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P.L. 2001, chapter 439, PART ZZZ
Sec. ZZZ-1. Health Care System and Health Security Board.
1. Board established. The Health Care System and Health Security Board, referred to in this section as the "board,"
consists of 19 members as follows:
A. The Commissioner of Human Services or the commissioner's designee;
B. The Executive Director of the State Employee Health Commission or the director's designee;
C. The State Tax Assessor or the assessor's designee;
D. Two members of the House of Representatives appointed by the Speaker of the House of Representatives with preference
to members of the joint standing committee of the Legislature having jurisdiction over health and human services
matters, the joint standing committee of the Legislature having jurisdiction over appropriations and financial
affairs and the joint standing committee of the Legislature having jurisdiction over banking and insurance matters;
E. Two members of the Senate appointed by the President of the Senate with preference to members of the joint standing
committee of the Legislature having jurisdiction over health and human services matters, the joint standing committee
of the Legislature having jurisdiction over appropriations and financial affairs and the joint standing committee
of the Legislature having jurisdiction over banking and insurance matters;
F. A representative of each of the following, appointed by the President of the Senate:
(1) A statewide organization that advocates universal health care;
(2) A statewide organization that defends the rights of children;
(3) A statewide organization representing health insurers and health maintenance organizations;
(4) Health care economists;
(5) A statewide organization of physicians; and
(6) Small hospitals in the State; and
G. A representative of each of the following, appointed by the Speaker of the House:
(1) A statewide organization that represents Maine senior citizens;
(2) A statewide labor organization;
(3) A statewide organization of nurses;
(4) Large hospitals in the State;
(5) The business community; and
(6) An organization representing the self-employed.
2. Chairs. The first-named Senate member is the Senate chair and the first-named House member is the House chair
of the board.
3. Appointments; convening board. All appointments must be made no later than 30 days following the effective date
of this Part. The chairs shall call and convene the first meeting of the board within 30 days of completion of
all appointments.
4. Purpose. The purpose of the board is to develop recommendations to provide health care coverage to all
citizens of this State through a plan or plans that emphasize 24-hour coverage, quality, cost containment, choice
of provider and access to comprehensive, preventive and long-term care.
5. Duties of board. The board has the following duties.
A. As its first priority, the board shall undertake a review to:
(1) Determine what percentage of health care benefits are paid from automobile insurance, general liability
insurance and workers' compensation insurance;
(2) Assess what, if any, savings are associated with a simplified billing system;
(3) Assess what, if any, savings would be realized by schools and correctional facilities with a single-payor system
based on their current expenses for services related to health care such as occupational therapy, physical therapy
and speech therapy; and
(4) Assess what, if any, savings are associated with a single-payor system by comparing hospitals of similar size
in the State and other states; and
(5) In its assessment, the board shall examine prior studies conducted in Maine and other states.
B. In developing proposals to implement a single-payor plan to provide health care coverage to all citizens
of this State, the board shall make recommendations related to standards for:
(1) Eligibility for coverage under the plan for residents of the State, including a requirement that residents
must apply for an identification card to enroll in the plan, responsibility for collection from individuals and
insurance companies and reimbursement for providers in the State;
(2) The types of health care services covered under the plan. The plan must provide coverage for health care services
from a provider within this State if those services are determined medically necessary by the provider for the
patient, except that the plan may not provide cosmetic services. Copayments may be charged only as charged under
current Medicaid coverage. Deductibles may not be charged to plan enrollees. The plan must be at least as inclusive
as Medicaid coverage. This subsection does not preclude supplementary benefit insurance for services that are not
medically necessary. Covered health care must include all services and providers for which coverage is mandated
under the Maine Revised Statutes, Title 24-A and must include all coverage offered by the Medicaid program;
(3) A system for the delivery of health care services throughout the State. Covered health care services must be
provided to plan enrollees by participating providers who are located within the State and who are chosen by the
plan enrollees. The plan must pay for health care services provided to a plan enrollee while the enrollee is temporarily
outside the State. The maximum period of time a plan enrollee may be covered while out of state is 90 days per
year. A plan enrollee may qualify to begin services out of state but, in order to receive continued treatment,
may be required to receive treatment within the State. Reimbursement for services rendered out of state must be
at rates set by the board. A participating provider may not charge plan enrollees or 3rd parties for covered health
care services in excess of the amount reimbursed to that provider by the plan. A participating provider may not
refuse to provide services to a plan enrollee on the basis of health status, medical condition, previous insurance
status, race, color, creed, age, national origin, citizenship status, gender, sexual orientation, disability or
marital status; and
(4) The role of other health care programs including, but not limited to, the following programs: the Medicare
program of the federal Social Security Act, Title XVIII; the Medicaid program of the federal Social Security Act,
Title XIX; the civilian health and medical program as referred to in 10 United States Code, Sections 1071 to 1106;
the federal Indian Health Care Improvement Act, 25 United States Code, Sections 1601 to 1682; other 3rd-party payors
who may be billable for health care services; and any state and local health programs, including, but not limited
to, workers' compensation and employers' liability insurance pursuant to the Maine Revised Statutes former Title
39 and Title 39-A.
The board shall also examine issues related to the implementation of a single-payor plan for universal coverage
and access such as: promoting the purposes of the plan; setting reimbursement rates for participating providers;
rules necessary to implement the plan; systems for enrollment, registration of providers for participation, rate
setting and contracts with providers of services and pharmaceuticals; developing budgets with hospitals and institutional
providers; administration of revenues of the plan; employment of staff as necessary to implement the plan; development
of plans and funding for training and assistance for workers in the health care sector displaced by moving to a
single-payor health care system; addressing the unique issues related to the delivery of a single-payor health
care system among the State's border communities and the impact on health care practitioners, providers and residents
of those communities; and conducting public hearings annually or more frequently regarding resource allocation,
revenues and services.
C. The board shall examine funding for the single-payor plan from a combination of sources, including
payments from government sources, including federal, state and other governmental health care and aid programs;
payments from workers' compensation, pension and health insurance employee benefit plans; payments from state,
county and municipal governmental units for coverage; payments from tobacco settlement funds; and payments from
any taxes or fees based on the results of the feasibility study required under paragraph D.
D. The board shall conduct a feasibility study of the economic impacts on individuals and businesses of a single-payor
plan that guarantees a minimum 5% savings over existing health care costs and the impact on individuals and businesses
of payment options and benefits should those options be necessary, including but not limited to increasing corporate
and individual income tax rates; increasing sales tax rates; eliminating sales tax exemptions and exclusions; and
establishing a payroll or other tax dedicated to funding the plan. The board shall also address the potential positive
or negative impact of the plan on the State's economy.
E. The board shall stress prevention of disease and maintenance of health in developing proposals to implement
the single-payor plan and shall attempt to retain and strengthen existing health facilities whenever possible in
developing those proposals.
F. The board may examine any other issues or gather information necessary to fulfill its purpose and duties.
The board may choose to organize subcommittees of its members to carry out the duties described in this subsection,
except that a subcommittee may not take any action without a final decision by the entire board. Any action or
decision of the board must be made by majority vote.
6. Staff assistance. The board may contract with and retain staffing and technical assistance from a health
policy organization.
7. Funding. The board may seek and accept outside funding through the public or private sector to advance
its work.
8. Compensation. Those members of the board who are Legislators are entitled to receive the legislative
per diem as defined in the Maine Revised Statutes, Title 3, section 2 and reimbursement for travel and other necessary
expenses related to their attendance at meetings of the board.
9. Report. Based on its review, the board shall develop recommendations regarding the implementation of
a single-payor plan to provide health care coverage to all citizens of this State and shall submit its report,
together with any necessary implementing legislation, to the Second Regular Session of the 120th Legislature by
March 1, 2002. If the board requires an extension of time to make its report, it may apply to the Legislative Council,
which may grant the extension. Upon submission of the report, the board may not take further action unless further
action is authorized by law.
Sec. ZZZ-2. Appropriation. The following funds are appropriated from the General Fund to carry out the purposes
of this Part.
2001-02
LEGISLATURE
Health Care System and Health Security Board
Personal Services $660
All Other 10,000
Provides funds for the per diem and expenses of legislative members of the Health Care System and Health Security
Board, to conduct public hearings, to contract for staffing and technical assistance and to print the required
report.
LEGISLATURE ____________
TOTAL $10,660
Sec. ZZZ-3. Allocation. The following funds are allocated from Other Special Revenue to carry out the purposes
of this Part.
2001-02
LEGISLATURE
Health Care System and Health Security Board
All Other $500
Provides funds as a base allocation in the event that outside sources of revenue are received by the Health Care
System and Health Security Board.
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