An Act To Protect Consumers from Rising Health Care Costs
Maine Legislature, Session 123, LD 1849
Committee Amendment CA_A_S237 (Senate)
Amends: 2 MRSA §104

COMMITTEE AMENDMENT ''A'' to S.P. 664, L.D. 1849, Bill, "An Act To 
Protect Consumers from Rising Health Care Costs" 
Amend the bill by striking out everything after the title and before the summary and 
inserting the following: 
'Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, the costs of health care in Maine are making health care coverage 
unaffordable for many consumers and contributing to a health care crisis in this State; and 
Whereas, this legislation expands the duties of the Advisory Council on Health 
Systems Development to include the collecting and reporting of data on health care costs 
and the development of specific recommendations for reductions in health care spending; 
and 
Whereas, these recommendations will assist the Legislature in determining what 
actions may be taken to lower the costs of health care for Maine consumers; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
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 enacted by the People of the State of Maine as follows: 
Sec. 1. 2 MRSA §104, as enacted by PL 2003, c. 469, Pt. B, §1 and amended by c. 
689, Pt. B, §6, is further amended to read: 
Page J- 123LR1867(02)-1 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to S.P. 664, L.D. 1849 
§I04. Advisory Council on Health Systems Development 
1. 
i .. ppoiatmeat; eompositioa. 
The Advisory Couacil oa Heakh Systems 
Developmeat, established ia Title 5, sectioft 12004 I, sl:lbseetioa 31 A aad referred to ia 
this sectioa as "the couacil," coftsists of the followiftg 11 members appoiated by the 
Governor with apprO\'al of the joiat standiftg committee of the Legislature haviag 
jurisdietioa o:ver health and hHman services matters: 
h. v.vo iadi:viduals with expertise ia health care deHy,.ery; 
B. 
Oae iadividual with eKpertise ift loag term care; 
C. Oae indi:vidual with expertise ia meatal health; 
D. 
One iadividual with expertise iR public health care fiaanciRg; 
E. ORe iadividual with expertise iR priYate health care fiftancing; 
F. 
One iRdividual "''lith expertise in health care quality; 
C. 
One ifteivieual YNith expertise in public health; 
H. 
Two represefttatives of consumers; afte 
I. 
ORe represefttatiy,.e of ilie Department of Health and Human Services, Bureau of 
Health program that ..... orks collaborati..'ely with other organi~atioRs to improve the 
health of the citi~ens ofthis State. 
Prior to makiag appoiRtmeats to the couscil, the GO\'emor shall seek aomiaations from 
the public, from statewiee associations represeftting hospitals, physiciaas aad CORSHmers 
and from iadi:viduals and organizatioRs with expertise ift health care deliy,.eI)' systems, 
health care fiRancing, health care quality and public health. 
I-A. 
Appointment; composition. 
The Advisory Council on Health Systems 
Development, established in Title 5, section 12004-1, subsection 31-A and referred to in 
this section as "the council," consists of 19 members appointed pursuant to this 
subsection. 
A. The Governor shall appoint 14 members with the approval of the joint standing 
committee of the Legislature having jurisdiction over health and human services 
matters: 
(1) 
Two individuals with expertise in health care delivery, one of whom 
represents hospitals; 
(2) One individual with expertise in long-tenn care; 
(3) One individual with expertise in mental health; 
(4) One individual with expertise in public health care financing; 
(5) One individual with expertise in private health care financing; 
(6) One individual with expertise in health care quality; 
(7) One individual with expertise in public health; 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A " to S.P. 664, L.D. 1849 
(8) Two representatives of consumers; 
(9) One individual with expertise in the insurance industry; 
(10) Two individuals with expertise in business, one representing a business or 
businesses with fewer than 50 employees; and 
(11) 
One representative of the Department of Health and Human Services, 
Maine Center for Disease Control and Prevention that works collaboratively with 
other organizations to improve the health of the citizens of this State. 
Prior to making appointments to the council, the Governor shall seek nominations 
from the public, from statewide associations representing hospitals, physicians and 
consumers and from individuals and organizations with expertise in health care 
delivery systems, health care financing, health care quality and public health. 
B. Five members of the council must be members of the Legislature who serve on 
the joint standing committee of the Legislature having jurisdiction over health and 
human services matters or the joint standing committee of the Legislature having 
jurisdiction over insurance and financial services matters: 
(1) Two members of the Senate, appointed by the President of the Senate, 
including one member recommended by the Senate Minority Leader; and 
(2) Three members of the House of Representatives appointed by the Speaker of 
the House, including one member recommended by the House Minority Leader. 
2. Term. Members Except for members who are Legislators, members of the 
council serve 5-year terms except for initial appointees. Initial appointees must include 3 
members appointed to 3-year terms, 4 members appointed to 4-year terms and 4 members 
appointed to 5-year terms. A member may not serve more than 2 consecutive terms. 
Members of the Legislature serve 2-year terms coterminous with their elected terms. 
Except for a member who is a Legislator, a member may continue to serve after 
expiration of the member's term until a successor is appointed. 
3. Compensation. Members of the council are entitled to compensation according 
to the provisions of Title 5, chapter 379. Members of the council who are Legislators are 
entitled to receive the legislative per diem as defined in the Maine Revised Statutes, Title 
3, section 2 and reimbursement for travel for attendance at meetings of the council. 
4. Quorum. A quorum is a majority of the members of the council. 
5. Chair. The council shall annually choose one of its members to serve as chair for 
a one-year term. 
6. Meetings. The council shall meet at least 4 times a year at regular intervals and 
may meet at other times at the call of the chair or the Governor. Meetings of the council 
are public proceedings as provided by Title 1, chapter 13, subchapter 1. 
7. Duties. The council shall advise the Governor in developing the plan to the extent 
data and resources are available by: 
A. 
Collecting and coordinating data on health systems development in this State; 
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to S.P. 664, L.D. 1849 
B. 
Synthesizing relevant research; aad 
C. 
Conducting at least 2 public hearings on the plan and the capital investment fund 
each biennium:-; 
D. Conducting a systemic review of cost drivers in the State's health care system, 
including, but not limited to, market failure, supply and demand for services, provider 
charges and costs, public and commercial payor policies, consumer behavior. cost 
and pricing of pharmaceuticals and the need for and availability and cost of capital 
equipment and services; 
E. 
Collecting and reporting on health care cost indicators, including the cost of 
services and the cost of health insurance. 
The council shall report on both 
administrative and service costs. These indicators must, at a minimum, include: 
(1) The annual rate of increase in the unit cost, adjusted for case mix or other 
appropriate measure of acuity or resource consumption, of key components of the 
total cost of health care, including without limitation hospital services, surgical 
and diagnostic services provided outside of a hospital setting, primary care 
physician services, specialized medical services, the cost of prescription drugs, 
the cost of long-term care and home health care and the cost of laboratory and 
diagnostic services; 
(2) The interaction of indicators including, but not limited to, cost shifting 
among public and private payors and cost shifting to cover uncompensated care 
to persons unable to pay for items or services and the effect of these practices on 
the total cost paid by all payment sources for health care; 
(3) The administrative costs of health insurance and other health benefit plans. 
including the relative costliness of private insurance as compared to Medicare 
and MaineCare. and the potential for measures and policies that would tend to 
encourage greater efficiency in the administration of public and private health 
benefit plans provided to consumers in this State; 
(4) Geographic distribution of services with attention to appropriate allocation of 
high-technology resources; 
(5) Regional variation in quality and cost of services; and 
(6) Overall growth in utilization of health care services. 
F. 
Identifying specific potential reductions in total health care spending without 
shifting costs onto consumers and without reducing access to needed items and 
services for all persons, regardless of individual ability to pay. In identifying specific 
potential reductions pursuant to this paragraph, the council shall recommend methods 
to reduce the rate of increase in overall health care spending and the rate of increase 
in health care costs to a level that is equivalent to the rate of increase in the cost of 
living to make health care and health coverage more affordable for people in this 
State; and 
G. 
Beginning March 
1. 
2008 and annually thereafter. make specific 
recommendations relating to paragraphs A to F to the joint standing committee ofthe 
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~,. .\). 
II 
COMMITTEE AMENDMENT "A .. to S.P. 664, L.D. 1849 
Legislature having jurisdiction over insurance and financial services matters and the 
joint standing committee of the Legislature having jurisdiction over health and human 
services matters and to any appropriate state agency. 
8. Staff support. The Governor's office shall provide staff support to the council. 
The Department of Health and' Human Services, Bureau of Health Maine Center for 
Disease Control and Prevention, the Maine Health Data Organization and other agencies 
of State Government as necessary and appropriate shall provide additional staff support 
or assistance to the council. 
9. Data. The council shall solicit data and information from both the public and 
private sectors to help inform the council's work. 
A. The following organizations shall forward data that documents key public health 
needs, organized by region of the State, to the council annually: 
(1) The Department of Health and Human Services, BHreaH of Health Maine 
Center for Disease Control and Prevention; 
(2) The Maine Center for Public Health Practice established pursuant to Title 
22, section 3-D; and 
(3) A statewide public health association. 
B. 
Public purchasers using state or municipal funds to purchase health care services 
or health insurance shall, beginning January 1, 2004, submit to the council a 
consolidated public purchasers expenditure report outlining all funds expended in the 
most recently completed state fiscal year for hospital inpatient and outpatient care, 
physician services, prescription drugs, long-term care, menta] health and other 
services and administration, organized by agency. 
C. 
The council shall encourage private purchasers established under Title 13, Title 
13-B and Title 13-C to develop and submit to the council a health expenditure report 
similar to that described in paragraph B. 
D. The Maine Health Data Organization and the Maine Quality Forum shall forward 
cost and quality data annually and any ad hoc data requested by the council. 
10. Funding. The council may apply for grants and other nongovernmental funds to 
provide staff support or consultant support to carry out the duties and requirements of this 
section. 
Sec. 2. Appointments; staggered terms. Notwithstanding the Maine Revised 
Statutes, Title 2, section 104, subsection 2, of the members of the Advisory Council on 
Health Systems Development appointed pursuant to Title 2, section 104, subsection I-A, 
paragraph A, subparagraphs (1), (9) and (10), 2 members must be appointed for 4-year 
terms and 2 members must be appointed for 5-year terms. 
Sec. 3. Current members continue to serve. Notwithstanding the Maine 
Revised Statutes, Title 2, section 104, subsection 2, any member serving on the Advisory 
Council on Health Systems Development on the effective date of this Act continues to 
serve until the expiration of the term for which the member was appointed or until a 
successor is appointed. 
COMMITTEE AMENDMENT 
" 
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COMMITTEE AMENDMENT" A" to S.P. 664, L.D. 1849 
\ •... 
Emergency clause. 
In view of the emergency cited in the preamble, this 
legislation takes effect when approved. ' 
SUMMARY 
This amendment replaces the bill. Unlike the bill, which proposes establishing the 
Blue Ribbon Commission To Study the Regulation of Health Care Expenditures, this 
amendment instead expands the membership and duties of the Advisory Council on 
Health Systems Development, updates statutory language and authorizes the council to 
seek grants and other funding to support its work. The amendment also adds an 
emergency preamble and emergency clause to the bill. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/14/07 
~ae 
LD 1849 
LR 1867(02) 
An Act To Protect Consumers from Rising Health Care Costs 
Fiscal Note for Bill as Amended by Committee Amendment "A" 
Committee: Health and Human Services and Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
Legislative Cost/Study 
This legislation expands the membership of the Advisory Council on Health Systems Development by five legislators 
and the additional costs are projected to be $2,100 in fiscal year 2007-08 and fiscal year 2008-09. The Legislature's 
proposed budget includes $30,000 in fiscal year 2007-08 and $20,000 in fiscal year 2008-09 for legislative studies. 
Whether the amounts are sufficient to fund all studies will depend on the number of studies authorized by the 
Legislative Council and the Legislature. 
LR 1867(02) - Fiscal Note - Page 1 of I