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P.L. 2001, chapter 439, PART ZZZ

P.L. 2003, c. 492 (amended original legislation)

CHAPTER 492

H.P. 27 - L.D. 20


An Act to Extend the Authority of the Health Care
System and Health Security Board



Be it enacted by the People of the State of Maine as follows:

Sec. 1. PL 2001, c. 439, Pt. ZZZ, §1, sub-§1, first is amended to read:

1. Board established. The Health Care System and Health Security Board, referred to in this section as the "board," consists of 19 20 members as follows:

Sec. 2. PL 2001, c. 439, Pt. ZZZ, §1, sub-§1, D and E are amended to read:

D. Two members of the House of Representatives appointed by the Speaker of the House of Representatives who are serving in the House of Representatives at the time of their appointment 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 who are serving in the Senate at the time of their appointment 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;

Sec. 3. PL 2001, c. 439, Part ZZZ, §1, sub-§1, G
is amended to read:

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.; and

(7) The public.

Sec. 4. PL 2001, c. 439, Pt. ZZZ, §1, sub-§§2 and 3
are amended to read:

2. Chairs. The first-named Senate member is the Senate chair and the first-named House member is the House chair of the board. The Senate and House chairs may continue to serve until successors are appointed.

3. Appointments; convening board.
All appointments must be made no later than 30 days following the effective date of this Part. Appointed members may continue to serve until their successors are appointed. The chairs shall call and convene the first meeting of the board within 30 days of completion of all appointments. The board may hold up to 4 meetings after June 30, 2003, all of which must be in the Augusta area.

Sec. 5. PL 2001, c. 439, Pt. ZZZ, §1, sub-§§6 to 9 are amended to read:

6. Staff assistance. The board may contract with and retain staffing and technical assistance from a health policy organization. Upon approval of the Legislative Council, the Office of Policy and Legal Analysis may provide necessary staffing services to the board.

7. Funding. The board may seek and accept outside funding through the public or private sector to advance its work and support its activities. Funds may not be appropriated from the General Fund to support any activity of the board, nor may expenses exceed available funding.

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. Public members not otherwise compensated by their employers or other entities whom they represent are entitled to receive reimbursement of necessary expenses and, upon demonstration of financial hardship, a per diem equal to the legislative per diem for 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 final report, together with any necessary implementing legislation, to the Second Regular Session of the 120th Legislature by March 1, 2002 for presentation to the First Regular Session of the 122nd Legislature by November 1, 2004. If the board requires an extension of time to make its report, it may apply to the Legislative Council, which may grant the extension. The board shall submit an interim report, together with any implementing legislation, to the First Regular Session of the 121st Legislature by January 15, 2003. Upon submission of the final report, the board may not take further action unless further action is authorized by law.

Sec. 6. Appropriations and Allocations. The following appropriations and allocations are made.

LEGISLATURE

Health Care System and Health Security Board


Initiative: Provides an allocation of Other Special Revenue funds for expenses of the board.

Other Special Revenue Funds 2003-04 2004-05
Personal Services $1,100 $0
All Other 5,202 0
________ ________
Other Special Revenue Funds Total $6,302 $0




Sec. 7. Retroactivity. This Act is retroactive to September 21, 2001.

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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