An Act To Protect Access to Health Care CAFfER DEADLINE)
Maine Legislature, Session 123, LD 2290
Committee: Appropriations and Financial Affairs
Sponsors: MILLS, MARTIN, BRIGGS, CLARK, CUMMINGS, PERRY, PINGREE, SAVIELLO, SIMPSON, TUTTLE, GOOLEY, NUTTING
Amends: 34-B MRSA §3608, 36 MRSA §2891

Legislative Document 
No. 2290 
H.P.1652 
House of Representatives, March 31, 2008 
An Act To Protect Access to Health Care 
CAFfER DEADLINE) 
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
205. 
Reference to the Committee on Appropriations and Financial Affairs suggested and ordered 
printed. 
Presented by Representative MILLS of Farmington. 
Cosponsored by Senator MARTIN of Aroostook and 
111~ 
1J7.71lu£~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BRIGGS of Mexico, CLARK of Millinocket, Speaker CUMMINGS of 
Portland, PERRY of Calais, PINGREE of North Haven, SAVIELLO of Wilton, SIMPSON of 
Auburn, Sl TTHERLAND of Chapman, TUTTLE of Sanford, Senators: GOOLEY of Franklin, 
NUTTING of Androscoggin. 
Printed on recycled papt:r 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 34-B MRSA §3608, sub-§l, ~, as amended by PL 2007, c. 286, §8, is 
further amended to read: 
E. 
Develop techniques for identifying and providing services to consumers at risk, 
based on the principle that services will be provided as close to the consumer's home 
as possible; aOO 
Sec. 2. 34-B MRSA §3608, sub-§l, ~, as enacted by PL 2007, c. 286, §8, is 
amended to read: 
F. Enable, among other things, the sharing of confidential client information to the 
extent necessary to protect the client's health and safety when it is determined the 
II 
client has an urgent need for mental health services. The network members shall 
share confidential client information, even without a client's consent, to the extent 
necessary to protect the client's health and safety in a period of urgent need for 
mental health services when the client lacks the capacity to give consent for the 
information sharing or when an exigency exists so that the client's health and safety 
is better protected if the information is shared without a delay to obtain consent. A 
person or entity participating in good faith in sharing information under this 
paragraph is immune from civil liability that might otherwise result from these 
actions, including, but not limited to, a civil liability that might otherwise arise under 
state or local laws or rules regarding confidentiality of information. The department 
shall adopt rules to identify the limits and requirements to be included in the 
memoranda. These rules are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A"; and 
Sec. 3. 34-B MRSA §3608, sub-§l, ~G is enacted to read: 
G. 
Provide consolidated mental health crisis services for children and adults, 
beginning March 1, 2009, through a memorandum of understanding among providers 
of mental health services in the network that must include provisions to ensure 
coordination, eliminate duplication and provide a level of crisis services established 
by the department. 
Sec. 4. 
MRSA §2891, sub-§l, as corrected by RR 2003, c. 2, §116, IS 
amended to read: 
1. Hospital. "Hospital" means an acute care health care facility with permanent 
inpatient beds planned, organized, operated and maintained to offer for a continuing 
period of time facilities and services for the diagnosis and treatment of illness, injury and 
deformity; with a governing board and an organized medical staff offering continuous 24-
hour professional nursing care; with a plan to provide emergency treatment 24 hours a 
day and including other services as defined in rules of the Department of Health and 
Human Services relating to licensure of general and specialty hospitals; and that is 
licensed under Title 22, chapter 405 as a general hospital, specialty hospital or critical 
access hospital. For purposes of this chapter, "hospital" does not include a nursing home 
Page I - 123LR3614(OI)-1 
or a publicly owned specialty hospital or, for state fiscal years beginning on or after July 
1, 2008, municipally funded hospitals. 
Sec. 5. 36 MRSA §2891, sub-§l-A is enacted to read: 
I-A. Municipally funded hospital. "Municipally funded hospital" means Mayo 
Regional Hospital in Dover-Foxcroft or Cary Medical Center in Caribou. 
Sec. 6. 36 MRS A §2892, as amended by PL 2005, c. 12, Pt. ZZ, §2, is further 
amended to read: 
§2892. Tax imposed 
For the state fiscal year beginning on July 1, 2003, a tax is imposed against each 
hospital in the State. The tax is equal to .74% of net operating revenue for the tax year as 
II 
identified on the hospital's most recent audited annual financial statement for that tax 
year. Delinquent tax payments are subject to Title 22, section 3l75-C. 
For state fiscal years beginning on or after July 1, 2004, a tax is imposed annually 
against each hospital in the State. 
The tax is equal to 2.23% of the hospital's net 
operating revenue as identified in the hospital's audited financial statement for the 
hospital's taxable year. For the state fiscal year beginning July 1, 2004, the hospital's 
taxable year is the hospital's fiscal year that ended during calendar year 2002. For the 
state fiscal year beginning July 1, 2005, the hospital's taxable year is the hospital's fiscal 
year that ended during calendar year 2003. For state fiscal years beginning on or after 
July I, 2006 but before July 1, 2008, the hospital's taxable year is the hospital's fiscal year 
that ended during calendar year 2004. 
For state fiscal years beginning on or after July 1, 2008, the hospital's taxable year is 
the hospital's fiscal year that ended during calendar year 2006. 
Sec. 7. 
Memorandum of understanding for consolidated services. 
Notwithstanding any provision of law to the contrary, reductions in funding by 
consolidating mental health crisis services must be accomplished through a memorandum 
of understanding subject to this section. The Department of Health and Human Services 
shall design standards for and negotiate the implementation of a memorandum of 
understanding among providers of mental health services in each community service 
network that will achieve savings through the consolidation of crisis services for children 
and adults. The department shall establish criteria for crisis services, including, but not 
limited to: access to telephone crisis services 24 hours a day, 7 days a week; mobile 
outreach for face-to-face assessments; crisis stabilization and follow-up; availability of 
fixed sites; access to psychiatric consultation; agreements with local hospitals; 
alternatives to inpatient hospital services through residential beds; compliance with the 
adult consent decree and reduction of the utilization of hospital emergency rooms. The 
department shall provide a progress report to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters on the progress of 
the consolidation by January 1, 2009 and an evaluation by January I, 20 I 0 of the impact 
of the consolidation on consumers and on savings achieved and any positive or negative 
effects on consumer access to services and the quality of crisis servIces consumers 
receive. 
Sec. 8. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY BDS) 
Mental Health Services - Child Medicaid 0731 
Initiative: Provides funding related to consolidating crisis services to one provider per 
district. The corresponding federal match increase is in the Medical Care - Payments to 
Providers program. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Mental Health Services - Community 0121 
2007-08 
$0 
$0 
2008-09 
$200,000 
$200,000 
Initiative: Provides funding for community integration services for consumers who are 
not eligible for MaineCare. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Mental Retardation Waiver - MaineCare 0987 
2007-08 
$0 
$0 
2008-09 
$500,000 
$500,000 
Initiative: Increases funding for MaineCare home- and community-based waiver services. 
The corresponding federal match increase is in the Medical Care - Payments to Providers 
program. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY BDS) 
DEPARTMENT TOTALS 
2007-08 
$0 
$0 
2007-08 
2008-09 
$142,568 
$142,568 
2008-09 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
$0 
$842,568 
$0 
$842,568 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Increases funding for MaineCare home- and community-based waiver services. 
The corresponding state funding increases are in the Mental Retardation Waiver -
MaineCare program. 
1 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Medical Care - Payments to Providers 0147 
Initiative: Provides funding for hospital-based physicians. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Medical Care - Payments to Providers 0147 
2007-08 
2008-09 
$0 
$254,930 
$0 
$254,930 
2007-08 
2008-09 
$0 
$7,282,509 
$0 
$7,282,509 
2007-08 
2008-09 
$0 
$13,022,827 
$0 
$13,022,827 
Initiative: Adjusts funding to reflect an update of the hospital tax base year from 2004 to 
2006 and the exclusion of municipally funded hospitals from the tax beginning July I, 
2008. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2007-08 
2008-09 
$0 
($11,394,341) 
$0 
($11,394,341) 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Medical Care - Payments to Providers 0147 
2007 -08 
2008-09 
$0 
$11,394,341 
$0 
$11,394,341 
Initiative: Appropriates and allocates funds for additional payments to hospitals under the 
MaineCare program. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Medical Care - Payments to Providers 0147 
2007-08 
$0 
$0 
2007-08 
$0 
$0 
2008-09 
$3,269,264 
$3,269,264 
2008-09 
$5,846,206 
$5,846,206 
Initiative: Provides funding related to consolidating crisis services to one provider per 
district. The corresponding state match increase is in the Mental Health Services -
Community Medicaid program. 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
2007-08 
$0 
$0 
2007-08 
$0 
$0 
2008-09 
$357,625 
$357,625 
2008-09 
($842,568) 
$19,481,588 
I 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL - ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
SECTION TOTAL - ALL FUNDS 
II 
SUMMARY 
$0 
$11,394,341 
$0 
$30,033,361 
2007-08 
2008-09 
$0 
$0 
$0 
$19,481,588 
$0 
$11,394,341 
$0 
$30,875,929 
This bill gives the community service networks the responsibility of providing 
consolidated mental health crisis services for children and adults, beginning March I, 
2009, through a memorandum of understanding among providers of mental health 
services in the network that includes provisions to ensure coordination, eliminate 
duplication and provide a minimum level of crisis services established by the department. 
This bill also updates the base year for the hospital tax and excludes municipally funded 
hospitals from the tax after July I, 2008. 
FISCAL NOTE REQUIRED 
(See attached) 
Approved: 03/31/08 Mac:.. 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Other Special Revenue Funds 
Fiscal Detail and Notes 
LD 
;;( ~ ~D 
LR 3614(01) 
An Act To Protect Access to Health Care 
Fiscal Note for Original Bill 
Sponsor: Rep. Mills, J. of Farmington 
Committee: Not Referred 
Fiscal Note Required: Yes 
Fiscal Note 
2007-08 
$0 
$0 
$0 
$0 
$0 
2008-09 
$0 
$0 
$19,481,588 
$11,394,341 
$11,394,341 
Projections 
2009-10 
$0 
$0 
$19,481,590 
$11,394,341 
$11,394,341 
Projections 
2010-11 
$0 
$0 
$19,481,590 
$11,394,341 
$11,394,341 
This bill includes offsetting General Fund appropriations and deappropriations resulting in no net General Fund 
impact during the 2008-2009 biennium. It also increases Other Special Revenue funds by $11,394,341 in fiscal year 
2008-09 due to an increase in the Hospital Tax. 
LR3614(01) - Fiscal Note - Page I of I