An Act Governing Direct Primary Care Membership Agreements
Maine Legislature, Session 128, LD 1385
Committee: Health and Human Services
Sponsors: WHITTEMORE, PICKETT, DOW, KATZ, LANGLEY, ROSEN, CRAIG, PICCHIOTTI, PRESCOTT, WALLACE

Legislative Document
No. 1385
S.P. 472
In Senate, April 11, 2017
An Act Governing Direct Primary Care Membership Agreements
Reference to the Committee on Health and Human Services suggested and ordered printed.
HEATHER J.R. PRIEST
Secretary of the Senate
Presented by Senator WHITTEMORE of Somerset.
Cosponsored by Representative PICKETT of Dixfield and
Senators: DOW of Lincoln, KATZ of Kennebec, LANGLEY of Hancock, ROSEN of 
Hancock, Representatives: CRAIG of Brewer, PICCHIOTTI of Fairfield, PRESCOTT of 
Waterboro, WALLACE of Dexter.
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA c. 403-A is enacted to read: 
CHAPTER 403-A 
HEALTH CARE EMPOWERMENT ACT 
§1771.  Care outside of insurance plan 
1.  Short title.  This chapter may be known and cited as "the Health Care 
Empowerment Act." 
2.  Care outside of plan.  Nothing in state law may be construed as prohibiting a 
patient or legal representative of a patient from seeking care outside of an insurance plan 
or outside of the Medicaid or Medicare program and paying for such care. 
3.  Acceptance of payment.  Nothing in state law may be construed as prohibiting a 
physician, other medical professional or a medical facility from accepting payment for 
services or medical products outside of an insurance plan. 
Nothing in state law may be construed as prohibiting a physician, other medical 
professional or a medical facility from accepting payment for services or medical 
products provided to a Medicaid or Medicare beneficiary, as long as the physician, 
medical professional or medical facility has opted out of the Medicare program.  As used 
in this section, "medical products" includes, but is not limited to, prescription drugs and 
pharmaceuticals. 
4.  Benefits not forfeited.  A patient or legal representative of a patient does not 
forfeit insurance benefits, Medicaid benefits or Medicare benefits by purchasing medical 
services or medical products outside of an insurance plan or the Medicaid or Medicare 
program. 
5.  Not offer of insurance.  The offer and provision of medical services or medical 
products purchased and provided under this Act may not be considered an offer of 
insurance and are not governed by the insurance laws of this State. 
§1772.  Direct primary care membership agreements 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Direct primary care membership agreement" means a contractual agreement 
between a direct primary care provider and an individual patient, or the patient's legal 
representative, in which: 
(1)  The direct primary care provider agrees to provide primary care services to 
the individual patient for an agreed-to fee over an agreed-to period of time; 
(2)  The direct primary care provider agrees not to bill 3rd parties on a fee-for-
service basis; and 
(3)  Any per-visit charges under the agreement are less than the monthly 
equivalent of the periodic fee. 
B.  "Direct primary care provider" means an individual or legal entity licensed, 
registered or otherwise authorized to provide primary care services in this State that 
enters into a direct primary care membership agreement.  The term includes, but is 
not limited to, an individual primary care provider or other legal entity alone or with 
others professionally associated with the individual or other legal entity. 
2.  Not insurance.  A direct primary care membership agreement is not insurance and 
is not subject to regulation by the Department of Professional and Financial Regulation, 
Bureau of Insurance. 
3.  Not subject to Maine Insurance Code.  Entering into a direct primary care 
membership agreement is not the business of insurance and is not subject to the Maine 
Insurance Code or rules adopted pursuant to the Maine Insurance Code. 
4.  License not required.  A direct primary care provider or the agent of a direct 
primary care provider is not required to obtain a certification of authority or license under 
Title 24 or the Maine Insurance Code to market, sell or offer to sell a direct primary care 
membership agreement. 
5.  Not a medical discount plan.  A direct primary care membership agreement is 
not a medical discount plan, and a direct primary care provider is not required to register 
as a medical discount plan. 
6.  Termination.  A direct primary care membership agreement must: 
A.  Allow either party to terminate the agreement upon written or electronic notice to 
the other party.  Either party may require up to 90 days' advance notice prior to 
cancellation; and 
B.  Provide that, upon termination of the agreement by an individual patient, all 
unearned fees must be returned to the patient, minus predetermined administrative 
fees, if any, as specified in the agreement. 
SUMMARY 
This bill provides that nothing in state law may be construed as prohibiting a patient 
or legal representative of a patient from seeking care outside of an insurance plan or 
outside of the Medicaid or Medicare program and paying for such care.  It also provides 
that nothing in state law may be construed as prohibiting a physician, other medical 
professional or a medical facility from accepting payment for services or medical 
products outside of an insurance plan.  It provides that a direct primary care membership 
agreement not insurance and is not subject to regulation by the Department of 
Professional and Financial Regulation, Bureau of Insurance.  A direct primary care 
membership agreement is defined as a contract between a direct primary care provider 
and an individual patient or legal representative of a patient in which the provider agrees 
to provide primary care services to the individual patient for an agreed-to fee over an 
agreed-to period of time, the provider agrees not to bill 3rd parties on a fee-for-service 
basis and any per-visit charges under the agreement are less than the monthly equivalent 
of the provider fee.