information to be provided within 3 business days of a request from an insured patient to the patient and to the patient's health insurance carrier. This bill also requires health care entities to post notice of a patient's right to request this information in their offices and include such notice in a patient's written consent to treatment form that must be signed prior to receiving health care treatment or services. The bill requires health insurance carriers to provide an insured patient with an advanced explanation of benefits within 3 business days of receiving a good faith estimate from a health care entity for medical services.
This proposed draft amendment replaces the bill. The new bill has a Part A and a Part B.
Part A does the following and incorporates some of the components of the bill.
Upon request of an uninsured or self-pay patient, it requires health care entities to provide a good faith estimate of the cost of medical services to be rendered directly by that health care entity during a single medical encounter. It requires the information to be provided within the following timeframes: (1) when a medical encounter is scheduled at least 3 business days before the date the medical service is scheduled to be furnished or a patient is seeking urgent care, the estimate must be provided no later than 1 business day after the date of scheduling or the date of the request; (2) when a medical encounter is scheduled at least 10 business days before such service is scheduled to be furnished, the estimate must be provided no later than 3 business days after the date of scheduling; or (3) in all other circumstances, the estimate must be provided no later than 3 business days after the date of the request.
It requires the health care entity to separately disclose the prices for each component of medical services, including any facility fees or fees for professional services, and the procedure codes for those services. It requires health care entities to post notice of a patient's right to request this information in their offices and include such notice in a patient's written consent to treatment form that must be signed prior to receiving health care treatment or services.
For insured patients, it requires health care entities to provide an estimate describing the medical services to be rendered during a single medical encounter and the applicable standard medical codes or current procedural technology codes used by the American Medical Association for those services and to notify the patient that the good faith estimate can be used to obtain an estimate of a patient’s out-of-pocket costs from the patient’s health insurance carrier. It requires health insurance carriers to respond to requests from a patient for an estimate of out-of-pocket costs based on a good faith estimate provided by the patient’s health care entity.
The amendment prohibits a health care entity from initiating or pursuing any collection action against an uninsured or self-pay patient for items or services provided on a date the health care entity unless the health care entity provided a good faith estimate to a patient that requested an estimate. The prohibition on collection action does not extend to insured patients
Part B incorporates some of the components of LD 953, An Act to Protect Maine Patients Regarding Hospital Price Transparency. Part B does the following.
1. It requires that hospitals comply with the price transparency requirements established at 45 Code of Federal Regulations, Part 180, as in effect on January 1, 2024.
2. It requires a hospital to provide price transparency data in a standardized uniform format as established in rule by the Maine Health Data Organization.
3. It provides that a hospital that fails to comply with the price transparency requirements established by MHDO may be subject to a financial penalty for noncompliance.
This bill was voted out of Committee on a divided vote, 7-6, as ONTP-AM
LD 1829: An Act to Reduce Prescription Drug Costs by Requiring Reference based Pricing - Sen Reny
New title from Amendment as of 1/25/2024:
An Act to Direct the Prescription Drug Affordability Board to Assess Strategies to Reduce Prescription Drug Costs and to Take Steps to Implement Reference-based Pricing
This bill requires that a state entity, health plan or participating plan qualified under the federal Employee Retirement Income Security Act of 1974 may not purchase prescription drugs to be dispensed or delivered to a consumer of this State at a cost that exceeds the referenced rate. The referenced rate of a prescription drug is the maximum rate for a drug determined by the Secretary of the United States Department of Health and Human Services under the federal Medicare program. Any savings generated as a result must be used to reduce costs to consumers.
This amendment replaces the bill and makes the following changes to laws governing the Maine Prescription Drug Affordability Board.
1. It adds the Executive Director of the Maine Health Data Organization as an ex officio, nonvoting member.
2. It removes the authority of the board to recommend that public payors pay an assessment to support the administration of the board.
3. It changes the scope of the duties of the board to focus on an assessment of strategies to reduce prescription drug costs, stem the rate of growth in prescription drug spending and reduce cost barriers for consumers.
4. In its next annual report, it requires the board to review how states with authority to establish upper payment limits have implemented that authority and to recommend whether the board should have comparable authority and to include an estimate of savings to the State if the State applies reference pricing to the first 10 prescription drugs for which Medicare will negotiate maximum fair prices through the Medicare Drug Price Negotiation Program established in the federal Inflation Reduction Act,
This bill was voted out of Committee on a divided vote, 9-4, as OTP-AM
LD 1832: An Act to Require Reimbursement of Fees for Treatment Rendered by Public and Private Ambulance Services - Rep Cyrway
This bill requires an ambulance service to be reimbursed for the cost of treating a person, regardless of whether the ambulance service transports the person to a hospital.
This bill was voted out of Committee as OTP-AM
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