An Act to Clarify That Health Insurers Must Comply with Plan Sponsors' Statutory Rights to Audit Claims and Data Requests Related to Those Audits
Sponsored By: Donna Bailey (Democratic)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 0 benefits, 0 costs, 3 mixed.
Audit and data rights for plan sponsors
Plan sponsors can audit paid health claims once a year, no sooner than 6 months after the last request. After you certify HIPAA-compliant use, administrators must share plan-level files within 30 business days. Data includes claims and remittance files, billed vs. paid amounts, and all fees and discounts. Administrators may require a nondisclosure/data-use agreement, but cannot demand insurance limits above their own contract cap, and may refuse data to auditors who breached or will not sign. You must tell the administrator right away if you discover any unauthorized disclosure or security breach of the listed personal or health data. The law broadens who counts as an “administrator” to include anyone handling premiums or claims for Maine residents. Employers with fully insured plans from a Maine-licensed insurer are not plan sponsors under these audit rules.
Pharmacy benefit managers must share data
Plan sponsors can audit paid prescription claims once a year, with at least 6 months between requests. After HIPAA certification, PBMs must provide plan-level data within 30 business days. Data must include claims and remittance files, all fees and revenues, rebates by drug or category, and all manufacturer pay (direct or indirect). PBMs may require a nondisclosure/data-use agreement, but cannot require insurance above their own liability cap, and may refuse data to auditors who breached or will not sign. If you discover an unauthorized disclosure or security breach of the listed personal or health data, you must notify the PBM right away.
When these transparency rules take effect
The law takes effect on approval under an emergency clause. It also states an effective date of July 1, 2026.
Sponsors & Cosponsors
Sponsor
Donna Bailey
Democratic • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Signed by Governor, ACTPUB Chapter 652
4/13/2026PASSED TO BE ENACTED - Emergency - 2/3 Elected Required, in concurrence.
4/7/2026SenateThis being an emergency measure, a two-thirds vote of all the members elected to the House was necessary.PASSED TO BE ENACTED.Sent for concurrence. ORDERED SENT FORTHWITH.
4/7/2026HouseCONSENT 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-624).In concurrence. ORDERED SENT FORTHWITH.
4/6/2026HouseReport READ and ACCEPTED.READ ONCE.Committee Amendment "A" (S-624) READ and ADOPTED.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (S-624).Ordered sent down forthwith for concurrence.
4/6/2026SenateCARRIED OVER, in the same posture, to any special or regular session of the 132nd Legislature, pursuant to Joint Order SP 800.
6/25/2025SenateCARRIED OVER, in the same posture, to the next special or regular session of the 132nd Legislature, pursuant to Joint Order SP 519.
3/21/2025SenateThe Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.In concurrence. ORDERED SENT FORTHWITH.
2/4/2025HouseCommittee 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
2/4/2025Senate
Bill Text
Amendment C-A (S-624), adopted by House & Senate
Enacted
Introduced
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