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132nd MAINE LEGISLATURE
FIRST SPECIAL SESSION-2025
Legislative Document No. 1511H.P. 995 House of Representatives, April 8, 2025
An Act to Expand Direct Health Care Service Arrangements
Reference to the Committee on Health Coverage, Insurance and Financial Services
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MORRIS of Turner. Page 1 - 132LR1901(01)
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2 as enacted by PL 2017, c. 112, ยง1, is amended to read:
3 health care service agreements
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5 following terms have the following meanings.
6 A. "Direct primary health care service agreement" means a contractual agreement
7 between a direct primary health care provider and an individual patient, or the patient's
8 legal representative, in which:
9 (1) The direct primary health care provider agrees to provide primary health care
10 services to the individual patient for an agreed-to fee over an agreed-to period of
11 time; and
12 (2) The direct primary health care provider agrees not to bill 3rd parties on a fee-
13 for-service or capitated basis for services already covered in the direct primary care
14 service agreement.
15 B. "Direct primary health care provider" means an individual who is a licensed
16 allopathic physician or osteopathic physician or other advanced health care practitioner
17 who is authorized to engage in independent medical practice in this State, who is
18 qualified to provide primary care services and who chooses to practice direct primary
19 health care by entering into a direct primary health care service agreement with
20 patients. The term includes, but is not limited to, an individual primary health care
21 provider or a group of primary health care providers.
22 C. "Primary care" means outpatient, nonspecialty health care services or the
23 coordination of health care for the purpose of:
24 ( 1) Promoting or maintaining mental and physical health and wellness; and
25 ( 2) The diagnosis, treatment or management of acute or chronic conditions caused
26 by disease, injury or illness.
27 D. "Health care" has the same meaning as in section 1711-C, subsection 1, paragraph
28 C.
29 health care service agreement is not an insurance
30 policy and is not subject to regulation by the Department of Professional and Financial
31 Regulation, Bureau of Insurance.
32 health care service agreement is an agreement
33 between the direct primary health care provider and either an individual or the individual's
34 representative, regardless of whether the periodic fee or other fees are paid by the
35 individual, the individual's representative or a 3rd party.
36 health care service agreement covers only the
37 services specified in the agreement. Any goods or services that are not covered by the
38 direct primary health care service agreement may be billed separately.
39 health care service agreement must clearly state within
40 the agreement that direct primary health care services are not considered health insurance
41 and do not meet requirements of any federal law mandating individuals to purchase health Page 2 - 132LR1901(01)
42 insurance and that the fees charged in the agreement may not be reimbursed or apply
43 towards a deductible under a health insurance policy with an insurer.
3 Other care not prohibited. A primary care provider is considered a direct primary
4 care provider only when the provider is engaged in a direct primary care service agreement
5 with a patient or group of patients. A primary care provider is not prohibited from
6 providing care to other patients under a separate agreement or contract with an insurer.
7 Other agreements not prohibited. This section does not prohibit a direct primary
8 care provider from entering into:
9 A. An agreement with an insurer offering a policy specifically designed to supplement
10 a direct primary care service agreement; or
11 B. A pilot program for direct primary care with a federal or state agency that provides
12 health coverage.
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14 Under current law, an individual can contract directly with a direct primary care
15 provider, which is a licensed allopathic or osteopathic physician or other advanced health
16 care practitioner who is authorized to provide primary care services, for the provision of
17 health care to that individual. This bill removes the requirement that the physician or
18 advanced health care practitioner be authorized to provide primary care services. The bill
19 also repeals provisions of law that do not expressly authorize or prohibit a primary care
20 provider from providing care to other patients or from entering into an agreement with an
21 insurer or a pilot program with a federal or state agency that provides health coverage.
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