An Act Regarding Health Care in the State
Maine Legislature, Session 131, LD 0227
Committee Amendment CA_A_H953 (House)
Amends: 14 MRSA §402, 14 MRSA §403, 15 MRSA §203, 16 MRSA §642, 5 MRSA §90-B, 10 MRSA §8012, 24 MRSA §2513, 24-A MRSA §2159-F, 24-A MRSA §4301-A, 24-A MRSA §4303, 22 MRSA §1711-C

COMMITTEE AMENDMENT "A,, to H.P. 148, L.D. 227, "An Act Regarding 
Health Care in the State
' 
Amend the bill by striking out the title and substituting the following: 
'An Act Regarding Legally Protected Health Care Activity in the State' 
Amend the bill by striking out everything after the enacting clause and insetting the 
following: 
'PART A 
Sec. A-1. 14 MRSA c. 763 is enacted to read: 
CHAPTER 763 
LEGALLY PROTECTED HEALTH CARE ACTIVITY 
§9001. Legislative findings and declaration of policy 
The Legislature finds and declares that: 
1. Legal right to gender-affirming health care services and reproductive health 
care services. Access to gender-affirming health care services and reproductive health care 
services in this State, as authorized under the laws of this State, is a legal right; 
2. Interference with legally protected health care activity against public policy. 
Whether or not under the color of law, interference with legally protected health care 
activity and interference with aiding and assisting legally protected health care activity is 
against the public policy of this State; and 
3. Public acts in other states. Any public act of another state that prohibits, 
criminalizes, sanctions, authorizes a person to bring a civil action against or otherwise 
interferes with a person in this State who e11gages in legJilly proteCt<iid health care activity 
or who aids and assists legally protected health care adtivity: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A• to H.P. 148, L.D. 227 
A. Interferes with the exercise and enjoyment of the rights secured by this State; and 
B. Is against the public policy of this State. 
§9002. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Aid and assist legally protected health care activity. "Aid and assist legally 
protected health care activity" and "aiding and assisting legally protected health care 
activity" mean: 
A. Any act or omission of a person aiding or effectuating or attempting to aid or 
effectuate any other person in legally protected health care activity; or 
B. The provision or administration of, or attempted provision or administration of, 
insurance coverage for gender-affirming health care services or reproductive health 
care services to a beneficiaty or a dependent of a beneficiary by any insurer, payor or 
employer. 
"Aiding and assisting legally protected health care activity" does not include any conduct 
that deviates from the applicable standard of care or that could form the basis of a civil. 
criminal or administrative action under the laws of this State had the course of conduct that 
forms the basis for liability occuned entirely within this State. 
2. Aggrieved person, "Aggrieved person" means: 
A. A person against whom hostile litigation is filed or prosecuted or the legal 
representative of a person against whom hostile litigation is filed or prosecuted; 
B, The employer of a person against whom hostile litigation is filed or prosecuted if 
the legally protected health care activity or aiding and assisting legally protected health 
care activity of the person that forms the basis of the hostile litigation was perfonned 
within the scope of the person's employment; or 
C, A person in this State upon whom a subpoena seeking information concerning 
legally protected health care activity or aiding and assisting legally protected health 
care activity is served by any federal or state comt in connection with hostile litigation. 
3, Foreign judgment. "Foreign judgment" means any judgment, decree or order of a 
court of another state. 
4. Gender-affirming health care services. 
11Gender-affi11ning health care services" 
means all supplies, care and services of a medical, behavioral health, mental health. 
surgical, psychiatric, therapeutic, diagnostic, preventive, rehabilitative or suppo1tive 
nature, including medication, relating to the treatment of gender dysphoria and gender 
incongruence in accordance with the accepted standard of care as defined by major medical 
professional organizations and agencies with expe1tise in the field of gender-affinning 
health care, including the Standards of Care for the Health of Transgender and Gender 
Diverse People, Version 8, or subsequent version, published by the World Professional 
Association for Transgender Health. "Gender-affirming health care services" does not 
include conversion therapy as defined in Title 32, section 59-C, subsection 1. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT «A" to H.P. 148, L.D. 227 
5. Health care practitioner. ''Health care practitioner" has the same meaning as in 
Title 24, section 2502, subsection 1-A, except that "health care practitioner" does not 
include a veterinarian, "Health care practitioner" also includes persons licensed under: 
A. Title 32, chapter 18; 
B. Title 32. chapter 32; 
C, Title 32, chapter 83; 
D. Title 32, chapter 117; and 
E. Title 32, chapter 119. 
6. Hostile litigation. "Hostile litigation" means any litigation or other legal action, 
including civil, criminal or administrative action, to deter, prevent. sanction or punish any 
health care practitioner or person assisting a health care practitioner who provides legally 
protected health care activity or aids and assists legally protected health care activity by: 
A. Filing or prosecuting any litigation or other legal action in any other state where 
liability, in whole or in pait, directly or indirectly. is based on legally protected health 
care activity or aiding and assisting legally protected health care activity that occurred 
in this State, including any action in which liability is based on any theo1y of vicarious. 
joint or several liability; or 
B. Attempting to enforce any order or judgment issued in connection with any litigation 
or other legal action under paragraph A by any party to the action or by any person 
acting on behalf of any party to the action. 
For purposes of this chapter, litigation or other legal action is based on legally protected 
health care activity or aiding and assisting legally protected health care activity that 
occurred in this State if any patt of any act or omission involved in the course of conduct 
that forms the basis for liability in the action occurs or is initiated in this State, whether or 
not the act or omission is alleged or included in any pleading or other filing in the lawsuit. 
7. Law enforcement agency, 
"Law enforcement agency" means any court, 
depaitment or agency of this State, a political subdivision of this State or a college or a 
university in this State charged with the enforcement of laws or the custody of detained 
persons. "Law enforcement agency" includes the Depaitment of the Attorney General and 
district attorneys' offices. 
8. Legally protected health care activity, "Legally protected health care activity" 
means: 
A. The exercise and enjoyment or attempted exercise and enjoyment by any person of 
the right secured by this State to gender-affirming health care services or reproductive 
5 
health care services; and 
B. The provision or attempted provision of gender-affirming health care services or 
7 
reproductive health cai·e services that are authorized under the laws of this State and 
8 
that are provided in accordance with the applicable standard of care by a health care 
practitioner licensed under the laws of this State and physically present in this State. 
regardless of whether the patient is located in this State or whether the health care 
practitioner is licensed in the state where the patient is located at the time the services 
are rendered. 
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COMMITTEE AMENDMENT "A" to H.P. 148, L.D. 227 
"Legally prntected health care activity" does not include any conduct that could form the 
basis of a civil, criminal or administrative action under the laws of this State had the course 
of conduct that forms the basis for liability occurred entirely within this State. 
9. Reproductive health care services. ''Reproductive health care services" means all 
supplies, care and services of a medical, behavioral health, mental health, surgical, 
psychiatric, therapeutic, diagnostic, preventive, rehabilitative or suppottive nature, 
including medication, relating to pregnancy, contraception, assisted reproduction, 
pregnancy loss management or the termination of a pregnancy in accordance with the 
applicable standard of care as defined by major medical professional organizations and 
agencies with expe1tise in the field of reproductive health care. 
10. State. "State" means a state of the United States, the District of Columbia, Pue1to 
Rico, the United States Virgin Islands or any territo1y or insular possession subject to the 
jurisdiction of the United States. 
§9003. Tortious interference with legally protected health care activity 
1. Civil action. An aggrieved person may bring a civil action for damages, punitive 
damages, equitable relief, injunctive relief or any other appropriate relief against another 
person that, whether or not acting under color of law, files or prosecutes hostile litigation. 
For purposes of this subsection, "damages" may include the amount of any judgment issued 
in connection with the hostile litigation as well as all other expenses, costs and reasonable 
attorney's fees incurred in connection with the hostile litigation. 
2. Attorney's fees and costs. An aggrieved person that prevails in an action brought 
under this section is entitled to an award of attorney's fees and costs. 
3. Exception. An aggrieved person may not bring an action under this section if the 
hostile litigation is based on conduct for which a civil, criminal or administrative action 
would exist under the laws of this State if the conduct or course of conduct that forms the 
basis for liability in the hostile litigation had occurred entirely within this State. 
§9004, Foreign judgments issued in connection with hostile litigation 
1. Jurisdiction and due process required. A comt of this State may not give any 
force or effect to any foreign judgment in connection with hostile litigation if the comtthat 
issued the foreign judgment did not: 
A. Have personal jurisdiction over the defendant; 
B. Have jurisdiction over the subject matter; or 
C. Provide due process of law. 
2. Limitations period, Notwithstanding any provision of law to the contra1y, an action 
on a foreign judgment in connection with hostile litigation must be commenced by filing a 
new and independent action on the judgment within 5 years of the foreign judgment. 
§9005. Testimony and documents in connection with hostile litigation 
1. Court order. Notwithstanding any provision of state law or comt rule to the 
contrary and except as required by federal law, a coutt of this State may not order a person 
who is domiciled or found within this State to give testimony or a statement or produce 
documents or other information in any proceeding involving hostile litigation. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT •A" to H.P. 148, L,D, 227 
2. Subpoena, An aggrieved person may move to modify or quash any subpoena issued 
in connection with hostile litigation on any grounds provided by law or court rnle or on the 
ground that the subpoena is inconsistent with the public policy of this State as provided in 
section 9001. 
3, Summons. Except as required by federal law, a court in this State may not issue a 
summons or warrant in a case involving criminal prosecution or a pending grand jury 
investigation under the criminal laws of another state for engaging in legally protected 
health care activity or aiding and assisting legally protected health care activity unless the 
conduct forming the basis of the prosecution or grand jury investigation would also 
constitute a criminal offense if the conduct occurred entirely within this State. 
§9006. Prohibition on expenditure of public resources; noncooperation 
1. Prohibition on expenditure of public resources, Notwithstanding any provision 
of state law to the contra1y and except as required by federal law, a public agency, including 
a law enforcement agency, and an employee, appointee, officer or official or any other 
person acting on behalf of a public agency may not knowingly provide any information or 
expend or use time, money, facilities, prope1ty, equipment, personnel or other resources in 
fmtherance of any interstate investigation or proceeding seeking to impose civil, 
administrative or criminal liability upon a person or entity for: 
A. Legally protected health care activity: or 
B. Aiding and assisting legally protected health care activity. 
2. Noncooperation, Notwithstanding any provision of state law to the contrary and 
except as required by federal law, an officer or employee of a law enforcement agency, 
while acting under color of law, may not lmowingly provide information or assistance to a 
federal law enforcement agency, to any law enforcement agency in another state or political 
subdivision of another state or to any private citizen in relation to an investigation or inquiiy 
into services constituting legally protected health care activity or aiding and assisting 
legally protected health care activity. 
3, No arrest. Notwithstanding any provision of state law to the contraiy and except as 
required by federal law, arrest of a person in this State is prohibited if the arrest is related 
to criminal liability that is based on legally protected health care activity or aiding and 
assisting legally protected health care activity. 
4. Exceptions, This section does not apply to a public agency, including a law 
enforcement agency, or an employee, appointee, officer or official or any other person 
acting on behalf of a public agency: 
A. When responding to a warrant or extradition demand on the good faith belief that 
the warrant or demand is valid in this State: or 
B. When exigent circumstances make compliance with this section impossible. For the 
purposes of this paragraph, "exigent circumstances" means circumstances in which 
there is insufficient time to comply with this section and there is a compelling need for 
action due to the presence of an imminent danger to public safety. 
§9007. Choice of law 
Notwithstanding any general or special law or common law conflict of law rule to the 
contrary, the laws of this State govern in any case or controversy heard in this State 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 148, L,D. 227 
involving legally protected health care activity or aiding and assisting legally protected 
health care activity, 
PARTB 
Sec. B-1. 14 MRSA §402, sub-§2-A is enacted to read: 
2-A. Aiding and assisting legally protected health care activity. "Aiding and 
assisting legally protected health care activity" has the same meaning as in section 9002, 
subsection 1. 
Sec. B-2. 14 MRSA §402, sub-§2-B is enacted to read: 
2-B. Legally protected health care activity. "Legally protected health care activity" 
has the same meaning as in section 9002, subsection 8. 
Sec. B-3. 14 MRSA §403, sub-§1-A is enacted to read: 
1-A. Attestation. A request for issuance of a subpoena under this section must be 
accompanied by an affidavit stating whether the foreign subpoena seeks documents, 
infonnation, inspection or testimony related to the provision or receipt of or attempted 
provision or receipt of legally protected health care activity or aiding and assisting legally 
protected health care activity. The comi shall provide a form for the completion of the 
affidavit. The form must contain a statement informing the affiant that making a false 
statement on the affidavit may be punishable as the crime of false swearing under the laws 
of this State. 
Sec. B-4. 14 MRSA §403, sub-§2, as enacted by PL 2019, c. 109, §1, is amended 
to read: 
2. Submission of foreign subpoena. Whett Except as provided in subsection 4, when 
a pa1iy submits a foreign subpoena to a clerk of court in the State, the clerk, in accordance 
with that court's procedure, shall promptly issue a subpoena for service upon the person to 
which the foreign subpoena is directed. 
Sec. B-5. 14 MRSA §403, sub-§4 is enacted to read: 
4. Prohibition, A clerk of comi in this State may not issue a subpoena under 
subsection 2 and must present the request to the comi if the attestation submitted under 
subsection 1-A indicates that the foreign subpoena seeks documents, information, 
inspection or testimony related to the provision or receipt of or attempted provision or 
receipt of legally protected health care activity or aiding and assisting legally protected 
health care activity. After reviewing the request and attestation, if the court finds that the 
foreign subpoena seeks documents, information, inspection or testimony related to the 
provision or receipt of or attempted provision or receipt of legally protected health care 
activity or aiding and assisting legally protected health care activity, the court shall deny 
the request for issuance of a subpoena and quash any subpoena previously issued by the 
comi in connection with the request unless the comi finds that the foreign subpoena seeks 
documents, information, inspection or testimony related to: 
A. An action in a foreign jurisdiction founded in t01i, contract or statute brought by 
the person who sought or received legally protected health care activity, or the person's 
legal representative, for damages suffered by the person or damages derived from an 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT •A "to H.P. 148, L.D. 227 
individual's loss of cons01tium of the person if a similar claim would exist under the 
laws of this State; 
B. An action in a foreign jurisdiction founded in contract that is brought by a person 
with a contractual relationship to the individual whose documents or information are 
the subject of the subpoena if a similar action would exist under the laws of this State; 
or 
C, An action in a foreign jurisdiction that is brought by a parent involving litigation 
between parents over custody of a minor child of the parents if the custody dispute 
involves legally protected health care activity or aiding and assisting legally protected 
health care activity for the minor child. 
If the comt finds that the foreign subpoena seeks documents, information, inspection or 
testimony as provided in paragraph A, B or C, the comt shall direct the clerk to issue the 
subpoena. 
PART C 
Sec. C-1. 15 MRSA §203, sub-§5 is enacted to read: 
5. Exception; legally protected health care activity. Notwithstanding any provision 
of state law to the contrary and except as required by federal law, the Governor may not 
surrender a person charged in another state as a result of the person's engaging in legally 
protected health care activity or aiding and assisting legally protected health care activity 
unless the executive authority of the demanding state alleges in writing that the accused 
was physically present in the demanding state at the time of the commission of the alleged 
offense and that thereafter the accused fled from the demanding state. For purposes of this 
subsection, "aiding and assisting legally protected health care activity" and "legally 
protected health care activity" have the same meanings as in Title 14, section 9002, 
subsections 1 and 8, respectively. 
Sec. C-2. 16 MRSA §642, sub-§3 is enacted to read: 
3. Exception; legally protected health care activity. Notwithstanding any provision 
of state law to the contrary and except as required by federal law, a justice, judge or justice 
of the peace may not issue a search warrant permitting a government entity to obtain 
electronic device content information directly from a provider of electronic communication 
service or remote computing service that relates to an investigation into legally protected 
health care activity or aiding and assisting legally protected health care activity. For 
purposes of this subsection, "aiding and assisting legally protected health care activity" and 
"legally protected health care activity" have the same meanings as in Title 14, section 9002, 
subsections 1 and 8, respectively. 
PARTD 
Sec. D-1. 5 MRSA §90-B, sub-§1, ~' as amended by PL 2021, c. 649, §1, is 
futther amended to read: 
B. "Application assistant" means an employee of a state or local agency or of a 
nonprofit program that provides counseling, referral, shelter or other specialized 
service to victims of domestic violence, sexual assault, stalking or human trafficking 
or to minor victims of kidnapping or that provides services related to legally prntected 
health care activity who has been designated by the respective agency and trained, 
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COMMITTEE AMENDMENT" A" to H.P. 148, L.D. 227 
accepted and registered by the secretary to assist individuals in the completion of 
program pa1ticipation applications. 
Sec. D-2. 5 MRSA §90-B, sub-§1, ,iB-1 is enacted to read: 
B-1. "Covered health care practitioner" has the same meaning as in Title 10, section 
8012, subsection 1, paragraph B. 
Sec, D-3. 5 MRSA §90-B, sub-§1, 1C-1 is enacted to read: 
C-1. "Legally protected health care activity" has the same meaning as in Title 14, 
section 9002, subsection 8. 
Sec. D-4. 5 MRSA §90-B, sub-§1, ,iF-1 is enacted to read: 
F-1. "Reproductive or gender-affirming health care services practitioner" means a 
person who in the person's capacity as a covered health care practitioner engages in 
legally protected health care activity. 
Sec, D-5. 5 MRSA §90-B, sub-§2, as amended by PL 2021, c. 649, §2, is fmther 
amended to read: 
2. Program established, The Address Confidentiality Program is established to 
protect victims of domestic violence, sexual assault, stalking or human trafficking aM~ 
minor victims of kidnapping; and reproductive or gender-affirming health care services 
practitioners by authorizing the use of designated addresses for such victims and 
practitioners. The program is administered by the secretary under the following application 
and certification procedures. 
A. Upon recommendation of an application assistant, an adult person, a parent or 
guardian acting on behalf of a minor or a guardian acting on behalf of an incapacitated 
person may apply to the secretary to have a designated address assigned by the 
secretary to serve as the person's address or the address of the minor or incapacitated 
person. 
B. The secretary may approve an application only if it is filed with the office of the 
secretruy in the manner established by rule and on a form prescribed by the secretary. 
A completed application must contain: 
(1) The application preparation date, the applicant's signature and the signature 
and registration number of the application assistant who assisted the applicant in 
applying to be a program pruticipant; 
(2) A designation of the secretary as agent for purposes of service of process and 
for receipt of first-class mail; 
(3) The mailing address where the applicant may be contacted by the secretruy or 
a designee and the telephone number or numbers where the applicant may be called 
by the secretary or the secretary's designee; and 
(4) One or more addresses that the applicant requests not be disclosed for the 
reason that disclosure will jeopardize the applicant's safety or increase the risk of 
violence to the applicant or members of the applicant's household. 
C. Upon receipt of a propedy completed application, the secretary may ce1tify the 
applicant as a program pa1ticipant. A program participant is ce1tified for 4 years 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 148, L,D, 227 
following the date of initial certification unless the ce1tification is withdrawn or 
invalidated before that date, 
The secretary shall send notification of lapsing 
ce1tification and a reapplication form to a program pa1ticipant at least 4 weeks prior to 
the expiration of the program pa1ticipant's ce1tification. 
D, The secretary shall forward first-class mail to the appropriate program participants, 
E, A person who violates this paragraph commits a Class E crime, 
(1) An applicant may not file an application knowing that it: 
(a) Contains false or incorrect information; or 
(b) Falsely claims that disclosure of the applicant's address or mailing address 
threatens the safety of the applicant or the applicant's children or the minor or 
incapacitated person on whose behalf the application is made. 
(2) An application assistant may not assist or paiticipate in the filing of an 
application that the application assistant knows: 
(a) Contains false or incorrect information; or 
(b) Falsely claims that disclosure of the applicant's address or mailing address 
threatens the safety of the applicant or the applicant's children or the minor or 
incapacitated person on whose behalf the application is made. 
PARTE 
Sec. E-1. 10 MRSA §8012 is enacted to read: 
§8012. Legally protected health care activity 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings, 
A. "Aiding and assisting legally protected health care activity" has the same meaning 
as in Title 14. section 9002, subsection 1. 
B. "Covered health care practitioner" has the same meaning as "health care 
practitioner" in Title 24, section 2502, subsection 1-A, except that "covered health care 
practitioner" does not include a veterinarian. "Covered health care practitioner" also 
includes persons licensed under: 
( 1) Title 3 2, chapter 18: 
(2) Title 32, chapter 32: 
(3) Title 32, chapter 83: 
(4) Title 32, chapter 117: and 
(5) Title 32, chapter 119. 
C. "Legally protected health care activity" has the same meaning as in Title 14, section 
9002, subsection 8, 
D. "Professional discipline" means the issuance of a letter of guidance or concern: a 
warning, censure or reprimand: a license or registration denial, nonrenewal. suspension 
or revocation: a civil penalty for violation of applicable laws, rnles and conditions of 
licensure or registration or for instances of actionable conduct or activity; the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A, to H.P. 148, L.D. 227 
imposition of conditions of probation upon an applicant, licensee or registrant; or the 
execution of a consent agreement with the consent of an applicant, licensee or 
registrant. 
2. Professional discipline prohibited, Notwithstanding any provision of state law to 
the contrary and except as required by federal law, the commissioner; the Director of the 
Office of Professional and Occupational Regulation within the depa1tment; any agency, 
bureau, board or commission within or affiliated with the depaitment; and the Department 
of Health and Human Services may not subject a covered health care practitioner to 
professional discipline based solely on: 
A. The covered health care practitioner1s engaging in legally protected health ca1·e 
activity or aiding and assisting legally protected health care activity; 
B. A criminal action, civil action or professional discipline action in another state 
against the covered health care practitioner that is based on the covered health care 
practitioner engaging in legally protected health care activity or aiding and assisting 
legally protected health care activity; or 
C. Conviction of a crime or any civil judgment or professional discipline in this State 
or another state against the covered health care practitioner based solely on a violation 
of another state1s law prohibiting legally protected health care activity or aiding and 
assisting legally protected health care activity. 
3. Confidentiality, Notwithstanding any provision of state law to the contrary and 
except when public disclosure is authorized by federal law or another state law, the po1tions 
of a record of a conviction of a crime in this State or another state, any civil judgment, 
arbitration award or settlement agreement from this State or another state or professional 
discipline imposed in this State or another state that are in the possession of the 
commissioner; the Director of the Office of Professional and Occupational Regulation 
within the depa1tment; any agency, bureau, board or commission within or affiliated with 
the depa1tment; or, for a licensed electrologist, the Depa1tment of Health and Human 
Services are confidential to the extent that the criminal conviction, civil judgment, 
arbitration award or settlement agreement or professional discipline is based on the covered 
health care practitioner1s engaging in legally protected health care activity or aiding and 
assisting legally protected health care activity, 
Sec, E-2, 24 MRSA §2513 is enacted to read: 
§2513. Legally protected health care activity 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
11Adverse action
means the reduction of, restriction of, suspension of, denial of, 
revocation of or failure to grant or renew a covered health care practitioner1s 
membership, clinical privileges, clinical practice authority, professional ce1tification 
or participation on a provider panel by a health care provider or health care entity, 
B. 
11Aiding and assisting legally protected health care activity
has the same meaning 
as in Title 14, section 9002, subsection 1. 
C. 
11Covered health care practitioner
has the same meaning as in Title 10, section 8012, 
subsection 1, paragraph B. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A• to H.P. 148, L.D. 227 
D, "Formal disciplinary action'' means the reduction of. restriction of. suspension of, 
denial of, revocation of or failure to grant or renew a covered health care practitioner's 
membership in a professional society. 
E. "Legally protected health care activity" has the same meaning as in Title 14. section 
9002, subsection 8, 
F. "Professional discipline" has the same meaning as in Title 10, section 8012, 
subsection 1. paragraph D. 
2. Prohibited actions of health care entity or health care provider. A health care 
entity or health care provider within this State may not take any adverse action against a 
covered health care practitioner solely as a result of: 
A. The covered health care practitioner's engaging in legally protected health care 
activity or aiding and assisting legally protected health care activity; 
B. An adverse action or formal disciplina1y action in another state against the covered 
health care practitioner based on the covered health care practitioner's engaging in 
legally protected health care activity or aiding and assisting legally protected health 
care activity; or 
C, Professional discipline imposed on the covered health care practitioner by another 
state's professional licensing board. agency or organization based on the covered health 
care practitioner's engaging in legally protected health care activity or aiding and 
assisting legally protected health care activity. 
Sec, E-3. 24-A MRSA §2159-F, as enacted by PL 2023, c. 345, §1, is amended to 
read: 
§2159-F. 
Discrimination based solely on provision of reproductive health care 
serlices in medical malpractice insurance based solely on legally protected 
health care activity 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Adverse action" means revocation, suspension or other disciplinary action against 
a health care professional
1s license. 
B. "Health care professional v,rho provides reprod:10tive health care services" means a 
health care professional v,110 provides, authorizes, recommends, aids, assists, refers for 
or otherwise participates in an abortion or any other reprodactive health care services 
provided for the purpose of an abrniion performed on an individual. 
C. "Aid and assist legally protected health care activity" and "aiding and assisting 
legally protected health care activity" have the same meanings as in Title 14. section 
9002. subsection 1. 
D. "Legally protected health care activity" has the same meaning as in Title 14, section 
9002, subsection 8. 
2. 
Discrimination prohibited. 
An insurer that provides medical malpractice 
insurance in this State may not refuse to issue or renew coverage, cancel or restrict 
coverage. impose any sanctions. fines, penalties or rate increases or require the payment of 
additional charges by a health care professional who provides reproductive health care 
COMMITTEE AMENDMENT 
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COMMITIEEAMENDMENT"A"toH.P. 148, L.0. 227 
services engages in legally protected health care activity or aids and assists legally 
protected health care activity on the sole basis that the health care professional is acting in 
violation of another state's law related to legally protected health care activity or aiding and 
assisting legally protected health care activity or is subject to an adverse action against the 
health care professional's license in another state for a violation of that state's law related 
to legally protected health care activity or aiding and assisting legally protected health care 
activity. 
3. Action based on adverse action in another state prohibited. An insurer that 
provides medical malpractice insurance in this State may not refuse to issue or renew 
coverage, cancel or restrict coverage or require the payment of additional charges by a 
health care professional who provides reproductive health care services engages in legally 
protected health care activity or aids and assists legally protected health care activity as a 
result of an adverse action against the health care professional's license in another state if 
the adverse action is solely based on a violation of the other state's law that prohibits 
abortion and any related reproductive health care services in that state or for a resident of 
that state related to legally protected health care activity or aiding and assisting legally 
protected health care activity. 
Sec. E-4. 24-A MRSA §4301-A, sub-§1-A is enacted to read: 
1-A. Aids and assists legally protected health care activity. "Aids and assists legally 
protected health care activity" has the same meaning as in Title 14, section 9002, subsection 
.L 
Sec. E-5. 24-A MRSA §4301-A, sub-§5-A is enacted to read: 
5-A. 
Gender-affil'ming health care services. 
"Gender-affirming health care 
services" has the same meaning as in Title 14, section 9002, subsection 4. 
Sec. E-6. 24-A MRSA §4301-A, sub-§8-A is enacted to read: 
8-A. Legally protected health care activity. "Legally protected health care activity" 
has the same meaning as in Title 14, section 9002, subsection 8. 
Sec, E-7. 24-A MRSA §4301-A, sub-§17-A is enacted to read: 
17-A. Reproductive health care services. "Reproductive health care services" has 
the same meaning as in Title 14, section 9002, subsection 9. 
Sec. E-8. 24-A MRSA §4303, sub-§2, ~' as amended by PL 2015, c. 84, §1, is 
further amended to read: 
B. All credentialing decisions, including those granting, denying or withdrawing 
credentials, must be in writing, The provider must be provided with all reasons for the 
denial of an application for credentialing or the withdrawal of credentials. 
A 
withdrawal of credentials must be treated as a provider termination and is subject to 
the requirements of subsection subsections 3-A and 3-C. 
Sec. E-9. 24-A MRSA §4303, sub-§3, ,rA, as enacted by PL 1995, c. 673, Pt. C, 
§ 1 and affected by §2, is amended to read: 
A. For the purposes of this section, "to advocate for medically appropriate health care" 
means to discuss or recommend a course of treatment, including gender-affirming 
health care services and reproductive health care services, to an enrollee; to appeal a 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 148, L.D. 227 
managed care plan's decision to deny payment for a service, including gender-affirming 
health care services and reproductive health care services, pursuant to an established 
grievance or appeal procedure; or to protest a decision, policy or practice that the 
provider, consistent with the degree of learning and skill ordinarily possessed by 
reputable providers, reasonably believes impairs the provider's ability to provide 
medically appropriate health care, including gender-affirming health care services and 
reproductive health care services, to the provider's patients. 
Sec. E-10. 24-A MRSA §4303, sub-§3-C is enacted to read: 
3-C. Provider's right to engage in legally protected health care activity. A carrier 
offering or renewing a health plan in this State may not terminate or nonrenew a contract 
with a participating provider or impose any monetmy penalties or financial disincentives 
on a participating provider on the sole basis that the participating provider engages in 
legally protected health care activity or aids and assists legally protected health care 
activity. 
PARTF 
Sec. F-1. 22 MRSA §1711-C, sub-§1, 1A-2 is enacted to read: 
A-2. "Aiding and assisting legally protected health care activity" has the same meaning 
as in Title 14, section 9002, subsection 1. 
Sec. F-2. 22 MRSA §1711-C, sub-§1, ~-1 is enacted to read: 
B-1. "Gender-affirming health care services" has the same meaning as in Title 14, 
section 9002, subsection 4. 
Sec. F-3. 22 MRSA §1711-C, sub-§1, 1G-1 is enacted to read: 
G-1. "Legally protected health care activity" has the same meaning as in Title 14, 
section 9002, subsection 8. 
Sec. F-4. 22 MRSA §1711-C, sub-§1, 1G-2 is enacted to read: 
G-2. "Reproductive health care services" has the same meaning as in Title 14, section 
9002, subsection 9. 
Sec. F-5. 22 MRSA §1711-C, sub-§8, as amended by PL 2011, c. 373, §2, is 
repealed and the following enacted in its place: 
8. Prohibited disclosure. Disclosure of health care information is prohibited as 
follows. 
A. A health care practitioner, facility or state-designated statewide health information 
exchange may not disclose health care information for the purpose of marketing or 
sales without written or oral authorization for the disclosure. 
B. Notwithstanding any provision of this section to the contrary and except as provided 
in paragraph C, a health care practitioner, facility or state-designated statewide health 
information exchange may not disclose any of the following in a civil or administrative 
action or proceeding or in response to a subpoena issued in a civil or administrative 
action or proceeding unless authorized in writing by the individual or the individual's 
authorized representative or pursuant to a court order issued by a court of competent 
jurisdiction in this State upon a showing of good cause, as long as the court order limits 
COMMITTEE AMENDMENT 
~os 
COMMITTEE AMENDMENT" A• to H.P. 148, L.D. 227 
the use and disclosure of records and includes sanctions for misuse of records or sets 
fo1th other methods to ensure confidentiality: 
(1) 
Any communication about reproductive health care services or gender-
affirming health care services made to the health care practitioner. facility or state-
designated statewide health information exchange from the individual or anyone 
acting on behalf of the individual. including an authorized representative of the 
individual: and 
(2) Any information obtained tlu·ough a personal examination of an individual 
relating to reproductive health care services or gender-affirming health care 
services. 
C. Paragraph B does not apply if: 
(1) The communication or information to be disclosed relates to an individual who 
is a plaintiff in a medical malpractice action and the health care practitioner. facility 
or state-designated statewide health information exchange from which the 
communication or information is requested is a defendant in the medical 
malpractice action: 
(2) The communication or information to be disclosed is requested by a 
professional licensing board that licenses health care practitioners in this State and 
the request relates to and is made in connection with a complaint investigation. 
This subparagraph does not apply if the complaint is based solely on an allegation 
that a licensee of the board provided reproductive health care services or gender-
affaming health care services that are legally protected health care activity or 
aiding and assisting legally protected health care activity within the licensee's 
scope of practice: or 
(3) The communication or information to be disclosed is requested by the United 
States Depaitment of Justice, a law enforcement agency of this State or a political 
subdivision of this State or any other federal agency or agency of this State that 
pursuant to statute is responsible for investigating abuse. neglect or exploitation 
and the request is made in connection with an investigation of abuse. neglect or 
exploitation of a child pursuant to the Child and Family Services and Child 
Protection Act or of an incapacitated or dependent adult pursuant to the Adult 
Protective Services Act. 
D. This subsection may not be constrned to impede the lawful disclosure of information 
to another health care practitioner or facility for diagnosis. treatment or care of 
individuals or to complete the responsibilities of a health care practitioner or facility 
that provides diagnosis. treatment or care of individuals or to impede the lawful 
disclosure of information to an insurer or payor related to the treatment provided by a 
health care practitioner or facility or to the payment or operatiorls of a health care 
practitioner or facility. 
PARTG 
Sec, G-1. Construction. This Act may not be construed to conflict with or in any 
way amend the Uniform Child Custody Jurisdiction and Enforcement Act, Maine Revised 
Statutes, Title 19-A, chapter 58.' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A "to H.P. 148, L.D. 227 
Amend the bill by relettering or renumbering any nonconsecutive Pait letter or section 
number to read consecutively. 
SUMMARY 
This amendment, which is the majority report of the committee, replaces the bill, which 
is a concept draft, and changes the title. The amendment provides protections to persons 
who seek, health care practitioners who provide and those who assist health care 
practitioners in providing gender-affirming health care services and reproductive health 
care services in accordance with the applicable standard of care. 
Pait A of the amendment does the following. 
1, It establishes that access to gender-affirming health care services and reproductive 
health care services, when those services are authorized under the laws of this State, is a 
legal right and that interference with access to such services or the provision of such 
services is against the public policy of this State, 
2. It defines ''legally protected health care activity" as the exercise or attempted 
exercise of the right to gender-affinning health care services 01· reproductive health care 
services secured in this State as well as the provision or attempted provision of gender-
affirming health care services or reproductive health care services authorized under the 
laws of this State by a health care practitioner licensed and physically present in this State, 
regardless of whether the patient is located in this State or the health care practitioner is 
licensed in the state where the patient is located. "Legally protected health care activity" 
does not include conduct that could form the basis of civil, criminal or administrative 
liability under the laws of this State had the course of conduct occurred entirely within this 
State. 
3. It authorizes a health care practitioner or person assisting a health care practitioner 
against whom a civil, criminal or administrative action in another state is brought to deter, 
prevent, sanction or punish that health care practitioner for engaging in legally protected 
health care activity or that person for aiding and assisting legally protected health care 
activity, referred to in the amendment as "hostile litigation," to bring a civil action in this 
State for damages, punitive damages and equitable relief. A couit in this State may include 
in a damage award the amount of any judgment issued in connection with the hostile 
litigation as well as the person's reasonable attorney's fees and expenses incurred in 
connection with that action. 
4. It requires a person seeking to enforce in this State a judgment from another state, 
referred to in the amendment as a 
11foreignjudgment,
in connection with hostile litigation 
to bring an action on the judgment within 5 years. A comt in this State may not enforce a 
foreign judgment in connection with hostile litigation if the couit that issued the judgment 
7 
lacked jurisdiction or failed to provide due process of law, 
5, It provides that, unless required by federal law, a court of this State may not order a 
person in this State to give testimony or produce documents or other information in any 
proceeding involving hostile litigation, In addition, unless required by federal law, a comt 
in this State may not issue a summons or warrant in a case involving a grand jury 
investigation of or prosecution under the criminal laws of another state for engaging in or 
for aiding and assisting legally protected health care activity unless the conduct at issue 
would constitute a criminal offense if it had occurred entirely within this State, 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT "fr" to H.P. 148, L.D. 227 
6. It prohibits public agencies, including law enforcement agencies, from knowingly 
cooperating with or expending public resources in furtherance of an investigation or 
proceeding against a person for engaging in or aiding and assisting legally protected health 
care activity. It also prohibits the arrest of a person in this State if the arrest is related to 
criminal liability for engaging in or aiding and assisting legally protected health care 
activity. The amendment does not prohibit a public agency, including a law enforcement 
agency, from cooperating or assisting an investigation or proceeding or from responding to 
a warrant or extradition demand on the good faith belief that the warrant or demand is valid 
in this State or when exigent circumstances make compliance impossible. 
7. It provides that the laws of this State apply to any case or controversy heard in this 
State involving legally protected health care activity or aiding and assisting legally 
protected health care activity. 
Part B of the amendment amends the Uniform Interstate Depositions and Discovery 
Act, through which a person may request that a court in this State issue a subpoena to 
effectuate a subpoena issued under the authority of a court in another state, referred to as a 
"foreign subpoena." Under the amendment, a person submitting a foreign subpoena to a 
clerk of coutt must also submit an affidavit attesting whether the foreign subpoena seeks 
documents, information, inspection or testimony related to the provision or receipt of 
legally protected health care activity or aiding and assisting legally protected health care 
activity. If the affidavit reveals that the foreign subpoena is related to legally protected 
health care activity or aiding and assisting legally protected health care activity, the clerk 
may not issue the subpoena and must present the request to the comt. The cou1t must deny 
the request unless it finds that the foreign subpoena seeks documents, information, 
inspection or testimony related to specified types of civil actions either brought by a person 
or brought under a contract for which a similar cause of action exists under the laws of this 
State. 
Part C of the amendment amends the Uniform Criminal Extradition Act to prohibit the 
Governor from surrendering a person charged in another state for engaging in or aiding and 
assisting legally protected health care activity unless the executive authority in the other 
state alleges that the accused was physically present in the other state when the alleged 
offense was committed and thereafter fled the other state. 
In addition, Patt C of the amendment prohibits a coutt in this State from issuing a 
search warrant authorizing a government entity to obtain p01table electronic device content 
information that relates to an investigation into legally protected health care activity or 
aiding and assisting legally protected health care activity. 
Pait D of the amendment provides that a health care practitioner that provides services 
related to legally protected health care activity may pa1ticipate in the Address 
Confidentiality Program administered by the Secretary of State. 
Current law prohibits an insurer that provides medical malpractice insurance in this 
State from discriminating or taking any adverse action against a health care professional 
who provides reproductive health care services on the sole basis that the health care 
professional is acting in violation of another state's law or is subject to an adverse action 
against the health care professional's license in another state. Pait E of the amendment 
extends analogous protections to health care practitioners who engage in or aid and assist 
legally protected health care activity as defined in Patt A of the amendment. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDME~T A 
"to H.P. 148, L.D. 227 
Part E of the amendment also: 
1. Prohibits a professional licensing authority in this State from subjecting a health care 
practitioner to professional discipline based solely on the health care practitioner's engaging 
in or aiding and assisting legally protected health care activity or a pending or final 
criminal, civil or professional discipline action in another state based on engaging in or 
aiding and assisting legally protected health care activity; 
2. Prohibits a health care provider or health care entity from restricting or denying the 
clinical privileges of or taking formal disciplinary action against a health care practitioner 
solely as a result of the health care practitioner's engaging in or aiding and assisting legally 
protected health care activity or the initiation or final disposition of a professional discipline 
action by a professional licensing authority in another state based on the health care 
practitioner's engaging in or aiding and assisting legally protected health care activity; and 
3. Prohibits a carrier offering or renewing a health care plan in this State from 
terminating or not renewing a contract with or imposing any monetary penalties against a 
participating provider on the sole basis that the participating provider engages in or aids 
and assists legally protected health care activity. 
Pait F of the amendment prohibits a health care practitioner or facility from disclosing 
in a civil or administrative action or proceeding or in response to a subpoena issued in such 
a proceeding information obtained th1'ough an examination of an individual relating to 
reproductive health care services or gender-affirming health care services and from 
disclosing a communication from an individual or a person acting on the individual's behalf 
about reproductive health care services or gender-affinning health care services unless: 
1. The disclosure is authorized in writing by the individual; 
2. The disclosure is requested in connection with a medical malpractice claim brought 
by the individual against the health care practitioner or facility; 
3. The disclosure is requested by a professional licensing board in this State in 
connection with a complaint that is not based solely on an allegation that a licensee 
provided reproductive health care services or gender-affirming health care services that are 
lawful in this State and within the licensee's scope of practice; or 
4. The disclosure is requested in connection with an investigation of abuse, neglect or 
exploitation of a child or an incapacitated or dependent adult by a federal or Maine agency 
responsible for investigating such abuse, neglect or exploitation. 
Patt G of the amendment makes clear that the legislation may not be construed to 
conflict with or amend the Uniform Child Custody Jurisdiction and Enforcement Act. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 04/02/24 wae 
LD227 
LR 2287(02) 
An Act Regarding Health Care in the State 
FI_Scal Note for Bill as Amended by Committee Altlendment A" ( J/--9 §3) 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor revenue increase - General Fund 
Correctional and Judicial Impact Statements 
This bill may increase the number of civil suits filed in the court system. The additional workload associated with 
minimal number of new cases filed in the court system does not require additional funding at this time, The collection 
of additional filing fees will increase General Fund revenue by minor amounts. 
Fiscal Detail and Notes 
Any additional costs to the Department of Secretaiy of State associated with including reproductive or gender-
affi1111ing health care services practitioners to the Address Confidentiality Program are expected to be minor and can 
be absorbed within existing budgeted resources, 
Any additional costs to the Office of the Attorney General associated with the provisions of this bill are expected to be 
'minor and can be absorbed within existing budgeted resources. 
LR2287(02) - Fiscal Note - Page 1 of 1