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Bill > LD1785
ME LD1785
An Act to Encourage Competition by Requiring Independent Health Care Provider Cost-of-living Adjustments in Health Insurance Contracts
summary
Introduced
04/24/2025
04/24/2025
In Committee
04/24/2025
04/24/2025
Crossed Over
Passed
Dead
Introduced Session
132nd Legislature
Bill Summary
This bill requires that, for health insurance plans issued or renewed on or after January 1, 2026, compensation provisions in a contract between an individual practice that is not affiliated with a hospital or a group practice up to 25 members that is not affiliated with a hospital and a health insurance carrier to provide health care services to enrollees of a health insurance plan must include an increase in compensation for health care services from the prior year that reflects increases in the Consumer Price Index for All Urban Consumers, CPI-U, over the previous year, as compiled by the United States Department of Labor, Bureau of Labor Statistics. This bill prohibits a health insurance carrier offering a health insurance plan from altering contractual reimbursement to an individual practice that is not affiliated with a hospital or a group practice up to 25 members that is not affiliated with a hospital during 2025 to reduce the baseline reimbursement for the purpose of reducing the required compensation increase. The bill also prohibits a health insurance carrier from reducing fees for services covered under a contract with an individual practice that is not affiliated with a hospital or a group practice up to 25 members that is not affiliated with a hospital for any reason other than to reflect changes to the national relative value unit standards determined by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services.
AI Summary
This bill requires health insurance carriers to provide annual cost-of-living adjustments for small, independent healthcare practices not affiliated with hospitals, starting in 2026. Specifically, these practices (defined as individual practices or group practices with up to 25 members) will receive compensation increases that match the Consumer Price Index for All Urban Consumers (CPI-U), which measures changes in the prices paid by urban consumers for goods and services. The bill prohibits insurance carriers from reducing fees for services except when national relative value unit standards change, and prevents carriers from manipulating baseline reimbursement rates in 2025 to minimize future required increases. Importantly, the bill does not mandate that practices must accept these contract terms, but it does prohibit carriers from discriminating against or excluding independent practices to avoid implementing the compensation adjustments. The provisions apply to health insurance plans but explicitly exclude dental and vision plans, aiming to support smaller, independent healthcare providers by ensuring their reimbursement rates keep pace with inflation.
Committee Categories
Health and Social Services
Sponsors (3)
Last Action
Voted: OTP-AM (on 05/21/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://legislature.maine.gov/legis/bills/display_ps.asp?LD=1785&snum=132 |
| BillText | https://legislature.maine.gov/legis/bills/getPDF.asp?paper=HP1196&item=1&snum=132 |
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