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MaineLD 1511132nd Maine Legislature (2025-2026)HouseWALLET

An Act to Expand Direct Health Care Service Arrangements

Sponsored By: Joshua Morris (Republican)

Became Law

INSURANCEINSURANCE - HEALTH INSURANCE

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Insurers must honor direct primary care referrals

Beginning January 1, 2018, your health plan cannot deny payment for a covered service just because a direct primary care provider made the referral and is not in network. The plan cannot charge a higher deductible, copay, or coinsurance than for an in-network referral. The carrier can ask for proof, like a written attestation or a copy of your direct primary care agreement.

More ways to use direct primary care

The law defines who can offer direct primary care and what a direct primary care agreement includes. You or your legal representative can sign the agreement, and a third party, like an employer, can pay the fee. Providers can still treat other patients under separate insurance contracts. Providers may also work with insurers on policies that add to a direct primary care agreement and join state or federal pilot programs.

Direct primary care is not insurance

Direct primary care agreements are not health insurance, and the state’s insurance bureau does not regulate them. The contract covers only the services listed in it; anything else can be billed separately. The agreement must say the fees may not be reimbursed by insurance and may not count toward your deductible. It must also say these services do not meet any federal requirement to buy health insurance.

Sponsors & Cosponsors

Sponsor

  • Joshua Morris

    Republican • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. ACTPUB Chapter 358

    5/1/2026

  2. PASSED TO BE ENACTED. Sent for concurrence. ORDERED SENT FORTHWITH.

    6/13/2025House

  3. PASSED TO BE ENACTED, in concurrence.

    6/13/2025Senate

  4. Report READ and ACCEPTED, in concurrence.READ ONCE.Committee Amendment "A" (H-668) READ and ADOPTED, in concurrence.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (H-668), in concurrence.Ordered sent down forthwith.

    6/13/2025Senate

  5. CONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (H-668).Sent for concurrence. ORDERED SENT FORTHWITH.

    6/12/2025House

  6. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES in concurrence

    4/8/2025Senate

  7. Committee on Health Coverage, Insurance and Financial Services suggested and ordered printed. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.Sent for concurrence. ORDERED SENT FORTHWITH.

    4/8/2025House

Bill Text

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