An Act To Amend the Laws Governing the Maine Health Data Processing Center and the Maine Health Data Organization
Maine Legislature, Session 124, LD 1544
Committee: Health and Human Services
Sponsors: PERRY, MILLER, PINGREE, MARRACHE
Amends: 10 MRSA §681, 10 MRSA §683, 10 MRSA §688, 10 MRSA §689, 24-A MRSA §2436

Legislative Document 
No. 1544 
H.P. 1088 
House of Representatives, December 21,2009 
An Act To Amend the Laws Governing the Maine Health Data 
Processing Center and the Maine Health Data Organization 
Submitted by the Maine Health Data Organization pursuant to Joint Rule 204. 
Received by the Clerk of the House on December 17, 2009. Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401. 
Presented by Representative PERRY of Calais. 
'77/d~ 111· 7ll{J£~{ 
MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Representatives: MILLER of Somerville, Speaker PINGREE of North Haven, 
SA VlELLO of Wilton, Senator: MARRACHE of Kennebec. 
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Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 10 MRSA §681, as enacted by PL 2001, c. 456, §1, is amended to read: 
§681. Authority to establish 
The Maine Health Data Organization, established pursuant to Title 22, chapter 1683, 
and a nonprofit health data processing entity referred to in this chapter as the "Maine 
Health Information Center" "Onpoint Health Data" or its successor organization may 
form a nonprofit corporation under Title 13-B in order to collect and process health care 
claims data, to be known as the Maine Health Data Processing Center, referred to in this 
chapter as the "center." The center shall carry out its purposes in complement to and in 
coordination with the Maine Health Data Organization and the Maine Health Information 
GeHter Onpoint Health Data. 
The center is a nonprofit corporation with a public purpose and the exercise by the 
center of the powers conferred by this chapter is an essential governmental function. 
Sec. 2. 10 MRS A §682, sub §2, as enacted by PL 2001, c. 456, §I, is amended to 
read: 
2. Developing claims-based data. Building upon the experience and expertise of 
the Maine Health Data Organization and the Maine Health Information Center Onpoint 
Health Data to collect, process and maintain health care data extracted from claims data 
in a cost-effective manner; 
Sec. 3. 10 MRSA §683, as amended by PL 2009, c. 71, §I, is further amended to 
read: 
§683. Board of directors; officers 
The Board of Directors of the Maine Health Data Processing Center, referred to in 
this chapter as the "board of directors," consists of.g 11 directors. 
1. 
Nominations. The director of the Maine Health Data Organization and the 
president of the Maine Health Information Center Onpoint Health Data are ex officio 
members of the board of directors and are authorized to vote. +He In order to achieve 
balanced representation, the director and president shall nominate the following 
representatives for service on the board of directors: 
A. One member Three members representing different constituencies of the Main:e 
Health Information Center Onpoint Health Data board of directors and one member l 
members representing different constituencies of the Maine Health Data Organization 
board of directors; and 
B. Four representatives of health care providers, 2 of whom must represent hospitals; 
Three nominees chosen from among the following constituency categories that are 
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unden'epresented on the board of directors: 
(1) Health care providers; 
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(2) Third-party payors; 
(3) Employers; and 
(4) Consumers of health care .. 
C. T\vo representatives of3rd party payors; 
D. One r~mresentative of consumers of health care; and 
E. Two reoresentatives of emolovers. 
2. Election. The names of the representatives nominated under this section must be 
presented to the boards of directors of the Maine Health Data Organization and the Maine 
Health Information Center Onpoint Health Data for election to the board of directors. 
3. Limitation on terms. An elected person may serve as a director for not more 
than 2 5-year terms in succession and continues to serve until a successor has been 
appointed. 
4. Chairs. The board of directors shall elect a chair and a vice-chair from among its 
members at the first meeting of the board each year. 
5. Manager. The board of directors shall appoint a manager to serve at the pleasure 
of the board and to represent the board in the management of the center. The manager 
has the necessary authority and responsibility for the operational management of the 
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center in all of the activities of the center. 
Sec. 4. 10 MRSA §688, as enacted by PL 2001, c. 456, § 1, is amended to read: 
§688. Audit; public access 
Before January 1 st of each year, the center shall provide an independent audit of the 
activities of the center to the boards of directors of the Maine Health Data Organization 
and the Maine Health Infonnation Center Onpoint Health Data. Audits must be done as 
required by law or by the Department of Administrative and Financial Services. To 
ensure public accountability, the center is subject to the provisions of Title 1, chapter 13, 
subchapter I1. 
Sec. 5. 10 MRS A §689, sub-§I, as amended by PL 2005, c. 565, §4, is further 
amended to read: 
1. Net earnings of center. The annual net earnings of the center must be distributed 
to the Maine Health Data Organization and the Maine Health Information Center Onpoint 
Health Data in proportion to the average annual funding provided by each entity for the 
operational costs of the center. The net earnings of the center may not inure to the benefit 
of any officer, director or employee, except that the center is authorized and empowered 
to pay reasonable compensation for services rendered and otherwise hold, manage and 
dispose of its property in furtherance of the purposes of the center. 
Sec. 6. 10 MRSA §689, sub-§2, as enacted by PL 2001, c. 456, § 1, is amended to 
read: 
2. Dissolution of center. Upon dissolution of the center, the board of directors shall, 
after paying or making provision for the payment of all liabilities of the center, cause all 
of the remaining assets of the center to be transferred to the Maine Health Data 
Organization and the Maine Health Information Center Onpoint Health Data in shares 
proportionate to the total revenue transferred to the center by each entity. 
Sec. 7. 22 MRS A §S712, as amended by PL 2009, c. 71, §8 and c. 350, Pt. A, § 1, 
is further amended to read: 
§8712. Reports 
The organization shaH produce clearly labeled and easy-to-understand reports as 
follows. Unless otherwise specified, the organization shaH distribute the reports on a 
publicly accessible site on the Internet or via mail or e-mail, through the creation of a list 
of interested parties. The organization shall publish a notice of the availability of these 
reports at least once per year in the 3 daily ne'tvspapers of the greatest general circulation 
published in the State. The organization shaH make reports available to members of the 
public upon request. 
1. Quality. At a minimum, the The organization, shal1 promote public transparency 
of the quality and cost of health care in the State in conjunction with the Maine Quality 
Forum, established in Title 24-A, section 6951, and shaH develop and produce annual 
quality reports col1ect, synthesize and publish information and reports on an annual basis 
that are easily understandable by the average consumer and in a format that al10ws the 
user to compare the information listed in this section to the extent practicable. The 
organization's publicly accessible websites and reports must, to the extent practicable, 
coordinate, link and compare information regarding health care services, their outcomes, 
the effectiveness of those services, the quality of those services by health care facility and 
by individual practitioner and the location of those services. The organization's health 
care costs website must provide a link in a publicly accessible format to provider-specific 
information regarding quality of services required to be reported to the Maine Quality 
Forum. 
2. Payments. The organization shal1 create a publicly accessible interactive website 
that presents reports related to health care facility and practitioner payments for services 
rendered to residents of the State. The services presented must include, but not be limited 
to, imaging, preventative health, radiology and surgical services and other services that 
are predominantly elective and may be provided to a large number of patients who do not 
have health insurance or are underinsured. The website must also be constructed to 
display prices paid by individual commercial health insurance companies, 3rd-party 
administrators and, unless prohibited by federal law, governmental payors. 
A. The organization shall promote public transparency of the quality and cost of 
health care in the State, in conjunction with the Maine Quality Forum as established 
in Title 24 A, section 6951, and shall collect, synthesize and publish information and 
reports on an annual basis that are easily understandable by the average consumer and 
in a format that allows the user to compare the information listed in this section to the 
extent practicable. The organization's publicly accessible v.'ebsites and reports shall, 
to the extent oracticable. coordinate. link and comoare information regarding health 
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care services, their outcomes, the effectiveness of those services, the quality of those 
services by health care facility and by individual practitioner and the location of those 
services. The organization's health care costs 'Neb site must provide a link in a 
publicly accessible format to provider specific information regarding quality of 
services reauired to be resorted to the Maine Oualit ... Forum. 
3. Comparison report. At a minimum, the organization shall develop and produce 
an annual report that compares the 15 most common diagnosis-related groups and the 15 
most common outpatient procedures for all hospitals in the State and the 15 most 
common procedures for nonhospital health care facilities in the State to similar data for 
medical care rendered in other states, when such data are available. 
4. Physician services. The organization shall provide an annual report of the 10 
services and procedures most often provided by osteopathic and allopathic physicians in 
the private office setting in this State. The organization shall distribute this report to all 
physician practices in the State. The first report must be produced by July 1, 2004. 
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Sec. 8. 24-AMRSA §2436, suh-§2-A, as amended by PL 2003, c. 469, Pt. D, §4 
and affected by §9, is repealed and the following enacted in its place: 
2-A. For a claim submitted by a health care provider or health care facility with 
respect to a health plan as defined in section 4301-A, subsection 7, for purposes of this 
section, "undisputed claim" means a timely claim for payment of covered health care 
expenses that is submitted to a carrier in conformity with the following requirements. 
A. The claim must be subm itted on one of the following claims forms: 
(1) For a health care facility claim submitted on paper, the standard claim form, 
using standards approved by a national uniform billing committee; 
(2) For a health care provider claim submitted on paper, the standard claim form, 
using standards approved by a national uniform claim committee; and 
(3) 
For health care facility and health care provider claims submitted 
electronically, an electronic form using standards approved by an accredited 
standards committee of the American National Standards Institute. 
B. The claim must use the most current published source codes with all required 
fields filled with correct and complete information. 
All fields identifying the 
rendering or service provider, the billing provider and the location where the service 
was performed are considered to be required fields and must be filled on all claims. 
Sec. 9. 24-A MRSA §2436, sub-§2-B is enacted to read: 
2-B. If a claim does not conform to the requirements specified in subsection 2-A and 
payment is denied to a health care provider or health care facility by a carrier, the health 
care provider or health care facility may not request payment from the insured or 
beneficiary and shall attempt to rectify the deficiencies with the claim and resubmit the 
claim to the carrier. 
Sec. 10. Claim forms. For the purposes of the Maine Revised Statutes, Title 
24-A, section 2436, subsection 2-A, paragraph A, subparagraph (1), it is the intent of the 
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Legislature that the standard claim form is the UB-04. For the purposes of Title 24-A, 
section 2436,·· subsection 2-A, paragraph A, subparagraph (2), it is the intent of the 
. Legislature that the standard claim form.is the CMS-1500. 
SUMMARY 
This bill amends the laws governing the Maine Health Data Processing Center to 
remove the phrase "Maine Health Information Center" and replace it with "Onpoint 
Health Data," the new name of the organization. It modifies the composition of the 
Board of Directors of the Maine Health Data Processing Center. 
It restructures the laws governing reports produced by the Maine Health Data 
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Organization and removes the requirement that the organization publish a notice of the 
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availability of these reports at least once per year in the 3 daily newspapers of the greatest 
general circulation published in the State. 
It also clarifies what constitutes an undisputed health care claim submitted by a health 
care provider or health care facility to a carrier and specifies fields in the claim that must 
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be fi1\ed. 
The language also. stipulates that if the claim does not conform to the 
requirements and does not contain anyone of the required fields, the provider or facility 
may not request payment directly from the insured and must resubmit the claim to the 
carrier. 
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