An Act to Encourage Competition by Requiring Independent Health
Maine Legislature, Session 132, LD 1785
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BOYER, BALDACCI
Amends: 24-A MRSA §4303

Legislative Document
No. 1785
H.P. 1196
House of Representatives, April 24, 2025
An Act to Encourage Competition by Requiring Independent Health 
Care Provider Cost-of-living Adjustments in Health Insurance 
Contracts
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative BOYER of Cape Elizabeth.
Cosponsored by Senator BALDACCI of Penobscot and
Representative: MATHIESON of Kittery.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4303, sub-§18-A is enacted to read:
18-A.  Nonaffiliated practice contract requirements.  In addition to the requirements 
of subsection 18, a carrier offering a health plan must meet the requirements of this 
subsection with respect to a contract offered by the carrier to an individual practice that is 
not affiliated with a hospital or a group practice up to 25 members that is not affiliated with 
a hospital, including a contract offered through a preferred provider arrangement, as 
defined in section 2671, subsection 7. This subsection does not apply to dental or vision 
plans.
A.  For health plans issued or renewed on or after January 1, 2026, compensation 
provisions in a contract between an individual practice that is not affiliated with a 
hospital or a group practice up to 25 members that is not affiliated with a hospital and 
a carrier to provide health care services to enrollees of a health plan must include an 
increase in compensation for health care services from the prior year that reflects 
increases in the Consumer Price Index for All Urban Consumers, CPI-U, over the 
previous year, as compiled by the United States Department of Labor, Bureau of Labor 
Statistics. A carrier may not reduce fees for services covered under the contract for any 
reason other than to reflect changes to the national relative value unit standards 
determined by the federal Department of Health and Human Services, Centers for 
Medicare and Medicaid Services.
B.  This subsection does not require an individual practice that is not affiliated with a 
hospital or a group practice up to 25 members that is not affiliated with a hospital to 
accept or reject, or prohibit an individual practice that is not affiliated with a hospital 
or a group practice up to 25 members that is not affiliated with a hospital from 
accepting or rejecting, a contract or an amendment to an existing contract including 
any increase in compensation required by this subsection. A contract may not directly 
or indirectly waive the requirements of this subsection and a carrier may not 
discriminate against any category of individual practice that is not affiliated with a 
hospital or a group practice up to 25 members that is not affiliated with a hospital by 
excluding or limiting payment for health care services provided by an individual 
practice that is not affiliated with a hospital or a group practice up to 25 members that 
is not affiliated with a hospital in an effort to avoid the compensation provisions of this 
subsection.
Sec. 2. Prohibition on altering contractual reimbursement during 2025. A 
carrier, as defined in Title 24-A, section 4301-A, subsection 3, offering a health plan, as 
defined in Title 24-A, section 4301-A, subsection 7, may not alter contractual 
reimbursement to an individual practice that is not affiliated with a hospital or a group 
practice up to 25 members that is not affiliated with a hospital during 2025 to reduce the 
baseline reimbursement for the purpose of reducing the compensation increase required 
pursuant to Title 24-A, section 4303, subsection 18-A.
SUMMARY
This bill requires that, for health insurance plans issued or renewed on or after January 
1, 2026, compensation provisions in a contract between an individual practice that is not 
affiliated with a hospital or a group practice up to 25 members that is not affiliated with a 
hospital and a health insurance carrier to provide health care services to enrollees of a health 
insurance plan must include an increase in compensation for health care services from the 
prior year that reflects increases in the Consumer Price Index for All Urban Consumers, 
CPI-U, over the previous year, as compiled by the United States Department of Labor, 
Bureau of Labor Statistics. This bill prohibits a health insurance carrier offering a health 
insurance plan from altering contractual reimbursement to an individual practice that is not 
affiliated with a hospital or a group practice up to 25 members that is not affiliated with a 
hospital during 2025 to reduce the baseline reimbursement for the purpose of reducing the 
required compensation increase. The bill also prohibits a health insurance carrier from 
reducing fees for services covered under a contract with an individual practice that is not 
affiliated with a hospital or a group practice up to 25 members that is not affiliated with a 
hospital for any reason other than to reflect changes to the national relative value unit 
standards determined by the federal Department of Health and Human Services, Centers 
for Medicare and Medicaid Services.