An Act to Expand
Maine Legislature, Session 132, LD 1511
Committee Amendment CA_A_H668 (House)
Amends: 24-A MRSA §4303

COMMITTEE AMENDMENT 'A" to H.P. 995, L.D. 1511, "An Act to Expand 
Direct Health Care Service Arrangements" 
Amend the bill by striking out everything after the enacting clause and inse1iing the 
following: 
'Sec. 1. 22 MRSA c. 403-A, headnote is amended to read: 
CHAPTER 403-A 
DIRECT PRIMARY HEALTH CARE SERVICE AGREEMENTS 
Sec. 2. 22 MRSA § 1771, as enacted by PL 2017, c. 112, § 1, is amended to read: 
§1771. Direct primary health care service agreements 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Direct primary health care service agreement
means a contractual agreement 
between a direct primary health care provider and an individual patient, or the patient's 
legal representative, in which: 
(1) The direct primary health care provider agrees to provide primary health care 
services to the individual patient for an agreed-to fee over an agreed-to period of 
time; and 
(2) The direct primary health care provider agrees not to bill 3rd parties on a fee-
for-service or capitated basis for services already covered in the direct primaiy 
health cal'e service agreement. 
B. 
"Dil'ect primary health cal'e provider" means an individual who is a licensed 
0 
allopathic physician 0l' osteopathic physician or other advanced health cal'e practitioner 
who is authorized to engage in independent medical practice in this State, who is 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT~" to H.P. 995, L.D. 1511 
qualified to prnvide p1·imary care services and who chooses to practice direct primary 
health care by entering into a direct primary health care service agreement with 
patients. The te11n includes, but is not limited to, an individual primary health care 
provider or a group of primary health care providers. 
C. 
"Primary care" means outpatient, nonspeeialty health care services or the 
coordination of health care for the purpose of: 
(1) Promoting or maintaining mental and physical heakh and 'Nellness; and 
(2) The diagnosis, treatment or management of acute or chronic conditions caused 
by disease, injury or illness. 
D, "Health care" has the same meaning as in section 1711-C. subsection 1. paragraph 
C. 
2. Not insurance. A direct primal)' health care service agreement is not an insurance 
policy and is not subject to regulation by the Department of Professional and Financial 
Regulation, Bureau of Insurance. 
3. Ability to contract. A direct primary health care service agreement is an agreement 
between the direct primary health care provider and either an individual or the individual's 
representative, regardless of whether the periodic fee or other fees are paid by the 
individual, the individual's representative or a 3rd party, 
4. Covered services. A direct primary health care service agreement covers only the 
services specified in the agreement. Any goods 01· services that are not covered by the 
direct primary health care service agreement may be billed separately, 
5. Disclosure. A direct primary health care service agreement must clearly state within 
the agreement that direct primal)' health care services are not considered health insurance 
and do not meet requirements of any federal law mandating individuals to purchase health 
insurance and that the fees charged in the agreement may not be reimbursed or apply 
towards a deductible under a health insurance policy with an insurer, 
6. Other care not prohibited. A primary health care provider is considered a direct 
primary health care provider only when the provider is engaged in a direct primary health 
care service agreement with a patient or group of patients. A primal)' health care provider 
is not prohibited from providing care to other patients under a separate agreement or 
contract with an insurer. 
7. Other agreements not prohibited. This section does not prohibit a direct primary 
health care provider from entering into: 
A. An agreement with an insurer offering a policy specifically designed to supplement 
a direct primal)' health care service agreement; or 
B. A pilot program for direct primary care or direct health care with a federal or state 
agency that provides health coverage. 
Sec. 3. 24-A MRSA §4303, sub-§22, as amended by PL 2019, c. 178, § 1, is fmther 
amended to read: 
22. Denial of referral by out-of-network provider prohibited. Beginning January 
1, 2018, a carrier may not deny payment for any health care service covered under an 
enrollee's health plan based solely on the basis that the enrollee's referral was made by a 
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COMMITTEE AMENDMENT 'A" to H.P. 995, L.D. 1511 
direct primary health care provider who is not a member of the carrier's provider network. 
A canfor may not apply a deductible, coinsurance or copayment greater than the applicable 
deductible, coinsurance or copayment that would apply to the same health care service if 
the service was referred by a participating primary care provider. A carrier may require a 
direct primary health care provider making a refeITal who is not a member of the carrier's 
provider network to provide infonnation demonstrating that the provider is a direct primary 
health care provider through a written attestation or copy of a direct primary health care 
service agreement with an enrollee and may request additional information necessary to 
implement this subsection. As used in this subsection, "direct primary health care provider" 
has the same meaning as in Title 22, section 1771, subsection 1, paragraph B.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill. Under current law an individual can contract directly 
with a direct primary care provider who is a licensed allopathic or osteopathic physician or 
other advanced health care practitioner who is authorized to provide primary care services 
for the provision of health care to that individual. 
This amendment removes the 
requirement that the physician or advanced health care practitioner be authorized to provide 
primary care services. 
The amendment also corrects a cross-reference. 
COMMITTEE AMENDMENT