Maine

Maine became the 23rd state to enact a DPC defining "not insurance" law on 06/01/17.  A final copy of the law can be viewed here and this legislative summary page is a helpful reference as well.  Multiple DPC practices are operating within Maine's borders.  Be sure to review the Maine Revised Statutes Title 24-A: Maine Insurance Code when planning your DPC practice. The Maine Academy of Family Physicians has supported DPC with live review courses and has helpful information on its website as well. In addition Maine's NPR station completed a comprehensive 50+ minute story on May 21, 2015 involving multiple DPC practices in Maine.  It would be wise to review this guide from the Maine Medical Association as well.

Main also passed S.P. 372-L.D. 1197 in 2019 prohibiting the denial of services solely on the basis of the ordered service being placed by a direct primary care provider who is not a member of the carrier’s provider network.

“a carrier may not deny payment for any health care service covered under an enrollee's health plan based solely on the basis that the enrollee's referral was made by a direct primary care provider who is not a member of the carrier's provider network. A carrier may not apply a deductible, coinsurance or copayment greater than the applicable deductible, coinsurance or copayment that would apply to the same health care service if the service was referred by a participating primary care provider. A carrier may require a direct primary care provider making a referral who is not a member of the carrier's provider network to provide information demonstrating that the provider is a direct primary care provider through a written attestation or copy of a direct primary care agreement with an enrollee and may request additional information necessary to implement this subsection.”

The law is also explained an summarized by Bulletin 434 from the Maine Dept of Insurance. “When a provider has demonstrated that it has a DPCSA with the enrollee, the carrier must honor any referral made by that provider on the same terms that it would honor a referral made by a participating primary care provider. If the plan has procedures for enrollees to designate a specific primary care provider within the plan’s network, the carrier must treat a DPCSA as the functional equivalent of a network primary care provider designation.”