ME LD2196

Beginning January 1, 2028, annual hospital price growth is limited to the Medicare inpatient prospective payment system hospital market basket percentage, and hospitals cannot charge more than 200% of Medicare rates for inpatient or outpatient services (with exceptions for critical access hospitals and financially distressed hospitals)

Hospitals exceeding price caps face civil fines of 110% to 200% of the excess charge amount, with the Office of Affordable Health Care responsible for monitoring compliance and determining financial distress status

Prior authorizations for chronic condition treatments must remain valid for one year, with renewals required no more frequently than every two years; new enrollees retain coverage for previously authorized services for 90 days after switching health plans

Insurers must pay at least 110% of Medicare rates for in-network primary care and behavioral health evaluation and management services

Starting with 2028 plan year filings, carriers must report detailed utilization trends and per-unit payment data by benefit category and by hospital to the Superintendent of Insurance