Bill > LD1906

This bill requires administrators and pharmacy benefits managers (PBMs) who provide health or prescription drug coverage to give plan sponsors more transparency and control over claims data. Specifically, the bill establishes that plan sponsors own the claims data related to their health coverage contracts and can request detailed claims information from administrators and PBMs within 20 business days. Plan sponsors are granted the right to conduct a post-payment audit at least once per calendar year, with restrictions on auditing frequency (no more than once every 6 months). The bill mandates that administrators and PBMs must provide comprehensive data, including electronic claims transactions, payment details, fees, out-of-network charges, and medical records. Importantly, the bill prohibits these entities from charging excessive audit fees or imposing conditions that would unreasonably limit a plan sponsor's ability to audit claims. The provisions are designed to ensure compliance with existing federal health privacy regulations (HIPAA) and will apply to any health coverage contracts entered into, issued, amended, or renewed on or after January 1, 2026. The goal is to increase transparency, accountability, and understanding of insurance and prescription drug transactions for plan sponsors.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=1906&snum=132