An Act To Establish a State Single-payor Health Insurance Plan
Maine Legislature, Session 121, LD 0889
Committee: Insurance and Financial Services
Sponsors: EDER, LERMAN, DUDLEY, LA VERRIERE-BOUCHER, PINEAU, PINGREE, WALCOTT

Legislative Document 
No. 889 
H.P.666 
House of Representatives, February 20,2003 
An Act To Establish a State Single-payor Health Insurance Plan 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative EDER of Portland. 
Cosponsored by Representative LERMAN of Augusta and 
'77/~/h.~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: DUDLEY of Portland, LA VERRIERE-BOUCHER of Biddeford, PINEAU of 
Jay, PINGREE of North Haven, WALCOTT of Lewiston. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 5 MRS A §12004-G, sub-§14-D is enacted to read: 
l4-D. 
Health 
Security 
Health 
Security 
Board 
Expenses 
Only 
24-A MRSA 
~ 
Sec. 2. 24-A MRSA c. 87 is enacted to read: 
CHAPTER 87 
MAINE SINGLE-PAYOR HEALTH CARE PLAN 
SUBCHAPTER 1 
GENERAL PROVISIONS 
§690l. 
Maine Single-payor Health Care Plan established 
There is established the Maine Single-payor Health Care Plan 
to provide health care coverage to all citizens of this State 
through a plan that emphasizes guality, cost containment, choice 
of provider and access to comprehensive, preventive and long-term 
care. 
§6902. 
Definitions 
As 
used 
in this 
chapter, 
unless 
the 
context 
otherwise 
indicates, the following terms have the following meanings. 
1. 
Agency. 
"Agency" means the Agency of Health Security, 
established in section 6921. 
2. 
Board. 
"Board" 
means 
the 
Health 
Security 
Board, 
established in Title 5, section l2004-G, subsection l4-D. 
3. 
Fund. 
"Fund" means the Maine Health Care Plan Fund, 
established in section 6922. 
4. 
Plan. 
"Plan" means the Maine Single-payor Health Care 
Plan, established in section 6901. 
5. 
Plan enrollee. 
"Plan enrollee" means a person enrolled 
in the plan. 
6. 
Provider. 
"Provider" means any person, organization, 
corporation or association that provides health care services and 
products and is authorized to provide those services and products 
under the laws of this State. 
"Provider" includes persons and 
Page l-LR0253(l) 
entities that provide treatment and care at least as inclusive as 
Medicaid coverage. 
1. 
Resident. 
"Resident" means a person who resides within 
the State, as defined by rules adopted by the board. 
§6903. 
Health Security Board 
1. 
Board 
established. 
The 
Health 
Security 
Board, 
as 
established 
in 
Title 
5, 
section 
12004-G, 
subsection 
14-D, 
consists of 19 members as follows: 
A. 
The commissioner or the commissioner's designee; 
B. 
The Executive Director of the Bureau of Health or the 
executive director's designee; 
C. 
The Executive Director of the Bureau of Revenue Services 
or the executive director's designee; 
D. 
The Senate chair of the joint standing committee of the 
Legislature 
having 
jurisdiction 
over 
health 
and 
human 
services matters; 
E. 
The House chair of the joint standing committee of the 
Legislature 
having 
jurisdiction 
over 
health 
and 
human 
services matters; and 
F. A representative of each of the following, appointed by 
the Governor and confirmed by the Legislature: 
(1) 
A statewide organization that advocates universal 
health care; 
(2) 
A statewide organization that represents 
Maine 
senior citizens; 
(3) 
A statewide organization that defends the rights 
of children; 
(4) 
An 
organization 
that 
provides 
services 
to 
low-income clients; 
(5) 
A statewide labor organization; 
( 6 ) 
An 
organization 
representing 
health 
care 
economists; 
(7) 
A statewide organization of physicians; 
(8) 
A statewide organization of nurses; 
(9) 
A statewide organization of health care providers; 
(10) 
A statewide organization of hospitals; 
( ll) 
A 
statewide 
organization 
of 
long-term 
care 
facilities; 
(12) 
The business community; 
( 13) 
An organization representing the self-employed; 
(14) 
The public. 
2. 
Duties of board. 
The duties of the board include: 
implementing this chapter; promoting the purposes of the plan; 
setting reimbursement rates for participating providers; adopting 
rules necessary to implement the plan; establishing 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; 
establishing 
a 
certificate of 
need; 
administering 
the 
revenues 
of 
the 
plan; 
employing 
staff 
as 
necessary to implement this chapter; developing plans and funding 
for training and assistance for workers in the health care sector 
displaced by moving to a single-payor health care system; 
and 
conducting public hearings annually or more frequently regarding 
resource allocation, revenues and services. 
The board shall stress prevention of disease and maintenance of 
heal th in the implementation of this plan and shall retain and 
strengthen existing health facilities whenever possible. 
§6904. 
Rulemaking 
The board shall adopt rules necessary to 
implement this 
chapter and negotiate reimbursement rates with providers. 
Rules 
adopted pursuant to this chapter are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
SUBCHAPTER 2 
ELIGIBILITY AND COVERED HEALTH CARE SERVICES 
§6911. 
Eligibility and covered health care services 
1. Eligibility. 
Residents are eligible to receive covered 
health care services under the plan in accordance with this 
section and must apply for an identification card to enroll in 
the plan. 
A. 
The board is responsible for collecting information and 
documentation from individuals and insurance companies and 
reimbursing providers in the State. 
A person who is unable to provide information or documentation of 
health care plan eligibility because of a health care condition 
is covered for the period in which that person is unable to 
provide the information. 
2. 
Covered health care services. 
The plan must provide 
coverage for health care services from a provider wi thin 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 this 
Title and must 
include all coverage offered by the Medicaid 
program. 
3. 
Service delivery. 
Covered health care 
services 
are 
governed by this subsection. 
A. 
Covered health care services must be provided to plan 
enrollees by participating providers who are located wi thin 
the State and who are chosen by the plan enrollees. 
B. 
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 
days per year. 
A plan 
enrollee may qualify to begin services out of state but, in 
order to receive continued treatment, 
may be requi red to 
receive 
treatment 
within 
the 
State. 
Reimbursement 
for 
services rendered out of state must be at rates set by the 
board. 
C. 
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. 
D. 
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. 
4. 
Role of other health care programs. 
Until the board 
determines otherwise, the plan is supplemental to all coverage 
available to a plan enrollee from another health care program, 
including, but not limited to, the following programs: 
A. 
The Medicare program of the Social Security Act, Title 
XVIII; 
B. 
The Medicaid program of the Social Security Act, Title 
C. 
The civilian health and medical program as referred to 
in 10 United States Code, Sections 1071 to 1106; 
D. 
The 
federal 
Indian Health Care 
Improvement 
Act, 
United States Code, Sections 1601 to 1682; 
E. 
Other 3rd party payor programs that may be billable for 
health care services; and 
F. 
Any state and local health programs, including, but not 
limi ted to, workers' 
compensation and employers' liability 
insurance pursuant to former Title 39 and Title 39-A. 
Health care services billed to 3rd-party payors must be paid for 
by those programs. 
Coverage 'J.nder the plan is supplemental to 
that coverage. 
SUBCHAPTER 3 
AGENCY OF HEALTH SECURITY 
§6921. 
Administration 
The Agency of Health Security is established to administer 
the plan. 
The agency operates as an independent agency of the 
State. 
§6922. 
Maine Health Care Plan Fund 
1. 
Fund established. 
The Maine Health Care Plan Fund is 
established to finance the plan. 
A. 
Deposits into the fund and expenditures from the fund 
must be made pursuant to this section and to rules adopted 
by the board to carry out the purposes of this section. 
Payments into the fund may include premiums charged to plan 
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• 
enrollees, payments from other governmental units, payments 
from 
3rd-party 
payors, 
payments 
under 
agreements 
of 
cooperation and coordination for plan enrollees in other 
insurance or health benefit programs and payments under any 
system of revenue or taxation imposed by the Legislature to 
fund the plan. 
B. 
All income generated pursuant to this chapter must be 
deposi ted into the fund, 
which may not lapse but must be 
carried forward from one fiscal year to the next. 
C. 
All funds remaining in the fund at the end of the fiscal 
year must be reported to the Legislature by January 1st of 
the 
following 
year 
and 
may 
be 
used, 
by 
vote 
of 
the 
Legislature, to expand the coverage of services paid for by 
the plan. 
D. 
Expenditures from the fund are authorized for payments 
to participating providers for health care services rendered 
and payments for administration of the fund, the plan and 
the agency. 
2. 
Budget. 
The annual administrative costs for the agency 
and for all administrative aspects of the plan may not exceed 5% 
of 
the total 
annual 
budget 
for 
the 
fund. 
The 
board shall 
implement cost control measures to reduce administrative costs 
and eliminate unnecessary health care. 
Cost control measures may 
not be implemented to limit necessary health care. 
3. 
Funding. 
Funding must be provided from a combination of 
sources, including: 
A. 
Payments 
from 
other 
government 
sources, 
including 
federal, state and other government health and aid programs: 
B. 
Payments from workers' compensation, pension and health 
insurance employee benefit plans and programs as provided by 
this chapter and the rules adopted to implement this chapter; 
C. 
Payments from state, county and municipal governmental 
units for coverage provided to employees of those units: 
D. 
Payments 
from 
any 
taxes 
or 
fees 
imposed 
by 
the 
Legislature to fund the plan, which may include but are not 
limited to 
corporate 
and individual 
income 
taxes: 
sales 
taxes: payroll taxes dedicated to the health care plan; any 
additional taxes to be determined by a feasibility study of 
economic impacts to individuals and businesses of payment 
options, 
including 
but 
not 
limited 
to 
corporate 
and 
individual 
income 
tax 
rate 
increases; 
sales 
tax 
rate 
increases: 
exclusions: 
dedicated to 
the board or 
elimination 
of 
sales 
tax 
exemptions 
and 
establishment 
of 
a 
payroll 
or 
other 
~:ax 
funding the plan: and other options proposed by 
the Legislature: and 
E. 
Payments by tobacco product manufacturers to the State 
in settlement of claims brought against them by the State. 
§6923. 
Reports 
1. 
Annual report. 
By January 1st of each year, the board 
shall submit to the Governor and to the Legislature an annual 
report of the 
agency's 
operations 
and activities during the 
previous year and the funding, tax and budget status of the plan. 
2. 
Public 
information. 
The 
board 
may 
publish 
and 
disseminate information helpful to the citizens of this State in 
making informed choices in obtaining health care in conj unction 
with the Bureau of Health. 
Sec. 3. Report. 
By January 1, 2004, the Health Security Board 
shall report to the joint standing committee of the Legislature 
having jurisdiction over human services matters on options for 
coordination of the Maine Single-payor Health Care Plan with 
other health care plans and options for the Maine Single-payor 
Health Care Plan to take over coverage of some persons on those 
other health care plans, with the plans to take effect January I, 
2005. 
SUMMARY 
This bill establishes the Maine Single-payor Health Care 
Plan. 
It establishes 
the 
Agency 
of 
Health Security 
as 
an 
independent 
agency 
to administer the plan. 
Under 
the plan, 
enrollees choose their own health care providers and the plan 
pays their bills. 
Coverage under the plan is supplemental to 
other coverage. 
The bill requires 
a 
report from 
the Health 
Security Board to the joint standing committee of the Legislature 
having jurisdiction over human services matters on the options 
for coordination of the plan with other health care plans and for 
the plan to take over coverage of some persons covered by those 
health care plans. 
The bill requires an annual report from the 
board to the Governor and the Legislature on the operation and 
activities of the plan. 
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