An Act to Support an Insured Patient's Access to Affordable Health Care with Timely Access to Health Care Prices
Maine Legislature, Session 131, LD 1740
Committee Amendment CA_A_H819 (House)
Amends: 22 MRSA §1718-B, 22 MRSA §1718-C, 22 MRSA §1718-J, 24-A MRSA §4303, 22 MRSA §1718

COMMITTEE AMENDMENT " fj[ " to H,P, 11 19, L,D. 1740, "An Act to Support an
Insured Patient's Access to Affordable Health Care with Timely Access to Health Care
Prices"
Amend the bill by striking out the title and substititing the following;
'An Act to Protect a Patient's Access to Affordable Health Care with Timely Access
to Health Care Prices'
Amend the bill by strikmg out everything after the enacting clause and inserting the
following:
'PART A
Sec. A-l. 22 MRSA §1718-B, sub-§2,1]B, as enacted by PL 2013,c. 515, §2, is
amended to read:
B, A health care entity shall inform patients about the availability of prices for the
most frequently provided health care services and procedures and the right of a patient
to reauest information about the price of medical services pursuant to section 1718-C.
subsection 1 or 2 by posting a notice on prominent display to patients.
Sec. A-2. 22 MRSA §1718-B, sub-§2, ^B-l is enacted to read:
B-L A health care entity shall include notice of a patient's right to request infonnation
about the price of medical services pursuant to section 1718-C. subsection 1 or 2 m any
written document provided to a patient prior to rendering health care treatment for the
purpose of obtainine infonned consent to that treatment.
Sec. A-3. 22 MRSA §1718-C, as enacted by PL 2013,c, 560,§2, is repealed and
the following enacted m its place:
81718-C. Patient reauest for eood faith estimate or other information related to price
of medical services
1. Uninsured or self-pav patient; eoodI faith estimate. Upon the request of an
4 uninsured or self-pav patient, a health care entity, as defined in section 1718-B. subsection
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COMMITTEE AMENDMENT "M-" to H.P. 1119, L.D. 1740
1. paraeraoh B. shall provide to the patient a eood faith estunate of the total price of medical
services to be rendered directly by that health care entity during a single medical encounter
as follows.
A. The health care entity shall provide the good faith estimate within the followme
time frames:
("It When the medical encounter is scheduled at least 3 business days before the
date the medical encounter is scheduled to be furnished or when the patient is
seekine urgent care as defined in Title 24-A. section 43 01-A. subsection 21. the
estimate must be wovided no later than one business day after the date of
scheduling or the date of the request if the patient is seeking urgent care;
(2) When the medical encounter is scheduled at least 10 business days before the
encounter is scheduled to be furnished, the estmiate must be provided no later than
3 business days after the date of scheduling; or
(3) In all other circumstances, the estimate must be provided no lateLthan 3
business days after the date of the request.
B. If the health care entity is unable to provide an accurate estimate of the total price
of a specific medical service because the amount of the medical service to be rendered
during the medicaLencounter is unknown in advance,_the health care entitv shall
provide a brief description of the basis for detennlnine the total price of that particular
medical service,
C, If the single medical encounter will involve medical services to be rendered by one
or more Srd-partv health care entities, the health care entity shall identify each
Srd-partv health care entity to enable the uninsured patient to seek an estimate of the
total_Drice ofmedicaLservicesto be^rendered directly bv each health care entity_to that
patient,
D, A good faith estimate must separately disclose the prices for each component of
medical services. mcluding_any facility fees or fees for .BrofessiQnal services,_and the
current procedural terminology codes used by the American Medical Association for
those services.
E. When providing an estimate as required by this subsection,, the health care entity
shall also notify the uninsured patient of any fmancial assistance riolicv adopted by the
health care entity and the availability of public or private health care coverage^
3 F. Notwithstanding other provisions of this subsection, a health care entity does not
violate this subsection if it provides a good faith estimate to the patient in compliance
5 with federal regulations .
2, Insured patient; description of medical services and current procedural
7 terminoloev codes. Upon the request of an insured patient, a health care entity, as defined
8 in section 1718-B. subsection Ljiaragraph B^shall piavide to the patient adescriBtion of
the medical services to be rendered directly by that health care entity during a smgle
medical encounter and the applicable standard medical codes or current procedural
terminoloev codes used by the American Medical Association for those services as follows,
A. The health care entity shall comply with the request within the following time
frames:
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COMMITTEE AMENDMENT " ^ " to H.P, 1119, L.D.1740
•A'
fl) When the medical encounter is scheduled at least 3 business days before the
date the medical encounter is scheduled to be furnished or when the patient is
seeking urgent care as defined in Title 24-A. section 43 01-A. subsection 21._the
health care entity must respond no later than one businessda.Y after the date of
scheduling or the date of the request if the patient is seeking urgent care;
(2~) When the medical encounter is scheduled at least 10 business days before the
encounter is scheduled to be furnished. the health care entity must respond no later
than 3 busmess days afLerth^ of scheduling; or
(3) In all other circumstances, the health care entity must reseond no later than 3
business days after the_date of the reauest,
B, If the single medical encounter will involve medical services to be rendered by one
or more Srd-partv health care entities, the health care entity shall identify each
Srd-oartv health care entity to enable the patient to seek a description ofthe medical
services to be rendered directly by that Srd-oartv health care entity to that patient and
the applicable standard medical codes or current procedural terminoloev codes used by
the American Medical Association for those services,
C. The health care entity shall also notify the patient that the patient may use the
information provided to request an estunate of the out-of-pocket costs expected tQ_be
paid by the uatient from the patient's health insurancecamer,
D, When providing the information required by this subsectioiL_the health care entity
shall also notify the insured patient of any financial assistance riolicv adopted by the
health care entity and the availability of other public or orivate health msurance
coverage^
E, Notwithstanding this subsection. if federal regulations are implemented that set
forth requirements for health care entities to provide estimates to an insured patient. a
health care entity shall comply with federal regulations and does not commit a violation
of this subsection.
Sec.A-4. 22 MRSA §1718-J is enacted to read:
§1718-J. Prohibition of collection actions for noncompliance with eood faith estimate
requirements for uninsured or self-pav patients
1. Definitions, As used in this section, unlessthe context otherwise indicates, the
2 followmg terms have the following meanings.
A. "Collection action" means any of the following actions:
(1') Attempting to collect a debt from a riatient or patient guarantor by referring the
debt directly or indirectly to a debt collector, collection aeencv or other 3rd party
6 retained by or on behalf of a health care entity;
f2) Suine the patient or patient guarantor or enforcine an arbitration or mediatJQn
clause in any health care entity documents, including contracts. agreements,
9 statements and bills: or
CD Directly or indu-ectly causing a report to be made to a consumer reporting
agency.
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COMMITTEE AMENDMENT "/-I" to H.P. lll9,L.D. 1740
B, "Collection agency" has the same meaning as "debt collector" has in Title 32.
section 11002, subsection 6,
C. "Consumer reportine agency" means any person that. for monetary fees or dues or
on a cooperative nonprofit Jbasis, regulariv engages in whole or m part in the practice
of assembliae or evaluating consumer credit information or other information on
consumers for the purpose of furnishing consumer reports to 3rd parties. "Consumer
reporting agency" includes any person defined in 15 United States Code. Section
1681a("f), "Consumer reoortins asencv" does not include any business entity that
exclusively provides check verification or check guarantee services.
D, "Health care entity" has the same meaninp as m section 1718-B, subsection 1.
paragraBhBi
E. "Items or services" means all items and services. includine individual items and
services and service packages. that are orovided by a health care entity to a patient in
connection with an inoatient admission or an outpatient visit for which the patient is
charged.
F. "Patient guarantor" means the individual held responsible for a patient's bill.
2, Failure to comply with good faith estimate requirements; relief from collection
action^ _Ahealth care entity that has not provided a good faith estimate m material
compliance with section 1718-C, subsection Lonthe^ate that items _OIL services are
Burchased by aj^atient or provided to a patient may not initiate or pursue a collection action
against the patient or patient guarantor for a debt_owed for the items or services. Unless a
health care entity can demonstrate that the health care entity provided a eood faith estimate
to the patient as requested, the_health care entity or hospital may not further pursue a
collection action against the patient or patient suarantor.
Sec. A-5. 24-A MRSA §4303, sub-§21, as enacted by PL 2017, c. 232, §6, is
amended to read;
21. Health care price transparency tools. Beginning January 1, 2018, a carrier
offering a health plan in this State shall comply with the following requirements.
A. A carrier shall develop and make available a website accessible to enrollees and a
0 toll-free telephone number that enable enrollees to obtain information on the estimated
costs for obtaining a comparable health care service, as defmed in Title 24-A, section
4318-A, subsection 1, paragraph A, from network providers, as well as quality data for
those providers, to the extent available. A carrier may comply with the requirements
of this paragraph by directing enrollees to the publicly accessible health care costs
5 website of the Maine Health Data Organization,
B. A carrier shall make available to the enrollee through a toll-free telephone number
the ability to obtain an estimated cost of a scheduled health care service or a comparable
health care service that is based on a description of the service or the applicable
standard medical codes or current procedural terminology codes used by the American
Medical Association provided to the enrollee by the provider, Upon an enrollee's
request, the carrier shall request additional or clarifying code mformation, if needed,
from the provider involved with the scheduled health care service or comparable health
care service. If the carrier obtains specific code information from the enrollee or the
enrollee's provider, the carrier shall provide the anticipated charge allowed amount and
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f\-
ROS COMMITTEE AMENDMENT "/^ " to H,P.1119, L.D,1740
the enrollee s anticipated out-of-pocket costs based on that code information, to the
extent such mformation is made available to the carrier by the provider,
Notwithstanding other provisions of this paraeraoh. a carrier does not commit a
violation of this paragraph if the carrier complies with federal regulations for price
transparency relating to an estimate of an enrollee's cost-sharing responsibility.
C. A carrier shall notify an enrollee that the amounts are estimates based on
information available to the carrier at the time the request is made and that the amount
the enrollee will be responsible to pay may vary due to unforeseen circumstances that
arise out of the proposed scheduled health care service or comparable health care
service, This subsection does not prohibit a carrier from imposing cost-sharing
requirements disclosed in the enrollee's certificate of coverage for unforeseen health
care services that arise out of the proposed scheduled health care service or comparable
health care service or for a procedure or service that was not included in the original
estimate. This subsection does not preclude an enrollee from contacting the carrier to
obtain more information about a particular admission, procedure or service with respect
to a particular provider.
D. Notwithstanding the provioions of this subsection and at the request of a carrier, the
superintendent may grant an additional year to comply with the provisionQ of thia
subsection as long aii the carrier hao demonstrated a good faith effort to comply with
the provisions of this subseotion and has providod tho superintendent with an action
plan detailing the steps to be taken by the carrier to comply with this subsection no
later than January 1, 2019,
PART B
Sec.B-1. 22 MRSA §1718-1 is enacted to read:
§1718-1. Hospital price transparency
1. Compliance with federal reeulations. A hospital must comply with the price
transparency requirements established in 45 Code of Federal Regulations. Part 180,
8 Subparts A and B. as in effect on January 1. 2024.
2. Standard format; rules. A hospital must provide priceJransparencv data in a
standardized format established inrulebv the Maine Health Data Organization. The Maine
Health Data Organization shall adopt by rule a standardized formatfor& hospital to disclose
2 price transparency data that is the same or substantially simila- to anv format reauired bv
federal regulations. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5. chapter 375. subchapter 2-A.
3. Failure to comply. A hospital that fails to comolv with subsection 2 or any rule
adopted by the Maine Health Date_ Organization may be subject to a fine for failure to
comply under section 8705-A, Notwithstandmg any Drovision of law to the contrary, the
8 Maine Health Data Oreanization shall retain anyjine collectedfrom a hospital for a failure
to comply with this section pursuant to a compliance action taken under section 8705-A,
4^ Determination of material compliance; notice. Upon a determination that a
hospital is not in material comuliance with subsections 1 and 2. the Maine Health Data
Oreanization shall notify the hospital that the hospital is not in material compliance and
reauire the hospital to take correctiYe action within 60 days to become materially
compliant. The Maine Health Data Organization shall adopt by rule standards for material
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ROS COMMITTEE AMENDMENT",
COMMITTEE AMENDMENT " /-+" to H.P. 1119, L.D. 1740
compliance that align with federal regulations, Rules adopted pursuant to this subsection
are routine techmcalrules as described in Title_5, chapterj75, subchaoter 2-A.'
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
number to read consecutively.
SUMMARY
This amendment is the minority report of the committee and replaces the bill.
Part A incorporates some of the components of the bill and does the following.
Upon request of an uninsured or self-pay patient, it requires health care entities to
provide a good faith estimate of the cost of medical services to be rendered directly by that
health care entity during a single medical encounter. It requires the information to be
provided within the following time frames:
1, When a medical encounter is scheduled at least 3 business days before the date the
medical encounter is scheduled to be furnished or when a patient is seeking urgent care,
the estimate must be provided no later than one business day after the date of scheduling
or the date of the request;
2. When a medical encounter is scheduled at least 10 business days before the
encounter is scheduled to be furnished, the estimate must be provided no later than 3
business days after the date of scheduling; or
3. In all other circumstances, the estimate must be provided no later than 3 business
days after the date of the request.
It requires the health care entity to separately disclose the prices for each component
of medical services, including any facility fees or fees for professional services, and the
procedure codes for those services. It requires health care entities to post notice on
prominent display of a patient's right to request this information and include the notice in
a patient's written consent to treatment form that must be signed prior to receiving health
care treatment or services.
For insured patients, it requires health care entities to provide a description of the
medical services to be rendered during a single medical encounter and the applicable
standard medical codes or current procedural terminology codes used by the American
0 Medical Association for those services and to notify the patient that the infonnation can be
used to obtain an estimate of the patient's out-of-pocket costs from the patient's health
insurance carrier. It requires health insurance carriers to respond to requests from a patient
for an estimate of out-of-pocket costs based on the description of the medical services and
the codes provided by the patient's health care entity,
It prohibits a health care entity from initiating or pursuing any collection action against
an uninsured or self-pay patient for items or services provided on a date the health care
7 entity has provided those items or services to a patient unless the health care entity provided
a good faith estimate to a patient that requested an estimate. The prohibition on collection
9 action does not extend to insured patients.
Part B incorporates some of the components of L.D, 953, "An Act to Protect Maine
Patients Regarding Hospital Price Transparency." Part B does the following.
COMMITTEE AMENDMENT
COMMITTEE AMENDMENT "M" to H,P. 1H9,L.D. 1740
'"M"1
1. It requires that hospitals comply with the price transparency requirements
established in 45 Code of Federal Regulations, Part 180, Subparts A and B as in effect on
January 1, 2024,
2. It requires a hospital to provide price transparency data in a standardized format as
established by rule by the Maine Health Data Organization.
3. It provides that a hospital that fails to comply with the price transparency
requirements established by the Maine Health Data Organization may be subject to a fme
for noncompliance,
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