Bill > LD1906

This bill aims to improve transparency and accountability in insurance transactions, specifically focusing on health coverage and prescription drug data. It establishes new rights for plan sponsors (organizations that provide health coverage to employees) to access and audit claims data from administrators and pharmacy benefits managers. Under the bill, these entities must provide detailed claims information within 30 business days when requested, including itemized billing statements, medical records, claims transactions, payment details, and various fees associated with healthcare services. For high-cost claims exceeding $100,000, sponsors can request data within two business days. The bill allows plan sponsors to conduct post-payment audits at least once per calendar year, with restrictions on the administrators' ability to impose excessive fees or limit the audit's scope. Administrators and pharmacy benefits managers are required to comply with federal healthcare privacy laws like HIPAA and can only require a nondisclosure agreement that reasonably restricts data use to audit purposes. Any violations will be exclusively enforced under the Maine Unfair Trade Practices Act, and the provisions will apply to new or renewed contracts starting January 1, 2026. The goal is to provide plan sponsors with more transparency and control over healthcare-related financial transactions.

Health and Social Services

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