Maine Legislature, Session 124, LD 1365
Committee: Insurance and Financial Services
Sponsors: PRIEST, BO WMAN, AYOTTE, BEAUDOIN, BRYANT, EATON, GOODE, HASKELL, LEGG, MARTIN, MILLER, MORRISON, PINGREE, STEVENS, STUCKEY, TREAT, TUTTLE, WEBSTER, BLISS, GERZOFSKY
Amends: 2 MRSA §6-F, 24-A MRSA §2185-A, 1 MRSA §71

MAINE STATE LEGISLATURE 
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LAW AND LEGISLATIVE DIGITAL LIBRARY 
at the Maine State Law and Legislative Reference Library 
http://legislature.maine.gov/lawlib 
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124th MA"INE LEGISLATURE 
FIRST PJ:GULAR SESSION=2009 " 
Legislative Document " 
No. 1365 
H.P.955 
House of Representatives, 
2,2009 
A~ Act To Establish a Single-payer Health Care System 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative PRIEST of Bnmswick. 
Cosponsored by Senator BO WMAN of York and 
'7f/~~ 111.17!II£~{ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: AYOTTE of Caswell, BEAUDOIN of Biddeford, BRYANT of Windham, 
CAINofOrono, EATON of Sullivan, GOODE of Bangor, HASKELL of Portland, LEGG of 
Kennebunk, MARTIN of Eagle Lake, MILLER of Somerville, MORRISON of South Portland, 
Speaker PINGREE of North Haven, STEVENS of Bangor, STUCKEY of Portland, TREAT of 
Hallowell, TUTTLE of Sanford, WEBSTER of Freeport, Senators: BLISS of Cumberland, 
. 
CRAVEN of Androscoggin, GERZOFSKY of Cumberland. 
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Be it enacted by the People of the State of Maine as follows: 
PART A . 
Sec. A-I. 22 MRSA c. 106 is enacted to read: 
CHAPTER 106 
ACCESS TO AFFORDABLE HEALTH CARE 
SUBCHAPTER 1 
GENERAL PROVISIONS 
§371. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Agency .. "Agency" means the Maine Health Care Agency established by section 
375. 
2. Council. "Council" means the Maine Health Care Council established by section 
377. 
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3. Fund. "Fund" means the Maine Health Care Trust Fund established by section 
374, subsection 1. 
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4. Global budget. "Global budget" means astatewide aggregate amount budgeted 
for the provision of all health care services or for any sector of health care services. 
5. Open plan. "Open plan" means the benefit delivery system for the Maine Health 
Care Plan that is open to all plan members and all participating providers, as specified in 
rules adopted pursuant to section 372, subsection 4. 
6. Organized delivery system. "Organized delivery system" means an organization 
that provides or contracts for a complete range of health care services, as specified in 
rules adopted pursuant to section 372, subsection 4. 
7. Participating provider. "Participating provider" means a provider approved for 
the delivery of health care services pursuant to section 372, subsection 4. 
8. Plan. "Plann means the Maine Health Care Plan established by section 372. 
9. Provider. "Provider" means any person, organization, corporation or association 
that provides. health care services and is authorized to provide those services under the 
laws of this State. 
"Provider" includes persons and entities that provide healing, 
treatment and care for those relying on a recognized' religious method of healing as 
provided for in the United States Social Security Act, Title XVIII and permitted under 
state law. 
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10. Resident. "Resident" means a person who resides within the State as defined by 
rules adopted by the agency pursuant to, section 376, subsection 1. 
11. Small Business Hardship Fund. '''Small Business Hardship Fund" means the 
fund created by section,374, subsection 1, paragraph A as part of the Maine Health Care 
Trust Fund. 
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SUBCHAPTER 2 
ENSURING ACCESS TO HEALTH CARE 
§372. Maine Health Care Plan 
The Maine Health Care Plan is established to provide security through high-quality, 
affordable health care for the people of the State. 
The plan becomes effective and 
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binding upon the State when substantially similar legislation has been enacted into law by 
any 2 states from among the states of New England. By common action, it is the policy 
of each of the states to provide forthe mutual development, execution and cooperation in 
the delivery of health care to its residents. ,The plan must offer health care services 
beginning 6 months after the plan becomes effective and the agency shall administer and 
oversee the plan in accordance with this chapter. 
1. Goals of Maine Health Care Plan. The goals of the plan are: 
A. To eliminate income-based dispa'rity in the health care status of residents; 
B. To reduce the rate of growth in the cost of health care services; 
C. To reduce waste and inefficiency in the administration of health care services and 
health insurance; 
D. To increase access t6 primary and preventive health care services; 
E. 
To reduce the number of excessively expensive health care procedures and 
eliminate unnecessalY and harniftil proc~dures; 
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F. 
To promote cooperation among communities and providers of health care, to 
eliminate cost-accelerating practices, to coordinate the delivery of care and use of 
technology and equipment and to increase quality and cost efficiency; 
G. To distribute the costs of health care fairly and equitably; 
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H. To simplify the health care system for consumers, businesses and providers; 
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I. To ensure providers clinical freedom to treat patients based on health care needs 
and criteria; and 
J: To ensure accountability 'inall aspects ofthe health care· system to promote public 
confidence and control of costs. 
2. Eligibility for Maine Health Care Plan. In accordance with this subsection, 
residents and nonresidents are eligible to j'eceive covered health care services from 
pal1icipating providers under the plan within this State if the service is necessalY or 
appropriate for the prevention, diagnosis or treatment of, or maintenance or rehabilitation 
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following~ injlllY, disability or disease. The agency shall adopt rules regarding payment 
of premiums, application fOl~ a plan card and membership in the plan. Rules adopted 
pursuant to this subsection are routine technical /"ules as defined in Title 5, chapter 375, 
subchapter 2-A. The rules must meet the criteria of this subsectioil. 
A. Each resident of the State is eligible to receive health care under the plan arid may 
enroll in the plan. 
B. 
A nonresident of the State who maintains significant contact with the State, 
including employment or self-employment within the State or attendance at a college, 
university or other institution of higher education in the State, is eligible to receive 
health care under the plan. Eligibility extends to a person qualifying under this 
paragraph and to that person's spouse and dependents. The agency shall adopt rules 
establishing criteria for eligibility ·for nonresidents and determine the premium to be 
paid by them and the method of pay'ment. 
C. A plan member who ceases to be eligible for the plan may elect, within 60 days of 
the event that causes ineligibility, to continue paJiicipation in the plan for a period of 
up to 18 months. For the purposes of this paragraph, a plan member is considered to 
have lost eligibility due to disability if the member could be determined disabled 
under the United States Social Security Act, Title II or Title XVI. The agency shall 
ensure that plan members who become ineligible for enrollment in the plan are 
promptly notified of the provisions of this paragraph. The agency shall adopt rules 
establishing the premium to be paid by persons eligible under this paragraph and the 
method of payment. 
D. To establish eligibility, each person must apply for a plan card, pay to the fund 
the premium determined applicable pursuant to section 374, subsection 1, paragraph 
B and satisfy the application requirements established by the agency.· 
3. Health care benefits. As provided in this subsection, the plan must provide 
coverage for' health care services from participating providers within this State if those 
services are necessary or appropriate for the prevention, diagnosis or treatment of, or 
maintenance or rehabilitation following, injury, disability or disease. The agency shall 
adopt rules regarding provision of the covered health care services in this subsection: 
A. Hospital services; 
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B. Medical and other professional services furnished by participating providers; 
C. Laboratory tests and imaging procedures; 
D. 
Home health care for persons requiring services performed by or under the 
supervision of professional or technical personnel, including, but not limited to, home 
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care for acute illness, personal care attendant services and the medical component of 
home care for chronic illness. Notwithstanding any other provision of law, the plan 
may use copayments for permanent care services; 
E .. Rehabilitative services for persons receiving therapeutic care; 
F. Prescription drugs and devices. Unless the prescribing practitioner-certifies that a 
more expensive drug is medically necessary, the plan may cover only part of the cost 
of a drug dispensed in a package or. form of dosage or administration when the 
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agency determines that a less expensive package or form of dosage or administration 
is available that is pharmaceutically equivalent in its therapeutic effect. If a plan 
member chooses to purchase a more expensive drug under this paragraph, the plan 
member is responsible for paying the amount not covered by the plan; 
G. Mental health services; 
H. Substance abuse treatment; 
I. Primary and acute dental services; 
1. 
Vision appliances, including lenses, frames and contact lenses, according to a 
schedule established by the agency; 
K. Medical supplies and durable medical equipment and selected assistance devices; 
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L. Hospice care; and 
M. Health care services payable pursuant to Tide 39-A for all employees whose date 
of injury is on or after July I, 20 I O. 
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Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
IS 
chapter 375, subchapter 2-A. 
4. Benefit delivery. Covered health care services must be provided to plan members 
by the paliicipating providers of their choice through organized delivery systems or the 
open plan. The delivelY of covered health care services to plan members is subject to the 
provisions of this subsection. The agency shall adopt rules regarding benefit delivery by 
the plan that meet the criteria of this subsection. 
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A. Organized delivelY systems authorized by the agency may provide health care 
services to plan members. 
B. The open plan is available to all plan members and to all paIiicipating providers. 
C. The plan must pay for health care services provided to a plan member while the 
plan member is out of the State. The plan member must have been out of the State 
temporari Iy for reasons other than to obtain the healtl~ care services, or the plan 
member must have obtained the health care services out of the State for compelling 
reasons related to the suitability of the services, the nature of the condition and 
personal circumstances. The agency shall establish and operate a plan to pay for 
health care sei;vices provided to a plan member while the plan member is out of the 
State. 
The payments must be made at the rates established by the agency for 
comparabJe services provided by the plan in the State. Charges in excess of the 
payment rates established in accordance with this paragraph .are the responsibility of 
the plan member. 
D. The plan must pay cash benefits to a provider of health care services or to a plan 
member for a reasonable amount charged for medically necessary emergency health 
care services obtained by a plan member from a provider .who is not a paIiicipating 
provider. 
E .. Copayments or deductibles do not apply to health care services provided through 
the plan, except that, to encourage the use of the most appropriate and cost-effective 
mode of service, an organized delivery system may require reasonable payments by a 
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plan member if payment is approved by the agency and does not substantially 
interfere with access to needed health care services. 
F. Accountability to the public of the open plan and organized delivery systems must 
be ensured in order to promote public confidence in the health care delivery system 
and awareness oftlle costs of care. 
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G. Flexible enrollment and transfer processes that preserve plan member confidence 
and ensure that health care needs are met must be provided. " 
H. An opportunity for negotiation of fair rates of compensation with participating 
providers in the open plan and organized delivery systems and negotiation with 
pharmaceutical companies for similarly classified pharmaceuticals must be provided. 
1. A program to expand services to underserved rurai and low-income communities 
roust be established. 
1. Mechanisms must be developed to provide incentives to participating providers in 
the open plan and to organized delivelY systems for additional savings that do not 
compromise the quality of health care. 
Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2~A. 
5. Provider reguirements. Pal1icipating providers, the open plan and organized 
delivery systems may not charge a plan member or a 3rd party for covered health services 
and may not charge rates in excess of the reimbursement levels set by the agency. A 
participating provider of health care services, the open plan and organized delivery 
systems may not refuse to provide services to a plan member on the basis of health status, " 
medical condition, previous insurance status, race, color, creed, age, national origin, 
citizenship status, gender, sexual orientation, disability, marital status or arrest record 
except as appropriate to the provider's professional specialization or other medically 
appropriate circumstances. 
6. Provision of information by participating providers. A participating provider 
shall make information available to the agency and permit examination of its records by 
the agency as necessary for the purposes of this section and section 374. 
7. Organized delivery system reguirements. Organized delivelY systems may not 
have loss ratios that exceed 90% and adrninistrative costs may not exceed 10%. 
8. Role of other health care programs. Until the agency determines otherwise, the 
plan is supplemental to all coverage available to a plan member from another health care 
program, including, but not limited to, the Medicare program of the United States Social 
Security Act, Title XVIII; the Medicaidprogram of tile United States Social Security Act, 
Title XIX; the Civilian Health and Medical Program of the Uniformed Services, 10 
United States Code, Sections 1071 to 1106; the federal Indian Health Care Improvement 
Act, 25 United States Code, Sections 1601 to 1682; the statewide plan provided through 
the Oirigo Health Program pursuant to Title 24-A. chapter 87; other 3rd-party payors who 
may be billable for health care services; and any state and local health care programs, 
including, but not limited to, workers' compensation and employers' liability insurance, 
pursuant to former Title 39 and Title 39-A. "Health care services billed to 3rd-party 
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payors other than the plan must be paid for by' those programs, and coverage under the 
plan is supplem~ntal to that coverage. A plan member who" receives health care services 
under another health care program or from a 3rd"'"party payor to which the plan' is 
supplementai shall pay a premium to the fund in proportion to the hea.lth care benefits 
available to the plan member under the plan. 
SUBCHAPTER 3 
7. 
. ENSURING THE QUALITY, AFFORDABILITY AND EFFICIENCY OF 
HEALTH CARE 
§373. Quality; affordability; efficiency; health planning 
The agency shall undertake the following duties to ensure the qualiiy, affordability, 
efficiency and planning of health care for the citizens of the State. 
1. Quality of care. The agency shall establish a quality assurance program and shall 
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adopt rules to implement that program. Rules adopted pursuant to this subsection are 
routine technical rules as defined in Title" 5, chapter 375, subchapter 2-A. The program 
must include, but is not limited to: 
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A. Operation of the plan; 
B. 
Use of covered health care 
nonparticipating providers; 
services of participating providers and 
C. Evaluation of the performance of participating providers; 
D. Standards and continuity of care; 
E. A plan for increased delivery of preventive and primaty care; 
F. Access to information and data for the agency; 
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G. A plan to ensure that the open plan and organized delivety systems address public 
health needs; 
H. Plan member involvement in policy decisions; and 
I. An efficient complaint resolution process regarding qliality of care and utilization 
and rate controls. 
2. 
Affordability of care. The agency shall establish an affordability assurance 
program and shall adopt rules to implement that program. Rules adopted pursuant to this' 
subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
The pt:0gram must include, but is not limited to: 
A. Rates of compensation for participating providers in organized delivery systems 
and in the op'en plan; . 
. 
B. Operation of the Small "Business Hardship Fund to assist employers for which the 
plan constitutes a hardship; 
C. Maintenance ofa prescriptiondrugformulary; and 
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D. Cost-containment mechanisms for organized delivery systems and for the open 
plan. Cost-containment mechanisms may include primary care case management, 
guaranteed provider payment, variable reimbursement rates for providers, review of 
treatment and services concurrent with the provision, of the treatment and services, 
expenditure targets, practice parameters and treatment norms. 
3. Efficiency of care. The agency shall establish an efficiency of care program and 
shall adopt rules to implement that program. Rules adopted pursuant to this subsection are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. The agency 
slulll review health care malpractice insurance costs and shall work with organized 
delivelY systems, paJ1icipating providers and insurers to ensure that the resources of the 
fund are used for maximum service delivery. The agency shall contract with a 3rd-party 
administrator for claims handling and data collection services, including, but not limited 
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to, unifonn billing procedures to facilitate the exchange of information and 
communication between the agency and participating providers. 
4. Health planning. The agency shall establish a health planning program and adopt 
rules to implement that program. Rules adopted pursuant to this subsection are routine 
technical rules as defined i.n Title 5, chapter 375, subchapter 2-A. Health planning must 
be considered in light of the programs on quality;:' affordability and efficiency established 
under subsections'l to 3. The program must include, but is not limited to: 
A. Global budgets for all expenditures of the plan for the base year of the plan and 
for each following year based on the level of expenditures in the preceding year as 
increased by the percentage of increase in the average per capita personal income 
applicable to the State, as developed by the United States DepaJ1mentof Commerce; 
B. Global budgets for hospitals and instituti~nal providers with adjustments for case 
mix, volume and region and separate capital budgets for hospitals and institutional,' 
providers; 
C. A certificate of need program pursuant to chapter 103-A; 
D. A health planning program; and 
E. Data collection regarding health care needs, resources and expenditures. 
SUBCHAPTER 4 
FINANCING OF THE MAINE HEALTH CARE PLAN 
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§374. Financing of Maine Health Care Plan 
FinanCing of the plan is accomplished by the fund. 
1. 
Maine Health Care Trust Fund. 
The Maine Health Care Trust Fund is 
established to finance the plan. Deposits into the fund and expenditures from the fund 
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must be made pursuant to this section and to rules adopted by the agency to carry out the 
purposes of this section. All income generated pursuant to this chapter must be deposited 
in the fund, which does not lapse but carries forward from one fiscal year to the next. 
Rules adopted pursuant to this section are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A. 
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A. The Small Business Hardship Fund is established as' a part of the fund to assist ' 
self-employed persons and employers for which participation in the plan constitutes a 
hardship. 
B. Payments are deposited into the fund from: 
(I) Payroll taxes transferred pursuant to Title 36, chapter 370-A; 
(2) Payments made by federal, state and local governmental units; 
(3) Payments appropriated from the General Fund; 
(4) Copayments for permanent care made pursuant to section 372, subsection 3, 
paragraph D; and 
(5) Other payments made pursuant to law. 
e. Expenditures from the fUlid are authorized forthe purposes in this paragraph: 
(1) One percent of the budget of the fund for' health, promotion and injUlY, 
disease and disability prevention programs; 
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(2) 
Payments to participating providers for health care services rendered 
pursuant to section 372, subsection 4; 
(3) Payments to nonparticipating providers for health care services Tendered 
pursuant to section 372, subsection 4; 
(4) Payments for capital expenditures approved pursuant to chapter 1 03~A; 
(5) Payments to the Small Business Hardship Fund; 
(6) Payments for administration of the fund and the plan; . 
(7) Payments for the operations and expenditures of the agency, the council and 
any advisory committees authorized by law or appointed by the agency; and 
(8) Other payments made pursuant to la\¥. 
2. 
Requirements for expenditures. . The agency shall adopt rules setting the 
requirements for expenditures from the fund. Rules adopted pursuant to this subsection 
are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. The agency 
shall perform qUaIt~r1y reviews of expenditures within the open plan and organized 
delivery systems to determine whether expenditures are within the budget of the agency. 
The requirements include: 
A. For organized delivery systems, rates that are based on capitation, that utilize risk 
adjustment and that are set to reflect whether a region is underserved or has low 
income and low utilization rates; 
B. For participating providers in the open pliil, rates, that are set to reflect costs, 
volume and relative value of services and that may be based on ,contracts and 
capitation; 
e. For institutional providers and hospitals,' rates that are based on global budgets; 
and 
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D. For rural health centers. as defined in Title 32, section 13702-A, subsection 32, 
and the system of family planning services as defined in section 1902, subsection 4, 
rates that reflect their special missions and needs. 
SUBCHAPTER 5 
MAINE HEALTH CARE AGENCY 
§375. Establishment 
The Maine Health Care Agency is established as an independent executive agency to: 
1. Maine Health Care Plan .. Administer and oversee the Maine Health Care Plan; 
2. Maine Health Care Council. Take action under the direction of the Maine 
Health Care Council; and 
3. Maine Health Care Trust Fund. Administer and oversee the Maine Health Care 
Trust Fund. 
§376. General powers 
In addition to the powers granted to the agency elsewhere in this chapter, the agency 
is authorized to act as necesSaIY to carlY out the purposes of this chapter. 
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1. Rulemaking. The agency may adopt, amend and repeal rules as necessary for the 
proper administration and enforcement of this chapter, subject to the Maine 
Administrative Procedure Act. Rules adopted pursuant to this subsection are routine 
technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
2. Executive director and staff. The agency shall employ an executive director, 
who must have had experience in the organization, financing or delivelY of health care 
and who shall perform the duties delegated by the agency. The agency may delegate to 
the executive director any of its functions and duties except the adoption of rules, the 
establishment of a global budget for health care for the State under section 373, 
subsection 4 and the review of celtificate of need applications under chapter 1 03~A. The 
executive director is an unclassified employee and serves at the pleasure of the council. 
The executive director, at the direction of the agency, shall hire personnel to administer 
. this chapter, subject to the Civil Service Law and within the budget set by the agency. 
3. Receipt of gifts, grants and payments; fees. The agency may solicit, receive and 
accept gifts, grants, payments and other funds and advances from any person and enter 
into agreements with respect to those grants, gifts, payments and other funds and 
advances, including agreements that involve the undertaking of studies, plans, 
. demonstrations and projects. The agency may charge and retain fees to recover the 
reasonable costs incurred in reproducing and distributing reports, studies and other 
publications and in responding to requests for information. 
4. Studies and analyses. The agency may conduct studies and analyses related to 
the provision of health care, health care costs and matters it consjders appropriate. 
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5. Grants. The agency may make grants to persons to· suppOli research or other 
activities undeliaken in furtherance of the purposes of this ·chapter. Without the specific 
written authorization of the agency, a party receiving a grant from the agency may not 
release, publish or otherwise use results of the research or information Imide available by 
the agency. 
6. Contracts. The agency may contract with anyone for services necessary to carry 
out the activities of the agency. Without the specific written authorization of the agency, a 
paliy entering into a contract with the. agency may not release, publish or otherwise use 
information made available to that paliy under contracted responsibilities. 
7. 
Audits. To the extent necessary to carry out its responsibilities, the agency, 
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during normal business hours and upon reasonable notification, may audit, examine and 
inspect any records of any health care provider, organi7ed delivery system or contractor 
under subsection 6. 
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8. Data collection. The agency shall institute a data collection system to acquire and 
analyze information on· the provision of health care and health care costs. 
All data 
released by the agency must protect the confidential ity of the health care provider and the 
plan member and, whenever possible, must be released as aggregate data. 
9. 
Complaint resolution. 
In cooperation with· health care providers and plan 
members, the agency shall institute a complaint resolution system to handle the 
complaints of health care providers and plan members. 
10. Funding. The agency shall determine the level of funding required to carlY out 
the purposes of this chapter. The agency shall submit biennially to the Legislature for 
approval a proposed budget with levels of premiums and assessments and taxes under 
Title 36, section 4365. Funding for the agency budget approved by the Legislature is 
paid from the fund. 
11. Coordination with federal, state and local health care systems. The agency 
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shall institute a system to coordinate the activities of the agency and the plan with the 
health care programs of the federal, state and municipal governments. 
12. Reports. By January 1 st of each year, the agency shall submit to the Govel1lor 
and the Legislature a repOli of its operations and activities during the previous year, 
including its operations and activity with respect to· the funding, tax and budget 
requirements pursuant to subsection 10. This report must include facts and suggestions 
. and policy recommendations that the agency considers necessary. 
As it determines 
appropriate, the agency shall publish and disserninate information helpful to the citizens 
of this State in making informed choices in obtaining health care, including the results of 
studies or analyses undeliaken by the agency. 
13. Advisory committees. The agency may appoint advisory committees to advise 
and assist the agency. Members of those committees serve without compensation but 
may be reimbursed by the agency for necessary expenses while on official businessofthe 
committee. 
14~ Headquarters. The agency's central office must be in the Augusta area, but the 
agency may hold hearings.and sessions at any place in the State. 
15. Seal. The agency may have a seal bearing the words "Maine Health Care 
Agency." 
§377 .. Maine Health' Care Council 
The Maine Health Care Council is established as the decision:..making and directing 
council for the agency. 
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Membership. Th'e council is composed of 3 members, appointed by the Governor 
and, within 30 days after authorization, slibject to review by the joint standing committee 
of the 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 confirmation by the Legislature. 
Persons eligible for appointment to the council must have had experience in the 
organization, delivery or financing of health care. At least one member of the council 
must be an individual with experience in the delivery and organization of primary and 
preventive care and public health services .. At least one meinber of the council must·be 
an individual who is not a health care provider and has not worked for a health care 
provider or health insurer. Members of the council shall devote full time to their duties. 
2. Terms. All appointments are for 5-year terms, except that a member appointed t6 
fill a vacancy in an unexpired term serves only for the remainder of that term. Members 
hold office until the appointment and confirmation oftheir successors. 
3. Chair; voting. The Governor shall designate one member of the council as chair. 
The chair shall preside at meetings of the council,. is responsible for the expedient 
organization of the agency's work and may vote on all matters before the council. Two 
council members constitute' a quorum. 
The council may take action only by an 
affirmative vote of at least 2 members. 
4. 
Duties. 
The council shall direct, administer and oversee the agency in the 
. performance of its duties under this chapter. The council shall annually prepare a state 
health plan in accordance with Title 2, chapter 5. The council has broad authority to 
carlY out the purposes of this chapter. 
Sec. A-2. Working capital advance. 
The State Controller shall transfer a 
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$400,000 working capital advance to the dedicated account of the Maine Health Care 
Trust Fund on the effective date of this Part. The Maine Health Care Agency shall repay 
this working capital advance by June 30, 2012. 
Sec. A-3. Initial appointees; staggered terms. The terms of the members of 
the Maine Health Care Council, established in the Maine Revised Statutes, Title 22, 
section 3 n,subsection 2, are staggered. Of the initial appointees, one must be appointed 
for one year, one for 2 years and one for 3 years .. 
Sec. A-4. Effective date. This Part takes effect July 1, 2010. 
Page J J - 124LRO 108(0 1 )-1 
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PARTB 
Sec. B-1. Maine Health Care Plan Transition Advisory Committee. The 
. Maine Health Care Plan Transition Advisory Committee, referred to in this section as 
"the committee," is established· to advise the members of the Maine Health Care Council 
as established in the Maine Revised Statutes, Title 22, section 377. 
1. Membership. The committee consists of 20 members, who are appointed as 
specified iri this subsection and are subject to confirmation by the Legislature. 
Four members must be Legislators. Two of those members must be appointed by the 
President of the Senate, one from each of the 2 political parties having the largest number 
of members in the Senate, and 2 must be appointed by the Speaker of the House of 
Representatives, Olie fwm each Of the 2 political paJiies having the largest number of 
members in the House. 
Sixteen members must be representatives of the public. Eight of those members must be 
appointed by the Governor, 4 of those members must be appointed by the President of the 
Senate and 4 of those members must be appointed by the Speaker of the House of 
Representatives. 
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The public members must represent statewide organizations from the following groups: 
consumers, uninsUl'yd persons, providers of maternal and child health services, Medicaid 
recipients, persons with disabilities, persons who are elderly, organized labor, allopathic 
and osteopathic physicians, nurses and allied health care professionals, organized delivery 
systems, . hospitals, community health· centers, the family planning system and the 
business community, including a: representative of small business. 
The appointing authorities shall notify the Executive Director of the Legislative Council 
upon making their appointments. All appointments must be made' within 30 days of the 
effective date of this Part. 
Within the following 30 days, the appointments must be 
reviewed and approved by a joint committee consisting of the members of the joint. 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters and the joint standing committee of the Legislature having jurisdiction 
over heahh and human servic;es matters and must be confirmed by the Legislature. 
When appointment of all members of the committee is· completed, the chair of the· 
Legislative Council shall call the committee together for its first meeting. 
The first 
meeting must be held within 90 days of the effective date of this Part. The members of 
the committee shall elect a chair from among the members. 
2. Duties. The committee shall hold public hearings, solicit public comments and 
advise the Maine Health Care CounciI for the purposes of planning .the transition to the 
Maine Health Care Plan established in the Maine Revised Statutes, Title 22, section 372 
and recommending legislative changes to accomplish the purposes of Title 22, chapter 
106. 
3. Staffing and funding. The Maine Health Care Council shall provide staffing and 
funding for the committee. 
4. Compensation. Members .of the committee serve without compensation. They 
are' entitled to reimbursement from the Maine Health Care Council for· travel and other 
necessary expenses incurred in the performance of their duties on the committee. 
5. Reports. Every 6 months beginning July; 1, 2010, the committee shall report to 
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the Maine Health. Care Council, the Governor and the Legislature. 
6. Completion of duties. The committee shall complete its duties when the Maine 
Health Care Plan becomes effective pursuant to the Maine Revised Statutes, Title 22, 
section 372. 
Sec. B-2. Effective date. This Part takes effect January 1, 2010. 
PART C 
Sec. C-l. 2 MRSA §6-F is enacted to read: 
§6-F. Salaries of members of the Maine Health Care Council and executive director 
of the Maine Health Care Agency 
Notwithstanding any other provision of law, the salaries of members of the Maine 
Health Care Council, as established in Title 22, section 377, and of certain employees of 
the Maine Health Care Agency, as established in Title 22, section 375, are set out in this 
section. 
1. Members; Maine Health Care Council. The salaries of the members of the 
Maine Health Care Council, as established in Title 22, section 377, are within salary 
range 91. 
2. Executive director; Maine Health Care Agency. . The salary. of the executive 
director of the Maine Health Care Agency, as established in Title 22, section 375, is 
within salaiyrange 91. 
Sec. C-2. Effective date. This PaJi takes effect July 1,2010. 
PART D 
Sec. D-l. 24-A MRSA §2185-A is enacted to read: 
§2185-A. Benefits that duplicate health care benefits of the Maine Health Care Plan 
Health insurance policies and contracts and health care contracts and plans are 
subject to the provisions of this section. 
1. 
Prohibited conduct. 
A person, insurer, health maintenance organization or 
nonprofit hospital or medical service organization may not sell or offer for sale in this 
State a health insurance policy or contract or a health care contract or plan that offers 
benefits that duplicate the health care benefits offered by the Maine Health Care Plan 
under Title 22, section 372, subsection 3 unless that person, insurer, health maintenance 
organization or nonprofit hospital or medical service organization has been authorized as 
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an organized delivery system by the Maine Health Care Agency pursuant to Title 22, 
section 372, subsection 4, paragraph A. A violation ofthis section constitutes an unfair 
and deceptive trade practice under section 2152. 
2.
Allowed conduct. 
A person, insurer, health maihtenance organization or 
nonprofit hOspital or medical service organization may sell or offer for sale in the State a 
health insurance policy or contract or a health care contract or plan that offers coverage 
and benefits that are supplemental to and do not duplicate covered health care benefits 
offered by the Maine Health Care Plan under Title 22, section 372, subsection 3. 
PARTE 
Sec. E-1. 
Employment retraining, 
The Maine Health Care Agency, as 
established in the Maine Revised Statutes, Title 22, section 375, shall coordinate with the 
Depaliment of Economic and Community Development, the Department of Labor and 
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private industry councils °to ensure that employment Tetraining services are available for 
administrative workers employed by insurers and providers who are displaced due to the 
transition to the Maine Health Care Plan established in Title 22, section 372. 
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Sec. E-2. Delivery of long-term health care services. The Maine Health Care 
Agency, as established in the Maine Revised Statutes, Title 22, section 375, shall study 
the delivery of long-term health care services to Maine Health Care Plan members under 
Title 22, chapter 106. The study mllst address the best and most efficient manner of 
delivery of health care services to individuals needing long-term care and funding sources 
for long-term care. In undertaking the study, the agency shall consult with the Maine 
Health Care Plan Transition Advisory Committee established in Part Bof this Act, 
repres<:.:ntatives of consumers and potential consumers of long-term care services, 
representatives of providers of long-term care services and representatives of employers, 
employees and the public. 
The agency shall report to the Legislature on or before 
January 1,2012 and may include suggested legislation in the report. 
Sec. E-3. Pr9vision of health care services. The Maine Health Care Agency, as 
established in the Maine Revised Statutes, Title 22, section 375, shall study the provision 
of health care services under the MaineCare and Medicare programs. The study must 
consider the waivers necessary to coordinate the MaineCare and Medicare programs with 
the Maine Health Care Plan established in Title 22, section 372; the method of 
coordination of benefit delivery and compensation; reorganization of State Government 
necessary to achieve the objectives of the agency; and any other changes in law needed to 
carry out the purposes of Title 22, chapter 106. The agency shall apply for aJI waivers 
required to coordinate the benefits of the Maine Health Care Plan and the MaineCare and 
Medicare programs. The agency shall report to the Legislature on or before March 1, 
2011 and may include suggested legislation in the report. 
PART F 
Sec. F-L 1 MRSA §71, sub-§7-B is enacted to read: 
7-B. Payer; payor. The words "payer" and "payor" may be used interchangeabiy 
and have the same" meaning. 
PARTG 
Sec. G-l. 36 MRS A c.370-A is enacted to read: 
CHAPTER 370-A 
PAYROLL 'fAX 
§2831.Payroll tax on wages and earnings 
1. 'fax levied. Every taxpayer constituting an employing unit in this State shall pay 
a tax of 7.5% on all gross earnings of that employing unit's employees. EvelY taxpayer 
who is self-employed shall pay a tax of 7.5% on all gross earnings of that taxpayer's 
wages and earnings. 
2. Payment of tax; returns. Every taxpayer subject to the tax imposed by this 
section shall, on or before the last day of each April, the last day of each June and the last 
day of each October, file with the assessor on forms prescribed by the assessor a return 
for the quarter ending the last day of the preceding month, except for the month of June, 
which is for the quarter ending June 30th. The final return and payment must be filed on 
or before March 15th' covering the prior calendar year. At the time of filing such returns, 
each taxpayer shall pay to the assessor the amount . of tax shown due. A taxpayer with 
annual tax liability not exceeding $500 may with approval of the assessor file an annual 
. return with payment on or before March 15th covering the prior calendar year. 
3. Maine Health Care 'frust Fund. The assessor shall pay taxes collected under 
this section to the Maine Health Care Trust Fund established in Title 22, section 374. 
SUMMARY 
This bill establishes a universal access health care system that offers a choice of 
coverage through organized delivery systems or through a managed care system operated 
by the Maine Health Care . .Agency and channels all health care dQllars through a 
dedicatedtrilst fund. 
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1. Pali A of the bill does the following . 
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It establishes the Maine Health Care Plan to provide security through high-quality, 
affordable heaith care for the people of the State. The plan becomes effective when 2 
other New England states enact substantially similar legislation. 
All residents' mid 
nonresidents who maintain significant contact with the State are eligible for covered' 
health care services through the Maine Health Care Plan. The plan is funded by the 
Mai~e Health Care Trust Fund, a dedicated fund receiving payments from payroll taxes 
and payments from the General Fund or any othersources. The Maine Health Care Plan 
provides a range of benefits, including hospital services, health care services from 
paliicipating providers, laboratory and imaging procedures, home health services, 
rehabilitative services, prescription drugs arid devices, mental health services, substance 
abuse 'treatment services, dental services, vision appliances, medical supplies and 
equipment and hospice care. Health care services under the Maine Health Care Plan are 
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provided by paJ1icipating providers in organized delivery systems and through the open 
plan, which is ,available to all providers. The plan is supplemental to other health care 
programs that may be available to plan members, such as MaineCare, Medicare, the 
Dirigo Health Program, the federal Civilian Health and Medical Program of the 
Uniformed Services, the federal Indian Health Care Improvement Act and workers' 
com pensation. 
It establishes the Maine Health Care Agency to administer and ovei"see the Maine 
Health Care Plan" to act under the direction of the Maine Health Care Council and to 
administer and oversee the Maine Health Care Trust Fund. The Maine Health Care 
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Council is the decision-making and directing ~ouncil for the agency and is composed of 3 
full-time appointees. 
It directs the Maine Health Care Agency to establish programs to ensure quality, 
affordability, efficiency of care and health planning. 
The agency health planning 
program includes the establishment of global budgets for health care expenditures for the 
State and for institutions and hospitals. The health planning program also encompasses 
the certificate of need responsibilities of the agency pursuant to the Maine Revised 
Statutes, Title 22, chapter 103-A and the health planning responsibilities pursuant to Title 
2, chapter 5. The agency is also required to contract with a 3rd-party administrator for 
claims processing and data collection servi~es. 
It requires the State Controller to advance $400,000 to the Maine Health Care Trust 
Fund on the effective date of the Part, July 1, 2010. This amount must be repaid by the 
Maine Health Care Agency by June 30, 2012. 
2. Part B of the bill establishes the Maine Health Care Plan Transition Advisory 
Committee. 
Composed of 20 members, appointed and subject to confirmation, the 
committee is charged with holding public hearings, soliciting public comments and 
advising the Maine Health Care Council on the transition from the current health c~re 
system to the Maine Health Care Plan. 
Members of the committee serve without 
compensation but may be reimbursed for their expenses. The committee is directed to 
rep0l1 to the Governor and to the Legislature every 6 months beginning July 1,2010. The 
committee completes its work when the Maine Health Care Plan becomes effective. 
31. 
" 3. Part C of the bill establishes the salaries of the members of the Maine Health Care 
CO,uncil and the executive director offhe Maine Health Care Agency. 
4. PaJ1 D of the bill prohibits the saie on the commercial market of health insurance 
policies and contracts that duplicate the coverage provided by the Maine Health Care 
Plan. It allows the sale of health insurance policies and contracts that do not duplicate 
and are supplemental to the coverage of the Maine Health Care Plan. 
5. PaJ1 E of the bill directs the Maine Health Care Agency to ensure employment 
retraining for administrative workers employed by insurers and providers who are 
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displaced by the transition to the Maine Health Care Plan. It directs the Maine Health 
Care Agency to study the delivery and financing of long-term care, services to plan, 
members. Consultation is required with the Maine Health Care Plan Transition Advisory 
Committee, representatives of consumers and potential consumers of long-term care 
servIces and representatives of providers of long-term care services, employers, 
employees and the public. A report by the agency to the Legislature is due January 1, 
2012. 
the Maine Health Care Agency is directed to study the provIsIon of health care 
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services under the MaineCare and Medicare programs, waivers, coordination of benefit 
delivery and compensation, reorganization of State Government necessary ~o accomplish 
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the objectives of the Maine Health Care Agency and legislation needed to can)' out the 
purposes of the bill. 
The .agency is directed to apply' for all waivers required to 
coordinate the benefits of the Maine Health Care Plan and the MaineCareand Medicare 
programs .. A report by the agency is dtle to the Legislature by March 1, 2011. 
6. Part F of the bill clarifies that, throughout the Maine Revised Statutes, the words 
"payer" and "payor" m~y be used interchangeably and have the same meaning. 
7., Part Gofthe bill establishes a 7.5% payroll tax on wages and earnings, including 
self-employed earnings, and dedicates that tax revenue to'the Maine Health Care Trust 
Fund. 
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