LAW WITHOUT
GOVERNOR'S CHAPTER
SIGNATURE
584
APRIL 2, 2024 PUBLIC LAW
STATE OF MAINE
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IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FOUR
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H.P. 1119 - L.D. 1740
An Act to Protect a Patient's Access to Affordable Health Care with Timely
Access to Health Care Prices
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1. 22 MRSA §1718-B, sub-§2, ¶B, as enacted by PL 2013, c. 515, §2, is
amended to read:
B. A health care entity shall inform patients about the availability of prices for the
most frequently provided health care services and procedures and the right of a patient
to request information about the price of medical services pursuant to section 1718-C,
subsection 1 or 2 by posting a notice on prominent display to patients.
Sec. A-2. 22 MRSA §1718-B, sub-§2, ¶B-1 is enacted to read:
B-1. A health care entity shall include notice of a patient's right to request information
about the price of medical services pursuant to section 1718-C, subsection 1 or 2 in any
written document provided to a patient prior to rendering health care treatment for the
purpose of obtaining informed consent to that treatment.
Sec. A-3. 22 MRSA §1718-C, as enacted by PL 2013, c. 560, §2, is repealed and
the following enacted in its place:
§1718-C. Patient request for good faith estimate or other information related to price
of medical services
1. Uninsured or self-pay patient; good faith estimate. Upon the request of an
uninsured or self-pay patient, a health care entity, as defined in section 1718-B, subsection
1, paragraph B, shall provide to the patient a good faith estimate of the total price of medical
services to be rendered directly by that health care entity during a single medical encounter
as follows.
A. The health care entity shall provide the good faith estimate within the following
time frames:
(1) When the medical encounter is scheduled at least 3 business days before the
date the medical encounter is scheduled to be furnished or when the patient is
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 seeking urgent care as defined in Title 24-A, section 4301-A, subsection 21, the
estimate must be provided no later than one business day after the date of
scheduling or the date of the request if the patient is seeking urgent care;
(2) When the medical encounter is scheduled at least 10 business days before the
encounter is scheduled to be furnished, the estimate must be provided no later than
3 business days after the date of scheduling; or
(3) In all other circumstances, the estimate must be provided no later than 3
business days after the date of the request.
B. If the health care entity is unable to provide an accurate estimate of the total price
of a specific medical service because the amount of the medical service to be rendered
during the medical encounter is unknown in advance, the health care entity shall
provide a brief description of the basis for determining the total price of that particular
medical service.
C. If the single medical encounter will involve medical services to be rendered by one
or more 3rd-party health care entities, the health care entity shall identify each
3rd-party health care entity to enable the uninsured patient to seek an estimate of the
total price of medical services to be rendered directly by each health care entity to that
patient.
D. A good faith estimate must separately disclose the prices for each component of
medical services, including any facility fees or fees for professional services, and the
current procedural terminology codes used by the American Medical Association for
those services.
E. When providing an estimate as required by this subsection, the health care entity
shall also notify the uninsured patient of any financial assistance policy adopted by the
health care entity and the availability of public or private health care coverage.
F. Notwithstanding other provisions of this subsection, a health care entity does not
violate this subsection if it provides a good faith estimate to the patient in compliance
with federal regulations.
2. Insured patient; description of medical services and current procedural
terminology codes. Upon the request of an insured patient, a health care entity, as defined
in section 1718-B, subsection 1, paragraph B, shall provide to the patient a description of
the medical services to be rendered directly by that health care entity during a single
medical encounter and the applicable standard medical codes or current procedural
terminology codes used by the American Medical Association for those services as follows.
A. The health care entity shall comply with the request within the following time
frames:
(1) When the medical encounter is scheduled at least 3 business days before the
date the medical encounter is scheduled to be furnished or when the patient is
seeking urgent care as defined in Title 24-A, section 4301-A, subsection 21, the
health care entity must respond no later than one business day after the date of
scheduling or the date of the request if the patient is seeking urgent care;
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 (2) When the medical encounter is scheduled at least 10 business days before the
encounter is scheduled to be furnished, the health care entity must respond no later
than 3 business days after the date of scheduling; or
(3) In all other circumstances, the health care entity must respond no later than 3
business days after the date of the request.
B. If the single medical encounter will involve medical services to be rendered by one
or more 3rd-party health care entities, the health care entity shall identify each
3rd-party health care entity to enable the patient to seek a description of the medical
services to be rendered directly by that 3rd-party health care entity to that patient and
the applicable standard medical codes or current procedural terminology codes used by
the American Medical Association for those services.
C. The health care entity shall also notify the patient that the patient may use the
information provided to request an estimate of the out-of-pocket costs expected to be
paid by the patient from the patient's health insurance carrier.
D. When providing the information required by this subsection, the health care entity
shall also notify the insured patient of any financial assistance policy adopted by the
health care entity and the availability of other public or private health insurance
coverage.
E. Notwithstanding this subsection, if federal regulations are implemented that set
forth requirements for health care entities to provide estimates to an insured patient, a
health care entity shall comply with federal regulations and does not commit a violation
of this subsection.
Sec. A-4. 22 MRSA §1718-J is enacted to read:
§1718-J. Prohibition of collection actions for noncompliance with good faith estimate
requirements for uninsured or self-pay patients
1. Definitions. As used in this section, unless the context otherwise indicates, the
following terms have the following meanings.
A. "Collection action" means any of the following actions:
(1) Attempting to collect a debt from a patient or patient guarantor by referring the
debt directly or indirectly to a debt collector, collection agency or other 3rd party
retained by or on behalf of a health care entity;
(2) Suing the patient or patient guarantor or enforcing an arbitration or mediation
clause in any health care entity documents, including contracts, agreements,
statements and bills; or
(3) Directly or indirectly causing a report to be made to a consumer reporting
agency.
B. "Collection agency" has the same meaning as "debt collector" has in Title 32,
section 11002, subsection 6.
C. "Consumer reporting agency" means any person that, for monetary fees or dues or
on a cooperative nonprofit basis, regularly engages in whole or in part in the practice
of assembling or evaluating consumer credit information or other information on
consumers for the purpose of furnishing consumer reports to 3rd parties. "Consumer
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 reporting agency" includes any person defined in 15 United States Code, Section
1681a(f). "Consumer reporting agency" does not include any business entity that
exclusively provides check verification or check guarantee services.
D. "Health care entity" has the same meaning as in section 1718-B, subsection 1,
paragraph B.
E. "Items or services" means all items and services, including individual items and
services and service packages, that are provided by a health care entity to a patient in
connection with an inpatient admission or an outpatient visit for which the patient is
charged.
F. "Patient guarantor" means the individual held responsible for a patient's bill.
2. Failure to comply with good faith estimate requirements; relief from collection
action. A health care entity that has not provided a good faith estimate in material
compliance with section 1718-C, subsection 1 on the date that items or services are
purchased by a patient or provided to a patient may not initiate or pursue a collection action
against the patient or patient guarantor for a debt owed for the items or services. Unless a
health care entity can demonstrate that the health care entity provided a good faith estimate
to the patient as requested, the health care entity or hospital may not further pursue a
collection action against the patient or patient guarantor.
Sec. A-5. 24-A MRSA §4303, sub-§21, as enacted by PL 2017, c. 232, §6, is
amended to read:
21. Health care price transparency tools. Beginning January 1, 2018, a carrier
offering a health plan in this State shall comply with the following requirements.
A. A carrier shall develop and make available a website accessible to enrollees and a
toll-free telephone number that enable enrollees to obtain information on the estimated
costs for obtaining a comparable health care service, as defined in Title 24‑A, section
4318‑A, subsection 1, paragraph A, from network providers, as well as quality data for
those providers, to the extent available. A carrier may comply with the requirements
of this paragraph by directing enrollees to the publicly accessible health care costs
website of the Maine Health Data Organization.
B. A carrier shall make available to the enrollee through a toll-free telephone number
the ability to obtain an estimated cost of a scheduled health care service or a comparable
health care service that is based on a description of the service or the applicable
standard medical codes or current procedural terminology codes used by the American
Medical Association provided to the enrollee by the provider. Upon an enrollee's
request, the carrier shall request additional or clarifying code information, if needed,
from the provider involved with the scheduled health care service or comparable health
care service. If the carrier obtains specific code information from the enrollee or the
enrollee's provider, the carrier shall provide the anticipated charge allowed amount and
the enrollee's anticipated out-of-pocket costs based on that code information, to the
extent such information is made available to the carrier by the provider.
Notwithstanding other provisions of this paragraph, a carrier does not commit a
violation of this paragraph if the carrier complies with federal regulations for price
transparency relating to an estimate of an enrollee's cost-sharing responsibility.
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 C. A carrier shall notify an enrollee that the amounts are estimates based on
information available to the carrier at the time the request is made and that the amount
the enrollee will be responsible to pay may vary due to unforeseen circumstances that
arise out of the proposed scheduled health care service or comparable health care
service. This subsection does not prohibit a carrier from imposing cost-sharing
requirements disclosed in the enrollee's certificate of coverage for unforeseen health
care services that arise out of the proposed scheduled health care service or comparable
health care service or for a procedure or service that was not included in the original
estimate. This subsection does not preclude an enrollee from contacting the carrier to
obtain more information about a particular admission, procedure or service with respect
to a particular provider.
D. Notwithstanding the provisions of this subsection and at the request of a carrier, the
superintendent may grant an additional year to comply with the provisions of this
subsection as long as the carrier has demonstrated a good faith effort to comply with
the provisions of this subsection and has provided the superintendent with an action
plan detailing the steps to be taken by the carrier to comply with this subsection no
later than January 1, 2019.
PART B
Sec. B-1. 22 MRSA §1718-I is enacted to read:
§1718-I. Hospital price transparency
1. Compliance with federal regulations. A hospital must comply with the price
transparency requirements established in 45 Code of Federal Regulations, Part 180,
Subparts A and B, as in effect on January 1, 2024.
2. Standard format; rules. A hospital must provide price transparency data in a
standardized format established in rule by the Maine Health Data Organization. The Maine
Health Data Organization shall adopt by rule a standardized format for a hospital to disclose
price transparency data that is the same or substantially similar to any format required by
federal regulations. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5, chapter 375, subchapter 2-A.
3. Failure to comply. A hospital that fails to comply with subsection 2 or any rule
adopted by the Maine Health Data Organization may be subject to a fine for failure to
comply under section 8705-A. Notwithstanding any provision of law to the contrary, the
Maine Health Data Organization shall retain any fine collected from a hospital for a failure
to comply with this section pursuant to a compliance action taken under section 8705-A.
4. Determination of material compliance; notice. Upon a determination that a
hospital is not in material compliance with subsections 1 and 2, the Maine Health Data
Organization shall notify the hospital that the hospital is not in material compliance and
require the hospital to take corrective action within 60 days to become materially
compliant. The Maine Health Data Organization shall adopt by rule standards for material
compliance that align with federal regulations. Rules adopted pursuant to this subsection
are routine technical rules as described in Title 5, chapter 375, subchapter 2-A.
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Statutes affected:
Bill Text LD 1740, HP 1119: 22.1718
Bill Text ACTPUB , Chapter 584: 22.1718, 24-A.4303