Resolve, To Reestablish the Health Care System and Health Security Board
Maine Legislature, Session 122, LD 0032
Committee: Insurance and Financial Services

Legislative Document 
No. 32 
H.P.35 
House of Representatives, January 6,2005 
Resolve, To Reestablish the Health Care System and Health Security 
Board 
(EMERGENCY) 
Reported by Representative PERRY of Calais for the Health Care System and Health 
Security Board pursuant to Public Law 2001, chapter 439, Pt. ZZZ, as amended by Public Law 
2003, chapter 492. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed under Joint Rule 218. 
Printed on recycled paper 
17/~ 
/J7.7Il~ 
MILLICENT M. MacFARLAND 
Clerk 
Emergency preamble. 
Whereas, acts 
and 
Legislature 
do 
not 
become 
effective 
until 
adjournment unless enacted as emergencies; and 
resolves 
of 
the 
days 
after 
Whereas, the Health Care System and Health Security Board 
established in Public Law 2001, chapter 439 has determined that 
additional work is needed to monitor current health care reform 
efforts before making a final recommendation on a single-payer 
health care plan; and 
Whereas. 
the 
board 
has 
completed 
substantial 
work 
to 
determine the feasibility of a single-payer health care plan for 
this State; and 
Whereas, the 
board 
intends 
to 
make 
recommendations 
to 
implement a single-payer health care plan if other reform efforts 
are not successful; 
Whereas, universal 
health 
care 
coverage 
for 
all 
Maine 
citizens must be achieved as soon as possible; and 
Whereas, the 
board 
has 
adequate 
funds 
to 
support 
its 
activities; and 
Whereas, in the judgment of the Legislature, these facts 
create an emergency wi thin the meaning of the Constitution of 
Maine 
and 
require 
the 
following 
legislation 
as 
immediately 
necessary for the preservation of the public peace, health and 
safety; now, therefore, be it 
Sec. 1. Board reestablished. Resolved: 
That the Health Care 
System 
and 
Health 
Security 
Board, 
which 
was 
originally 
established in Public 
Law 
2001, 
chapter 
439, 
Part 
ZZZ 
and 
referred to in this resolve as "the board," is reestablished. The 
board consists of 20 members as follows: 
A. 
The Commissioner of Health and 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 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 jurisdict.ion over appropriations and 
financial affairs and the 
j oint standing committee of the 
Page l-LR013 9 (1) 
Legislature having jurisdiction over insurance and financial 
services matters; 
E. 
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 insurance and financial 
services 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; 
(6) 
An organization representing the self-employed; and 
(7) 
The public; and be it further 
Sec. 2. Chairs. Resolved: 
That 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; and be it further 
Sec. 3. Members; appointments; meetings. Resolved: 
That those 
members serving on the Health Care System and Health Security 
Board established by Public Law 2001, chapter 439, Part ZZZ on 
November 
1, 
2004 
continue to serve unless they submit their 
resignations to the chairs. 
All appointments for vacancies to 
the board as of November 1, 2004 must be made no later than 30 
days following the effective date of this resolve. 
Appointed 
members 
may 
appointed. 
continue 
The chairs 
to 
serve 
shall call 
until 
and 
board as necessary; and be it further 
their 
successors 
convene meetings of 
are 
the 
Sec. 4. Board purpose. Resolved: That the purpose of the board 
is to develop recommendations to provide health care coverage to 
all citizens of this State through a single-payer health care 
plan that emphasizes 
access 
to comprehensive, 
preventive 
and 
long-term 
care; 
quality; 
cost 
containment; 
and 
choice 
of 
provider; and be it further 
Sec. 5. Duties of board. Resolved: 
That the board has 
the 
following duties. 
A. 
In developing a proposal to implement a single-payer 
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 this 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 the 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 
MaineCare 
coverage. 
Deductibles may not be charged to plan enrollees. The 
plan 
must 
be 
at 
least 
as 
inclusive 
as 
MaineCare 
coverage. This paragraph does not preclude supplemental 
insurance 
coverage 
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 
MaineCare 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 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; 
(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, 
United States Code, Sections 
1601 
to 
1682; 
the 
statewide 
plan provided 
through 
Dirigo 
Health; 
other 
3rd party payers 
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, Title 
39-A; and 
(5) 
Other issues 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 
necessary staff to implement the plan; development of 
plans and funding for training and assistance of health 
care workers displaced by the State's moving 
to 
a 
single-payer health care plan; addressing the unique 
issues related to the delivery of a single-payer health 
care plan among the State's border communities and the 
impact on providers and residents of those communities; 
and 
conducting 
public 
hearings 
annually 
or 
more 
frequently regarding resource allocation, revenues and 
services; 
B. 
The board shall examine funding for the single-payer 
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 payment from any taxes or fees based 
on 
the results of 
the 
feasibility study prepared under 
contract with the board in December 2002; 
C. 
The 
board 
shall 
stress 
prevention 
of 
disease 
and 
maintenance of health in developing proposals to implement 
the 
single-payer 
plan 
and 
shall 
attempt 
to 
retain 
and 
strengthen existing health care facilities whenever possible 
in developing those proposals; and 
D. 
The board shall evaluate current health care reform 
efforts, including but not limited to Dirigo Health, and may 
examine any other issues or gather information as necessary 
to fulfill its purpose and duties; and be it further 
Sec. 6. Staff assistance. Resolved: 
That upon approval of the 
Legislative Council, the Office of Policy and Legal Analysis may 
provide necessary staffing services to the board. 
The board may 
also contract with and retain staffing and technical assistance 
from a health policy organization; and be it further 
Sec. 7. Funding. Resolved: 
That the board may seek and accept 
outside funding through the public or private sector to advance 
its work 
and 
support its activities. 
Any 
unexpended 
funds 
allocated to the board as of November 1, 2004 must be carried 
forward for use by the board and may not lapse. 
Funds may not be 
appropriated from the General Fund to support any activity of the 
board, 
nor may expenses exceed available funding; 
and be it 
further 
Sec. 8. Compensation. Resolved: 
That 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 
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; and be it further 
Sec. 9. 
Report. Resolved: 
That 
the 
board 
shall 
develop 
recommendations 
regarding the implementation of a single-payer 
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 122nd Legislature by November 
1, 
2006. 
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 final report, the board may not take further 
action unless further action is authorized by law. 
Emergency clause. 
In view of the emergency cited in the 
preamble. this resolve takes effect when approved. 
SUMMARY 
This resolve reestablishes the Health Care System and Health 
Security Board, which was originally established in Public Law 
2001, chapter 439, through the next biennium of the Legislature. 
The bill requires 
that the board 
submit 
a 
final 
report by 
November 1, 2006 to the 122nd Legislature. 
The bill allows those 
members serving on the board as of November 1, 2004 to continue 
as members. 
It also preserves any unexpended funds allocated to 
the board for use to pay future expenses.