An Act to Address Anticompetitive Terms in Health Insurance Carrier and Health Care Provider Contracts
Maine Legislature, Session 131, LD 1708
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MORRIS
Amends: 22 MRSA §1728, 24-A MRSA §4308-A

Legislative Document
No. 1708
H.P. 1097
House of Representatives, April 18, 2023
An Act to Address Anticompetitive Terms in Health Insurance 
Carrier and Health Care Provider Contracts
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MORRIS of Turner.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §1728 is enacted to read:
§1728.  Health care provider contract requirements
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "All-or-nothing clause" means a provision in a contract that:
(1)  Requires a carrier to include all members of a provider in a network plan;
(2)  Requires a carrier to enter into any additional contract with any or all affiliates 
of a provider as a condition to entering into a contract with that provider; or
(3)  Requires a carrier to agree to payment rates or other terms for an affiliate or 
individual facility that is not party to the contract.
B.  "Anti-steering clause" means a provision in a contract that restricts the ability of a 
carrier to direct or steer an enrollee to obtain a health care service from another 
provider, including offering incentives to encourage enrollees to use specific providers.
C.  "Anti-tiering clause" means a provision in a contract that:
(1)  Restricts the ability of a carrier to introduce or modify a tiered network plan or 
assign providers into tiers; 
(2)  Requires a carrier or health plan administrator to place all members of a 
provider in the same tier of a tiered network plan; or
(3)  Restricts the ability of a carrier to introduce or assign providers to a particular 
network.
D.  "Carrier" has the same meaning as in Title 24-A, section 4301-A, subsection 3.
E.  "Enrollee" has the same meaning as in Title 24-A, section 4301-A, subsection 5.
F.  "Excessively concentrated market" means a market in which the provider has a 
Herfindahl-Hirschman index of 2,500 or more.
G.  "Health plan" has the same meaning as in Title 24-A, section 4301-A, subsection 
7.
H.  "Provider" has the same meaning as in Title 24-A, section 4301-A, subsection 16.
2.  Contract requirements.  Beginning January 1, 2024, a provider, or a person acting 
on the provider’s behalf, may not offer, solicit, request, amend, renew or enter into a 
contract with a carrier that would directly or indirectly include any of the following 
provisions:
A.  An anti-steering clause;
B.  An anti-tiering clause; or
C.  An all-or-nothing clause.
3.  Termination of contracts; notice.  A provider may not terminate a contract with a 
carrier prior to the date on which the contract ends unless the provider provides prior notice 
to the Attorney General and the Superintendent of Insurance. The Attorney General may 
intervene to prevent termination of the contract if the Attorney General finds the 
termination would result in any of the following:
A.  The health care market would be excessively concentrated in the county in which 
the provider is located;
B.  Fewer than 2 of that type of provider in a county or a net loss of more than 5 primary 
care providers in a county; or 
C.  A material adverse impact on health care costs.
4.  Unenforceable.  A person may not enforce any contract provision, written policy, 
written procedure or agreement contrary to the provisions set forth in this section.
5.  Enforcement. The following provisions apply.
A.  A carrier may institute a civil action against a provider to enforce the provisions of 
subsection 2, including specific performance, injunctive or declaratory relief, and any 
other relief the court deems appropriate.
B.  The Attorney General may:
(1)  Subpoena any records necessary to enforce this section or to investigate 
suspected violations of this section;
(2)  Institute proceedings on behalf of the State or as parens patriae of the persons 
residing in this State for:
(a)  Injunctive relief to prevent and restrain a violation of this section, 
including, but not limited to, a temporary restraining order, preliminary 
injunction or permanent injunction;
(b)  Civil penalties for violations of this section; or
(c)  Other equitable relief for violations of this section, including, but not 
limited to, disgorgement or restitution.
Sec. 2.  24-A MRSA §4308-A is enacted to read:
§4308-A.  Health care provider contract requirements
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "All-or-nothing clause" means a provision in a contract that:
(1)  Requires a carrier to include all members of a provider in a network plan;
(2)  Requires a carrier to enter into any additional contract with any or all affiliates 
of a provider as a condition to entering into a contract with that provider; or
(3)  Requires a carrier to agree to payment rates or other terms for an affiliate or 
individual facility that is not party to the contract.
B.  "Anti-steering clause" means a provision in a contract that restricts the ability of a 
carrier to direct or steer an enrollee to obtain a health care service from another 
provider, including offering incentives to encourage enrollees to use specific providers.
C.  "Anti-tiering clause" means a provision in a contract that:
(1)  Restricts the ability of a carrier to introduce or modify a tiered network plan or 
assign providers into tiers; 
(2)  Requires a carrier to place all members of a provider in the same tier of a tiered 
network plan; or
(3)  Restricts the ability of a carrier to introduce or assign providers to a particular 
network.
2.  Contract requirements.  Beginning January 1, 2024, a carrier, or a person acting 
on the carrier's behalf, may not offer, solicit, request, amend, renew or enter into a contract 
with a provider that would directly or indirectly include any of the following provisions:
A.  An anti-steering clause;
B.  An anti-tiering clause; or
C.  An all-or-nothing clause.
3.  Termination of contracts; notice.  A provider may not terminate a contract with a 
carrier prior to the date on which the contract ends unless the provider provides prior notice 
to the Attorney General and the Superintendent of Insurance. The Attorney General may 
intervene to prevent termination of the contract if the Attorney General finds the 
termination would result in any of the following:
A.  The health care market would be excessively concentrated in the county in which 
the provider is located;
B.  Fewer than 2 of that type of provider in a county or a net loss of more than 5 primary 
care providers in a county; or
C.  A material adverse impact on health care costs. 
4.  Unenforceable.  A person may not enforce any contract provision, written policy, 
written procedure or agreement contrary to the provisions set forth in this section.
5.  Enforcement.  A carrier may institute a civil action to enforce the provisions of this 
section, including specific performance, injunctive or declaratory relief, and any other 
relief the court deems appropriate.
SUMMARY
Beginning January 1, 2024, this bill prohibits contractual agreements between health 
insurance carriers and health care providers that include provisions restricting the ability of 
a health insurance carrier to encourage enrollees to use specific health care providers, to 
use tiering as part of a carrier’s provider network or to require the inclusion of all members 
or affiliates of a health care provider in a carrier’s network.