An Act To Strengthen and Improve Review Procedures in the Certificate of Need Program
Maine Legislature, Session 122, LD 1814
Committee Amendment CA_A_H934 (House)

COMMITTEE AMENDMENT .,4 to H.P. 1254, L.D. 1814, Bill, "An Act To 
Strengthen and Improve Review Procedures in the Certificate of Need Program" 
Amend the bill by striking out the title and substituting the following: 
'Resolve, To Establish the Work Group To Review and Recommend 
Improvements for the Certificate of Need Program' 
Further ~end the bill by striking out everything after the title and inserting in its 
place the following: 
'Sec. 1. Work group established. Resolved: That the Work Group to Review 
and Recommend Improvements for the Certificate of Need Program, referred to in this 
resolve as "the work group," is established; and be it further 
Sec. 2. Work group membership. Resolved: That the work group consists of 
members appointed as follows. 
1. The President of the Senate and Speaker of the House shall appoint 6 members to 
the work group as follows: 
A. The President of the Senate shall appoint one member of the Senate who serves 
on the Joint Standing Committee on Health and Human Services and 2 
representatives from businesses, unions, advocacy organizations or public health 
groups; and 
B. 
The Speaker of the House shall appoint one member of the House of 
Representatives who serves on the Joint Standing Committee on Health and Human 
Services and 2 representatives from businesses, unions, advocacy organizations or 
public health groups. 
The Senate and House appointees must represent the 2 major political parties. Businesses, 
unions, advocacy organizations and public health groups must each be represented when 
the appointments of the President of the Senate and the Speaker of the House are 
combined. 
COMMITTEE AMENDMENT 
~,,. 
COMMITTEE AMENDMENT A 
to H.P. 1254, L.D. 1814 
2. 
The Governor shall appoint 4 medical representatives: 2 representatives of 
hospitals, nominated by the Maine Hospital Association; one representative of a statewide 
association of physicians, nominated jointly by the Maine Medical Association and the 
Maine Osteopathic Association; and one· representative of the ambulatory surgical 
centers. 
3. The Director of the Governor's Office of Health Policy and Finance, or the 
director's designee, and the Director of Licensing and Regulatory Services within the 
Department of Health and Human Services shall serve as nonvoting ex officio members; 
and be it further 
Sec. 3. 
Chairs. Resolved: 
That the Senate member and the House of 
Representatives member of the work group shall serve as cochairs of the work group; and 
be it further 
Sec. 4. 
Appointments; convening of work group. Resolved: 
That all 
appointments must be made no later than 30 days following the effective date of this 
resolve. The appointing authorities shall notify the Executive Director of the Legislative 
Council once all appointments have been completed. 
Within 15 days after the 
appointment of all members, the chairs shall call and convene the first meeting of the 
work group; and be it further 
Sec. 5. Duties. Resolved: That the work group may hold Up' to 4 meetings to 
prioritize and examine some or all of the following issues. Based on findings from the 
examination of the prioritized issues, the work group shall identify improvements and 
make recommendations for changes in law or rule. The work group may examine the 
following issues: 
1. Recent changes made by law or rule to the certificate of need program and the need 
for any modifications to the law or rule; 
2. The current dollar amount threshold used in determining whether a project requires 
review and, if inadequate, a potential process for identifying projects that fall below the 
threshold; 
3. The current statutory authority of and methods used by the Department of Health 
and Human Services to determine whether review is needed. This should include the 
definition of "reviewable project" and clarification of the term "new service"; 
4. The current statutory authority of and methods used by the Department of Health 
and Human Services to define co~unity need for new services or facilities; 
5. The relationship between the State Health Plan, the certificate of need process and 
the capital investment fund; 
6. The roles of the Maine Quality Forum; the Department of Health and Human 
Services, Maine Center for Disease Control and Prevention; and the Department of 
Professional and Financial Regulation, Bureau of Insurance in the certificate of need 
review process; 
7. The criteria used by the Department of Health and Human Servcies for evaluating 
a certificate of need application along with procedures for public hearings and the use of 
review panels; 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT A 
to H.P. 1254, L.D. 1814 
8. Historical review of revenues and expenditures in the certificate of need unit to 
identify and detennine the amount of resources that are adequate to have a highly 
functioning unit; 
9. Historical review of the certificate of need application process including number of 
submissions, approvals, disapprovals and withdrawn applications and associated 
timelines to determine any improvements needed; 
10. Review of the most recent studies on the impact that the competitive market 
versus regulation has on health care costs and access; and 
11. Additional topics determined by unanimous agreement of the work group 
members; and be it further 
Sec. 6. Staff assistance. Resolved: That the Legislative Council shall provide 
necessary staffing services to the work group; and be it further 
Sec. 7. Compensation. Resolved: That legislative members of the work group 
are entitled to receive the legislative per diem, as defmed in the Maine Revised Statutes, 
Title 3, section 2, and reimbursement for travel and other necessary expenses related to 
their attendance at authorized meetings of the work group. Public members not otherwise 
compensated by their employers or other entities that they represent are entitled to receive 
reimbursement of necessary expenses and, upon demonstration of fmancial hardship, a 
per diem equal to the legislative per diem for their attendance at authorized meetings of 
the work group; and be it further 
. 
Sec. 8. Department background report on certificate of need. Resolved: 
That, no later than August 10, 2006, the Department of Health and Human Services shall 
provide a written report to the work group that provides information on revenues, 
expenditures, staffing levels, staffmg needs and review cycles, including submissions, 
approvals, disapprovals and withdrawals of certificate of need applications for the last 5 
years of the certificate of ne~d program; and be it further 
Sec. 9. Report. Resolved: That, no later than November 1,2006, the work group 
shall submit a report that includes its fmdings and recommendations, including suggested 
legislation, for presentation to the First Regular Session of the 123rd Legislature. The 
work group is authorized to introduce legislation related to its report to the First Regular 
Session of the 123rd Legislature at the time of submission of its report; and be it further 
Sec. 10. Extension. Resolved: 
That, if the work group requires a limited 
extension of time to complete its study and make its report, it may apply to the 
Legislative Council, which may grant an extension; and be it further 
Sec. 11. Work group budget Resolved: That the chairs of the work group, 
with assistance from the work group staff, shall administer the work group's budget. 
Within 10 days after its first meeting, the work group shall present a work plan and 
proposed budget to the Legislative Council for its approval. The work group may not 
incur expenses that would result in the work group's exceeding its approved budget. 
Upon request from the work group, the Executive Director of the Legislative Council 
shall promptly provide the work group chairs and staff with a status report on the work 
group budget, expenditures incurred and paid and available funds. ' 
COMMITTEE AMENDMENT 
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COMMI1TEE AMENDMENT A 
to H.P.US4, L.D.1814 
S~y 
This amendment replaces a concept draft and changes the legislation from an Act to a 
Resolve. It also changes the title. The amendment creates the 12-member Work Group to 
Review and Recommend Improvements for the Certificate of Need Program, which 
includes 6 members appointed by the President of the Senate and Speaker of the House, 4 
members appointed by the Governor, a nonvoting ex officio member from the Governor's 
Office of Health Policy and Finance and a nonvoting ex officio member from the 
Department of Health and Human Services. The work group may hold up to 4 meetings 
to prioritize and examine some or all of 11 issues that are listed in the amendment and 
then, based on fmdings from the examination of the prioritized issues, identify 
improvements and make recommendations for changes in law or rule. It requires the 
Department of Health and Human Services to provide a certificate of need background 
report to the work group by August 10, 2006. The amendment also requires the work 
group to submit a report that includes its findings and recommendations, including 
suggested legislation, for presentation to the First Regular Session of the 123rd 
Legislature by November 1, 2006 and authorizes the work group to introduce legislation 
related to its report. 
FISCAL NOTE REQYJRED 
(See AtIaBd) 
COMMITTEE AMENDMENT 
Approved: 03/28/06 ,A?ac:.. 
LD 1814 
LR2772(02) 
An Act To Strengthen and Improve Review Procedures in the Certificate of Need Program 
Fiscal Note for Bill as Amended by Committee Amendment A" 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Current Costs - Legislative Study 
Legislative Study 
The proj ected costs of the Work Group to Review and Recommend Improvements for the Certificate of Need Program 
are $3,240 in fiscal year 2006-07. The Legislature's budget includes $20,000 in fiscal year 2006-07 for legislative 
studies. Whether that amount is sufficient to fund all studies will depend on the number of studies authorized by the 
Legislative Council and the Legislature. 
The additional costs associated with providing staffing assistance to the work group during the interim between 
legislative sessions can be absorbed by the Legislature utilizing existing budgeted resources. If an extension of the 
reporting deadline is granted and the work group requires staffing assistance during the legislative session, the 
Legislature may require an additional General Fund appropriation to contract for staff services. 
Any additional costs to the Department of Health and Human Services and the Department of Professional and 
Financial Regulation in assisting the work group can be absorbed by the Department utilizing existing budgeted 
resources. 
LR2772(2) - Fiscal Note - Page 1 of 1