An Act To Provide Maine Consumers Information about the Cost and Quality of Health Care Services in Maine
Maine Legislature, Session 121, LD 0857
Committee: Insurance and Financial Services
Sponsors: KANE, MA YO, CANAVAN, CRA YEN, FAIRCLOTH, O'NEIL, TREAT
Amends: 22 MRSA §8702, 22 MRSA §8703, 22 MRSA §8712, 32 MRSA §2600, 32 MRSA §3300-B

Legislative Document 
No. 857 
H.P.634 
House of Representatives, February 20, 2003 
An Act To Provide Maine Consumers Information about the Cost 
and Quality of Health Care Services in Maine 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative KANE of Saco. 
Cosponsored by Senator MA YO of Sagadahoc and 
/Jf~/h.~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: CANAVAN of Waterville, CRA YEN of Lewiston, FAIRCLOTH of Bangor, 
O'NEIL of Saco, W ALCOTI of Lewiston, Senator: TREAT of Kennebec. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec.!. 22 MRSA §!832 is enacted to read: 
S183Z. 
Price disclosure 
Each 
hospital, 
ambulatory 
surgical 
facility 
or 
other 
institution of hospitalization licensed under this chapter shall 
maintain a price list of the most common inpatient services and 
outpatient procedures 
rendered. 
For 
inpatient services, 
the 
price list must include a per diem bed charge and an average 
charge for all ancillary charges for the 15 most common services 
involving inpatient stays. 
If the per diem bed charge includes 
all ancillary charges for a procedure, no further information is 
reguired. 
For outpatient procedures 
for which 
an 
individual 
would not incur a bed charge, the price list must include the 20 
most common surgical and diagnostic procedures rendered by the 
licensee. 
The licensee may not be reguired to publicly post the 
price list. 
The licensee shall post in a conspicuous place a 
statement about the availability of the price list for the most 
common services involving inpatient stays and procedures. 
The 
licensee shall provide its price list to a consumer upon oral or 
written reguest by the consumer. 
The price list may include a 
disclaimer regarding changes or other factors that may affect 
actual charges for services rendered by the licensee. 
Sec. 2. 22 MRSA §8702. sub-§9-A is enacted to read: 
9-A. 
Ouality" data. 
"Quality data" means data submitted by 
health care providers from which health care service indicators 
can be developed and reported to the public. 
Sec. 3. 22 MRSA §8703, sub-§l, as amended by PL 200L c. 457, 
§4, is further amended to read: 
1. 
Objective. 
The FRFF9se purposes of the organization is 
~ to create and maintain a useful, objective, reliable and 
comprehensive health information database that is used to improve 
the health of Maine citizens and to issue periodic reports. 
This 
database must be publicly accessible while protecting patient 
confidentiality 
and 
respecting 
providers 
of 
care. 
The 
organization shall 
collect, 
processL 
aBa 
analyze 
and 
report 
clinical aBaL 
financial 
and quality data as defined in this 
chapter. 
Sec. 4. 22 MRS A §8704, sub-§l, ,A, as amended by PL 2001, c. 
457, §7, is further amended to read: 
A. 
The board shall develop and implement data collection 
policies 
and 
procedures 
for 
the 
collection, 
processing, 
Page l-LR1244(1) 
• 
.. 
.. 
.. 
storage 
and 
analysis 
of 
clinical, 
financial L 
aae 
restructuring 
and 
quality data 
in 
accordance 
with 
this 
subsection for the following purposes: 
(1) 
To 
use, 
build and 
improve 
upon 
and coordinate 
existing data sources and measurement efforts through 
the integration of data systems and standardization of 
concepts; 
(2) 
To coordinate the development of a linked public 
and private sector information system; 
(3) 
To emphasize data that is useful, relevant and is 
not duplicative of existing data; 
(4) 
To minimize the burden on those providing data; 
(5) 
To 
preserve 
the 
reliability, 
accuracy 
integrity of collected data while ensuring that 
data is available in the public domain; aae 
and 
the 
(6) 
To 
collect information from providers 
who 
were 
required 
to 
file 
data 
with 
the 
Maine 
Health 
Care 
Finance 
Commission. 
The 
organization 
may 
collect 
information 
from 
additional 
providers 
only 
when 
a 
linked 
information 
system 
for 
the 
electronic 
transmission, 
collection 
and 
storage 
of 
data 
is 
reasonably available to providersTL 
(7) 
Pursuant to rules adopted by the board, to develop 
a meaningful, easy-to-understand report of quality data 
for distribution to consumers. 
The organization shall 
distribute 
the 
quality 
data 
report 
on 
a 
publicly 
accessible site on the Internet or, 
upon 
a 
written 
request 
by 
a 
consumer, 
via mail 
or 
e-mail. 
Rules 
adopted for reports of quality data must be developed 
in conjunction with affected providers and payors, if 
applicable. 
Rules adopted pursuant to this subsection 
are routine technical rules 
as defined in Title 
5, 
chapter 375, subchapter 2-A; 
(8) 
To submit at least annually the reports required 
in section 8712. 
The organization shall distribute the 
reports 
required 
in 
section 
8712 
on 
a 
publicly 
accessible site on 
the Internet or, 
upon 
a 
written 
request by a consumer, via mail or email; 
(9) 
To publish in 2 local papers at least twice per 
year the availability of the quality data reports and 
to publish as a paper document the guality data reports 
twice per year: and 
(10) 
To develop and issue guality and cost reports the 
cost 
of 
which 
must 
be 
borne 
by 
the 
sale 
to 
nongovernment entities of clinical data collected by 
the organization. 
Sec. 5. 22 MRSA §8712 is enacted to read: 
§S712. 
Cost reports for consumer use 
The 
organization shall distribute at least annually the 
following clearly labeled and easy-to-understand cost reports for 
consumer use. 
The reports must contain data elements by payor 
type such as, but not limited to, Medicare, Medicaid, self-pay, 
uncompensated care and insured, aggregated for all insurers and 
3rd-party administrators. 
The board may adopt rules to add other 
data elements to the reports as long as the reports remain easy 
to 
understand. 
Rules 
adopted pursuant 
to 
this 
section 
are 
routine technical rules 
as defined in Title 5, 
chapter 
375, 
subchapter 2-A. 
1. 
HODIRaternity inpatient medical discharge report. 
for 
each 
hospital, 
a 
report 
on 
nonmaternity 
inpatient 
medical 
discharges must contain the following data elements for the 15 
most common diagnostically related groups of services rendered by 
each hospital in an easy-to-understand format: 
A. 
The 
total 
number 
of 
discharges 
per 
diagnostically 
related group of services for all payor types: 
B. 
The 
number 
of discharges per diagnostically related 
group of services per payor type; 
C. 
The average charge per diagnostically related group of 
services per payor type; and 
D. 
The average length of stay to at least 2 decimal places 
per diagnostic related group of services per payor type. 
2. 
HODIRaterni ty inpatient surgical discharge report. 
for 
each 
hospital, 
a 
report 
on 
nonmaternity 
inpatient 
surgical 
discharges must contain the following data elements for the 15 
most common diagnostic related groups of services rendered by 
each hospital in an easy to understand format: 
A. 
The 
total 
number 
of 
discharges 
per 
diagnostically 
related group of services for all payor types: 
.. 
B. 
The 
number 
of discharges 
per diagnostically related 
group of services per payor type; 
C. 
The average charge per diagnostically related group of 
services per payor type; and 
D. 
The average length of stay to at least 2 decimal places 
per diagnostically related group of services per payor type. 
3. 
Maternity 
ip,patient 
discharge 
report. 
For 
each 
hospital, a report on maternity inpatient discharges must contain 
the following data elements for maternity discharges rendered by 
each hospital in an easy-to-understand format: 
A. 
The total number of discharges per type of delivery for 
all payor types; 
B. 
The number of discharges per type of delivery per payor 
~ 
c. 
The average charge per type of delivery per payor type; 
and 
D. 
The average length of stay to at least 2 decimal places 
per type of delivery per payor type. 
4. 
Hospital-based outpatient 
surgical 
procedure 
report. 
For each hospital, a report on hospital-based outpatient surgical 
procedures must contain the following data elements for the 15 
most common surgical procedures rendered by each hospital in an 
easy-to-understand format: 
A. 
The total number of procedures for all payor types; 
B. 
The number of procedures per payor type; and 
C. 
The 
average 
charge 
per 
surgical 
procedure 
and 
per 
episode of surgical care per payor type. 
5. 
Hospital-based outpatient diagnostic procedure report. 
For 
each 
hospital, 
a 
report 
on 
hospital-based 
outpatient 
diagnostic procedures must contain the following data elements 
for the 15 most common diagnostic procedures rendered by each 
hospital in an easy-to-understand format: 
A. 
The total number of procedures for all payor types; 
B. 
The number of procedures per payor type; 
C. 
The average charge per procedure per payor type; and 
D. 
The average payment in percentage format per procedure 
per payor type. 
6. 
Hospital-based outpatient laboratory procedure report. 
For 
each 
hospital, 
a 
report 
on 
hospital-based 
outpatient 
laboratory procedures must contain the following data elements 
for the 15 most common diagnostic procedures rendered by each 
hospital in an easy-to-understand format: 
A. 
The total number of procedures for all payor types; 
B. 
The number of procedures per payor type; and 
c. 
The average charge per procedure per payor type. 
1. 
Nonhospital-based outpatient surgical procedure report. 
For each medical facility that is not a hospital, 
a report on 
nonhospital-based outpatient surgical procedures must contain the 
following 
data 
elements 
for 
the 
most 
common 
surgical 
procedures 
rendered by each facility in an easy-to-understand 
format: 
A. 
The total number of procedures for all payor types; 
B. 
The number of procedures per payor type; and 
c. 
The 
average charge per procedure and per e12isode of 
surgical care per payor type. 
8. 
Nonhospital-based 
outpatient 
diagnostic 
procedure 
report. 
For each medical facility that is not a hospital, 
a 
report on nonhospital-based out12atient diagnostic procedures must 
contain the 
following 
data elements 
for 
the 
most 
common 
diagnostic 
12rocedures 
rendered 
by 
each 
facility 
in 
an 
easy-to-understand format: 
A. 
The total number of 12rocedures for all payor types; 
B. 
The number of procedures per payor type; and 
C. 
The average charge per procedure per payor type. 
9. 
Nonhospital-based 
outpatient 
laboratory 
procedure 
report. 
For each medical facility that is not a hospital, 
a 
report on nonhospital-based outpatient laboratory procedures must 
contain the 
following 
data elements 
for 
the 
most 
common 
laboratory 
procedures 
rendered 
by 
each 
facility 
~n 
an 
easy-to-understand format: 
( 
A. 
The total number of procedures for all payor types; 
B. 
The number of procedures per payor type; and 
C. 
The average charge per procedure per payor type. 
10. 
Comparison report of diagnostically related groups and 
outpatient procedures. 
A report that compares the 15 most common 
diagnostically related groups and the 15 most common outpatient 
procedures for all hospitals and facilities in the State to 
similar data for medical care rendered in 2 other states in the 
region, one of which must be Massachusetts. 
Sec. 6. 32 MRSA §2600.B is enacted to read: 
§2600-B. 
Price disclosure 
Each professional licensed under this chapter shall maintain 
a price list containing, at a minimum, the 15 most common medical 
procedures 
rendered 
by 
that 
licensed 
professional. 
The 
professional may not be 
reguired to publicly post the price 
list. 
The professional shall post at the professional's place of 
business 
in 
a 
conspicuous 
place 
a 
statement 
about 
the 
availabili ty of the price list for the most common procedures. 
The professional shall provide the price list to a consumer upon 
oral or written reguest by the consumer. 
The price list may 
include a disclaimer regarding changes or other factors that may 
affect actual charges for services rendered by the professional. 
Sec. 7. 32 MRSA §3300-B is enacted to read: 
§3300-B. 
Price disclosure 
Each professional licensed under this chapter shall maintain 
a price list containing, at a minimum, the 15 most common medical 
procedures 
rendered 
by 
that 
licensed 
professional. 
The 
professional may not 
be 
required to publicly post the price 
list. 
The professional shall post at the professional's place of 
business 
in 
a 
conspicuous 
place 
a 
statement 
about 
the 
availability of the price list for the most common procedures. 
The professional shall provide a price list to a consumer upon 
oral or written request by the consumer. 
The price list may 
include a disclaimer regarding changes or other factors that may 
affect actual charges for services rendered by the professional. 
This bill 
collect quality 
SUMMARY 
directs the Maine 
data and produce 
Health Data Organization 
periodic quality and cost 
to 
of 
medical care 
medical care 
Organization 
in the State 
the region. 
reports for 
consumers' 
use in determining their 
needs. 
The bill also requires the Maine Health Data 
to produce similar reports for medical care rendered 
compared to medical care rendered in other states in 
This bill also requires hospitals and certain other health 
care 
institutions 
licensed under 
the 
Maine 
Revised Statutes, 
Title 22, chapter 405 to develop, maintain and release a price 
list of the 15 most common services involving inpatient stays and 
outpatient procedures rendered for use by consumers for their 
medical care needs. 
This bill also requires medical doctors and 
osteopaths to develop, maintain and release a price list of at 
least the 15 most common procedures rendered by that professional 
for use by consumers for their medical care needs.