An Act To Amend the Maine Health Data Organization Laws
Maine Legislature, Session 123, LD 0902
Committee: Health and Human Services
Sponsors: BRANNIGAN, PERRY, GROSE, WALCOTT
Amends: 22 MRSA §8702, 22 MRSA §8703, 22 MRSA §8705-A, 22 MRSA §8706, 22 MRSA §8711

Legislative Document 
No. 902 
S.P.290 
March 1, 2007 
An Act To Amend the Maine Health Data Organization Laws 
Submitted by the Maine Health Data Organization pursuant to Joint Rule 204. 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator BRANNIGAN of Cumberland. 
Cosponsored by Representative PERRY of Calais and 
Representatives: GROSE of Woolwich, WALCOTT of Lewiston. 
Printed on recycled paper 
JOY J. O'BRIEN 
Secretary of the Senate 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §8702, as amended by PL 2005, c. 253, §2, is further amended 
to read: 
§8702. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. 
Board. 
"Board" means the Board of Directors of the Maine Health Data 
Organization established pursuant to section 8703. 
I-A. Carrier. "Carrier" means an insurance company licensed in accordance with 
Title 24-A, including a health maintenance organization, a multiple employer welfare 
arrangement licensed pursuant to Title 24-A, chapter 81, a preferred provider 
organization, a fraternal benefit society or a nonprofit hospital or medical service 
organization or health plan licensed pursuant to Title 24. An employer exempted from 
the applicability of Title 24-A, chapter 56-A under the federal Employee Retirement 
Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not 
considered a carrier. 
2. Clinical data. "Clinical data" includes but is not limited to the data required to be 
submitted by providers, and payors, 3rd party administrators and carriers that provide 
only administrath'e services for a plan sponsor pursuant to sections 8708 and 8711. 
3. 
Financial data. 
"Financial data" includes but is not limited to financial 
information required to be submitted pursuant to section 8709. 
4. Health care facility. "Health care facility" means a public or private, proprietary 
or not-for-profit entity or institution providing health services, including, but not limited 
to, a radiological facility licensed under chapter 160, a health care facility licensed under 
chapter 405 or certified under chapter 405-A, an independent radiological service center, 
a federally qualified health center, rural health clinic or rehabilitation agency certified or 
otherwise approved by the Division of Licensing and Certification within the Department 
of Health and Human Services, a home health care provider licensed under chapter 419, 
an assisted living program or a residential care facility licensed under chapter 1663, a 
hospice provider licensed under chapter 1681, a retail store drug outlet licensed under 
Title 32, chapter 117, a state institution as defined under Title 34-B, chapter 1 and a 
mental health facility licensed under Title 34-B, chapter 1. 
4-A. Health care practitioner. "Health care practitioner" has the meaning provided 
in Title 24, section 2502, subsection I-A. 
5. 
Managed care organization. 
"Managed care organization" means an 
organization that manages and controls medical services, including but not limited to a 
health maintenance organization, a preferred provider organization, a competitive 
medical plan, a managed indemnity insurance program and a nonprofit hospital and 
medical service organization, licensed in the State. 
• 
• 
.. 
~\ 
• 
.. 
5-A. Medicare prescription drug sponsor. "Medicare prescription drug sponsor" 
means a health insurance carrier or other private company authorized by the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
to administer Medicare Part C and Part D benefits under a health plan or prescription 
drug plan. 
5-B. Nonlicensed carrier. "Nonlicensed carrier" means a health insurance carrier 
that is not required to obtain a license in accordance with Title 24-A and pays health care 
claims on behalf of residents of this State. 
6. 
Organization. 
"Organization" means the Maine Health Data Organization 
established under this chapter. 
7. 
Outpatie~t services. "Outpatient services" means all therapeutic or diagnostic 
health care services rendered to a person who has not been admitted to a hospital as an 
inpatient. 
8. Payor. "Payor" means a 3rd-party payor ef~ 3rd-party administrator, Medicare 
prescription drug sponsor, pharmacy benefits manager or nonlicensed carrier. 
8-A. Plan sponsor. "Plan sponsor" means any person, other than an insurer, who 
establishes or maintains a plan covering residents of this State, including, but not limited 
to, plans established or maintained by 2 or more employers or jointly by one or more 
employers and one or more employee organizations or the association, committee, joint 
board of trustees or other similar group of representatives of the parties that establish or 
maintain the plan. 
8-B. Pharmacy benefits manager. "Pharmacy benefits manager" means an entity 
that performs pharmacy benefits management as defined in section 2699, paragraph E. 
9. Provider. "Provider" means a health care facility, health care practitioner, health 
product manufacturer, health product vendor or pharmacy. 
9-A. Quality data. "Quality data" means information on health care quality required 
to be submitted pursuant to section 8708-A. 
to. Restructuring data. "Restructuring data" means reports, charts and information 
required to be submitted pursuant to section 8710 . 
to-A. Third-party administrator. "Third-party administrator" means any person 
who, on behalf of a plan sponsor, health care service plan, nonprofit hospital or medical 
service organization, health maintenance organization or insurer, receives or collects 
charges, contributions or premiums for, or adjusts or settles claims on, residents of this 
State. 
11. 
Third-party payor. 
"Third-party payor" means a health insurer, carrier, 
including a carrier that provides only administrative services for plan sponsors, nonprofit 
hospital, medical services organization or managed care organization licensed in the State 
or the plan established in chapter 854. "Third-party payor" does not include carriers 
licensed to issue limited benefit health policies or accident, specified disease, vision, 
disability, long-tenn care or nursing home care policies. 
Sec. 2. 22 MRSA §8703, sub-§2, ~A, as amended by PL 2005, c. 253, §3, is 
further amended to read: 
A. 
The Governor shall appoint 18 board members in accordance with the following 
requirements. 
Appointments by the Governor are not subject to review or 
confinnation. 
. 
(1) Four members must represent consumers. For the purposes of this section, 
"consumer" means a person who is not affiliated with or employed by a 3rd-party 
payor, a provider or an association representing those providers or those 3rd-
party payors. 
(2) Three members must represent employers. One member must be chosen 
from a list provided by a health management coalition in this State. One member 
must be chosen from a list provided by a statewide organization representing 
chambers of commerce in the State. 
(3) Two members must represent 3rd-party payors chosen from a list provided 
by a statewide organization representing 3rd-party payors. 
(4) Nine members must represent providers. 
Two provider members must 
represent hospitals chosen from a list provided by the Maine Hospital 
Association. Two provider members must be physicians or representatives of 
physicians, one chosen from a list provided by the Maine Medical Association 
and one chosen from a list provided by the Maine Osteopathic Association. One 
provider member must be a doctor of chiropractic chosen from a list provided by 
a statewide chiropractic association. 
One provider member must be a 
representative, chosen from a list provided by the Maine Primary Care 
Association, of a federally qualified health center. One provider member must be 
a phannacist chosen from a list provided by the Maine Phannacy Association. 
One provider member must be a mental health provider chosen from a list 
provided by the Maine Association of Mental Health Services. One provider 
member must represent a home health care company. 
Sec. 3. 22 MRS A §8704, sub-§3, as enacted by PL 1995, c. 653, Pt. A, §2 and 
affected by §7, is amended to read: 
3. Contracts generally. The board may enter into all other contracts necessary or 
proper to carry out the powers and duties of this chapter, including contracts allowing 
organization staff to provide technical assistance to other public or private entities, with 
the proceeds used to offset the operational costs of the organization. 
Sec. 4. 22 MRS A §8705-A, sub-§2, as enacted by PL 2003, c. 659, §2, is 
amended to read: 
2. Rulemaking. The board shall adopt rules to implement this section. Rules 
adopted pursuant to this subsection are major substantive routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. The rules may contain procedures for 
• 
• 
• 
• 
• 
monitoring compliance with this chapter. Rules adopted pursuant to this subsection must 
include a schedule of fines for: 
A. 
Failure to file data; 
B. 
Failure to pay assessments; and 
C. 
Intentionally or knowingly and without authorization using or disseminating 
health care information that directly or indirectly identifies patients or health care 
practitioners performing abortions as defined in section 1596. 
Sec. 5. 22 MRSA §8705-A, sub-§3, ~A, as enacted by PL 2003, c. 659, §2, is 
amended to read: 
A. 
When a person or entity that is a health care facility, or payor, 3rd flarty 
administrator or earrier that flFOvides only administrative serviees for a fllan sflonsor 
violates the requirements of this chapter, except for section 8707, that person or entity 
commits a civil violation for which a fine of not more than $1,000 per day may be 
adjudged. A fine imposed under this paragraph may not exceed $25,000 for anyone 
occurrence. 
Sec. 6. 22 MRSA §8706, sub-§2, ~C, as amended by PL 2005, c. 565, §7, is 
further amended to read: 
C. 
The operations of the organization must be supported from 3 sources as provided 
in this paragraph: 
(1) Fees collected pursuant to paragraphs A and B; 
(2) Annual assessments of not less than $100 assessed against the following 
entities licensed under Titles 24 and 24-A: nonprofit hospital and medical service 
organizations, health insurance carriers and health maintenance organizations on 
the basis of the total annual health care premium; and 3rd-party administrators 
and~ carriers that provide only administrative services for a plan sponsor and 
pharmacy benefits managers that process and pay claims on the basis of claims 
processed or paid for each plan sponsor. The assessments are to be determined 
on an annual basis by the board. Health care policies issued for specified disease, 
accident, injury, hospital indemnity, disability, long-term care or other limited 
benefit health insurance policies are not subject to assessment under this 
subparagraph. 
For purposes of this subparagraph, policies issued for dental 
services are not considered to be limited benefit health insurance policies. The 
total dollar amount of assessments under this subparagraph must equal the 
assessments under subparagraph (3); and 
(3) 
Annual assessments of not less than $100 assessed by the organization 
against providers. The assessments are to be determined on an annual basis by 
the board. The total dollar amount of assessments under this subparagraph must 
equal the assessments under subparagraph (2). 
The aggregate level of annual assessments under subparagraphs (2) and (3) must be 
an amount sufficient to meet the organization's expenditures authorized in the state 
budget established under Title 5, chapter 149. 
The annual assessment may not 
exceed $1,346,904 in fiscal year 2002-03. In subsequent fiscal years, the annual 
assessment may increase above $1,346,904 by an amount not to exceed 5% per fiscal 
year. The board may waive assessments otherwise due under subparagraphs (2) and 
(3) when a waiver is determined to be in the interests of the organization and the 
parties to be assessed. 
Sec. 7. 22 MRS A §S70S, sub-§6-A, as amended by PL 2001, c. 457, §18, is 
further amended to read: 
6-A. Additional data. Subject to the limitations of section 8704, subsection 1, the 
board may adopt rules requiring the filing of additional clinical data from other providers, 
and payors, 3rd party admiaistrators aad carners that provide oaly admiaistrative seryices 
for a plaa spoasor as long as the submission of data to the organization is consistent with 
federal law. 
Data filed by payors, 3rd party admiaistrators or carriers that provide 
admiaistrati~re seryices only for a plaa spoasor must be provided in a format that does not 
directly identify the patient. 
Sec. S. 22 MRS A §S70S-A, first~, as enacted by PL 2003, c. 469, Pt. C, §28, is 
amended to read: 
The board shall adopt rules regarding the collection of quality data. The board shall 
work with the Maine Quality Forum and the Maine Quality Forum Advisory Council 
established in Title 24-A, chapter 87, subchapter 2 to develop the rules. The rules must be 
based on the quality measures adopted by the Maine Quality Forum pursuant to Title 24-
A, section 6951, subsection 2. The rules must specify the content, form, medium and 
frequency of quality data to be submitted to the organization. In the collection of quality 
data, the organization must minimize duplication of effort, minimize the burden on those 
required to provide data and focus on data that may be retrieved in electronic format from 
within a health care practitioner's office or health care facility. As specified by the rules, 
health care practitioners and health care facilities shall submit quality data to the 
organization. 
Rules adopted pursuant to this section are major substaatiye routine 
technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 9. 22 MRSA §8711, sub-§l, as amended by PL 2001, c. 457, §19, is further 
amended to read: 
1. Development of health care information systems. In addition to its authority to 
obtain information to carry out the specific provisions of this chapter, the organization 
may require providers, and payors, 3rd party admiaistrators aad carriers that provide oaly 
admiaistrative services for a plaa spoasor to furnish information with respect to the 
nature and quantity of services or coverage provided to the extent necessary to develop 
proposals for the modification, refinement or expansion of the systems of information 
disclosure established under this chapter. 
The organization's authority under this 
subsection includes the design and implementation of pilot information reporting systems 
affecting selected categories or representative samples of providers, and payors, 3rd party 
admiaistrators aad carriers that provide only admiaistrative seFyices for a plaa spoasor. 
• 
• 
.. 
• 
SUMMARY 
This bill makes a number of modifications to the laws governing the operation of the 
Maine Health Data Organization, including adding Medicare prescription drug sponsors, 
pharmacy benefits managers and nonlicensed carriers to the definition of "payor"; 
modifying the appointment process for employer representatives on the Board of 
Directors of the Maine Health Data Organization; expanding the contract authority of the 
board; and changing the major substantive rule designation for the organization's 
enforcement and quality data rules to routine technical rulemaking . 
• 
Page''J - 123LRlO43(Ol}-1