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MaineLD 1906132nd Maine Legislature (2025-2026)SenateWALLET

An Act to Improve Accountability and Understanding of Data in Insurance Transactions

Sponsored By: Donna Bailey (Democratic)

Became Law

INSURANCEINSURANCE - HEALTH INSURANCE

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Bill Overview

Analyzed Economic Effects

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

Only self-funded sponsors get these rights

Beginning July 1, 2025, employers with fully insured health plans are not treated as plan sponsors under this law. The access and audit rights apply to sponsors of self-funded plans.

Plan sponsors get medical-claim audit rights

Beginning July 1, 2025, plan sponsors can get itemized bills and medical records for any claim over $100,000. They must ask within 2 business days and be certified under 45 C.F.R. §164.504(f); the administrator must respond in 30 business days. Sponsors can do audits at least once a year, at least 6 months apart, and must request audits within 24 months after the plan year ends. For audits, administrators must share electronic claim and payment files, billed and paid amounts, and all related fees, discounts, recoveries, and subrogation charges within 30 business days. Administrators may require a reasonable nondisclosure and data-use agreement and can limit any required insurance to their own liability cap; they can refuse data to auditors who broke or refuse the agreement. All disclosures must follow HIPAA and HITECH, and administrators can charge only their actual direct costs. Violations are enforced under the Maine Unfair Trade Practices Act. Contracts entered, amended, or renewed on or after January 1, 2026 cannot block these rights.

Plan sponsors get PBM drug audit rights

Beginning July 1, 2025, certified plan sponsors can get from a PBM the exact amounts paid to pharmacies for a drug and any dispensing fee within 30 business days. Sponsors can do audits at least once a year, at least 6 months apart, and must request audits within 24 months after the plan year ends. For audits, PBMs must share rebates by drug and therapeutic category, electronic claim files, payment and EFT/remittance data, and any other revenue or fees, including manufacturer remuneration, within 30 business days. PBMs may require a reasonable nondisclosure and data-use agreement and may cap any required insurance at the PBM’s liability limit; they can refuse data to auditors who broke or refuse the agreement. All disclosures must follow HIPAA and HITECH, and PBMs can charge only their actual direct costs. Violations are enforced under the Maine Unfair Trade Practices Act, and each bad act is a separate violation. Contracts entered, amended, or renewed on or after January 1, 2026 cannot block these rights.

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

  1. ACTPUB Chapter 487

    5/1/2026

  2. On motion by Senator ROTUNDO of Androscoggin taken from the Special Appropriations Table PASSED TO BE ENACTED in concurrence.

    6/25/2025Senate

  3. On motion by Senator RENY of Lincoln PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence

    6/13/2025Senate

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

    6/13/2025House

  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" (S-367).In concurrence. ORDERED SENT FORTHWITH.

    6/13/2025House

  6. Report 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.

    6/12/2025Senate

  7. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.In concurrence. ORDERED SENT FORTHWITH.

    5/6/2025House

  8. Committee 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

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