An Act to Improve Accountability and Understanding of Data in Insurance Transactions
Sponsored By: Donna Bailey (Democratic)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 2 benefits, 0 costs, 2 mixed.
Contracts must honor data access rights
Beginning January 1, 2026, administrators and PBMs cannot enter into, issue, amend, or renew contracts that block these audit and data-access rights. This protects your rights in new and renewed agreements.
PBM audits and rebate transparency
Certified plan sponsors can get PBM data on what was actually paid to pharmacies and any dispensing fees within 30 business days. You can audit a PBM once a year, at least 6 months after the last request. The PBM must share rebates by drug or category, claims, payments, and all other revenue and fees within 30 business days. PBMs can charge only their direct costs and cannot restrict your audit scope; requests must cover plan years that ended within the last 24 months. A PBM may require a nondisclosure agreement and insurance up to its own liability limit and can refuse auditors who broke past NDAs. All shared data must follow HIPAA and HITECH privacy and security rules.
Stronger audit rights for self-funded plans
The law gives self-funded plan sponsors that certify under HIPAA new audit and data rights. For any claim over $100,000, you can ask within 2 business days and get itemized bills and medical records within 30 business days. You can do one post-payment audit each year, at least 6 months after the last, and get claims and payment files within 30 business days. Administrators can only charge their direct costs and cannot limit your audit scope; requests must cover plan years that ended within the last 24 months. They may require a reasonable nondisclosure agreement and insurance up to their own liability limit and can refuse auditors who broke past NDAs. Employers with fully insured plans are not covered by these rights.
Enforced under Unfair Trade Practices
Violations of these audit and data-access rules are enforced under the Maine Unfair Trade Practices Act. Each violation counts separately. Investigators can involve third parties who have evidence.
Sponsors & Cosponsors
Sponsor
Donna Bailey
Democratic • Senate
Cosponsors
Drew Gattine
Democratic • House
Joshua Morris
Republican • House
Kristi Mathieson
Democratic • House
Lori Gramlich
Democratic • House
Matthea E. L. Daughtry
Democratic • Senate
Michelle Boyer
Democratic • House
Robert Foley
Republican • House
Rolf Olsen
Republican • House
Ryan Fecteau
Democratic • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Signed by Governor, ACTPUB Chapter 487
7/1/2025On motion by Senator ROTUNDO of Androscoggin taken from the Special Appropriations Table PASSED TO BE ENACTED in concurrence.
6/25/2025SenateOn motion by Senator RENY of Lincoln PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence
6/13/2025SenatePASSED TO BE ENACTED. Sent for concurrence. ORDERED SENT FORTHWITH.
6/13/2025HouseCONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (S-367).In concurrence. ORDERED SENT FORTHWITH.
6/13/2025HouseReport READ and ACCEPTED.READ ONCE.Committee Amendment "A" (S-367) READ and ADOPTED.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (S-367).Ordered sent down forthwith for concurrence.
6/12/2025SenateThe Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.In concurrence. ORDERED SENT FORTHWITH.
5/6/2025HouseCommittee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES suggested and ordered printed REFERENCE to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES Ordered sent down forthwith for concurrence
5/6/2025Senate
Bill Text
Amendment C-A (S-367), adopted by House & Senate
Enacted
Introduced
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