An Act To Establish Transparency in Primary Health Care Spending
Maine Legislature, Session 129, LD 1353
Committee: Health Coverage, Insurance and Financial Services
Sponsors: JORGENSEN, CLAXTON, GRATWICK, DUNPHY, HUBBELL, PERRY
Amends: 22 MRSA §8702, 22 MRSA §8718, 24-A MRSA §6903, 24-A MRSA §6951

Legislative Document
No. 1353
S.P. 421
In Senate, March 21, 2019
An Act To Establish Transparency in Primary Health Care 
Spending
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator SANBORN, L. of Cumberland.
Cosponsored by Representative JORGENSEN of Portland and
Senators: CLAXTON of Androscoggin, GRATWICK of Penobscot, SANBORN, H. of 
Cumberland, Representatives: DUNPHY of Old Town, HUBBELL of Bar Harbor, PERRY of 
Calais.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §8702, sub-§8-D is enacted to read:
8-D.  Primary care.  "Primary care" means regular check-ups, wellness and general 
health care provided by a health care practitioner with whom the patient has initial 
contact for a health issue, not including an urgent care or emergency health issue, and by 
whom the patient may be referred to a specialist.
Sec. 2.  22 MRSA §8718 is enacted to read:
§8718.  Primary care data
1.  Report.  An insurer shall report annually to the organization the insurer's total 
primary care expenditures on a date and in a form determined by the organization.  The 
organization shall provide information received under this subsection to the Maine 
Quality Forum for the purposes of Title 24-A, section 6951, subsection 12.  For purposes 
of this section, "insurer" has the same meaning as in Title 24-A, section 4.
2.  Rules.  The organization may adopt rules to carry out the purposes of this section.  
Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A.
Sec. 3.  24-A MRSA §6903, sub-§13-B is enacted to read:
13-B.  Primary care.  "Primary care" means regular check-ups, wellness and general 
health care provided by a provider with whom the patient has initial contact for a health 
issue, not including an urgent care or emergency health issue, and by whom the patient 
may be referred to a specialist.
Sec. 4.  24-A MRSA §6951, sub-§12 is enacted to read:
12.  Primary care reporting.  The forum shall submit an annual report to the 
Department of Health and Human Services and the joint standing committee of the 
Legislature having jurisdiction over health and human services matters that includes:
A.  Of their respective total medical expenditures, the percentage paid for primary 
care by commercial insurers, the MaineCare program, Medicare, the organization that 
administers health insurance for state employees and the Maine Education 
Association benefits trust and the average percentage of total medical expenditures 
paid for primary care across all payers; and
B.  The methods used by commercial insurers, the MaineCare program, Medicare, the 
organization that administers health insurance for state employees and the Maine 
Education Association benefits trust to pay for primary care.
Sec. 5.  Maine Quality Forum to conduct health spending reporting study.  
The Maine Quality Forum, established in the Maine Revised Statutes, Title 24-A, section 
6951, shall consult with other state and national agencies and organizations to determine 
the best practices for reporting spending on primary care services by insurers. For 
purposes of this section, "primary care" means general health care provided by a health 
care provider with whom the patient has initial contact for a health issue and by whom the 
patient may be referred to a specialist. By January 15, 2020, the forum shall submit a 
report containing its findings from the study and any recommended legislation to the 
Department of Health and Human Services and the Joint Standing Committee on Health 
and Human Services.  The committee may report out legislation based upon the report to 
the Second Regular Session of the 129th Legislature.
SUMMARY
This bill requires insurers to report primary care expenditures to the Maine Health 
Data Organization and for the Maine Quality Forum to use this data to report annually to 
the Department of Health and Human Services and the Legislature the percentage of total 
medical expenditures paid for primary care by commercial insurers, the MaineCare 
program, Medicare, the organization that administers health insurance for state employees 
and the Maine Education Association benefits trust respectively, the average of the 
percentage of total medical expenses paid for primary care across all organizations and 
the methods used by these organizations to pay for primary care.  This bill also requires 
the Maine Quality Forum to conduct a study on best practices in health care spending 
reporting and submit its findings to the Department of Health and Human Services and 
the Joint Standing Committee on Health and Human Services.