An Act To Implement Shared Decision Making To Improve Quality of Care and Reduce Unnecessary Use of Medical Services.
Maine Legislature, Session 124, LD 1358
Committee: Insurance and Financial Services
Sponsors: MILLS
Amends: 22 MRSA §3174-L, 24-A MRSA §4301-A, 24-A MRSA §4303

MAINE STATE LEGISLATURE 
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124tlt MAINE LEGISLATURE 
Legislative Document 
No. 1358 
S.P.493 
In S.enate, April 2, 200~ 
An Act To Implement Shared Decision Making To Improve Quality 
of Care and Reduce Unnecessary Use of Medical Services. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Senator MILLS of Somerset. 
Printed an recycled paper 
9tf)(J~ 
JOY J. O'BRIEN 
Secretary of the Senate 
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Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §3174-LL is enacted to r.ead: 
. §3174-LL. Coverage for shared decision making . 
As a service covered under Medicaid, the department shall adopt the shared decision-
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making program as established by the Maine Quality Forum pursuant to Title 24-A, 
section 6951, subsection 12. The department shall adequateIy compensate a provider to 
ensure a reasonable measure of shared decision making for each eligible patient who· 
elects to participate.. The department shall recowze participation in shared decision 
making as a factor to be rewarded in any system of extra compensation provided to 
practitioners. 
As part of the shared decision-making program, the department shall 
relieve each participating provider of the requirement to obtain prior authorization for 
prescription drugs as long as. the provider can demonstrate a continuing record of 
substantial compliance with MaineCare's preferred drug list. The department shall report 
to the Maine Quality Forum and the Maine Health Data Organization upon request such 
data as may be required to evaluate the effectiveness of the program. 
Sec. 2. 24 MRS A §2905, sub-§4 is enacted to read: 
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4. Shared decision making. If a patient engages in shared decision making in 
accordance with Title 24-A, section 4303, subsection 12 and section 6951, subsection 12, 
an aclmowledgement. signed by the patient or patient's representative is prima facie 
evidence that informed consent was given to be treated or not treated, as the case may be, 
for the condition covered by the aclmowledgement. The presumption of informed consent 
. created by this subsection may be overcome onlyby clear and convincing evidence.- An 
aclmowledgement of shared decision making must: 
A. 
State that the patient or patient's representative intends to proceed or not to . 
proceed, as the case may be, with the service or course of treatment identified in the 
aclmowledgement; 
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B. 
Identify the patient decision aid or aids that have been used to facilitate the 
exchange of information about the patient's options;. and 
C. 
State that the patient or patient's representative understands the available 
alternatives for care. 
Sec. 3. 24-A MRS A §4301-A, sub-:§13-A is enacted to read: . 
13-A. Patient decision aid. "Patient decision aid" means written, audio, visual or 
online material approved by the Maine Quality Forum to assist patients in selecting 
preference-sensitive health care services; "Patient decision aid" includes educational 
material that describes the diagnosed condition, explains treatment options, presents the 
possible benefits and harms of each choice or discusses the range of likely outcomes. 
Where appropriate, a patient decision aid may describe the limits of reliable scientific 
knowledge concerning the patient's condition and options for care. "Patient decision aid" . 
also includes any material or tool that may help to define the patient's personal goals and 
values relevant to a health care decision. 
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The purpose of a p~tient decision aid is to provide clear, reliable, up-to-date methods by 
which to implement shared decision making efficiently and cost-effectively but with 
particular attention to the individuality of the patient. 
Sec. 4. 24-A MRSA §4301-A, sub-§15-A is enacted to read: 
.IS-A. Preference-sensitive health care service. "Preference-sensitive health care 
'. service" means a health care service that meets the criteria for medically necessary health 
care but whose suitability for a particular patient may depend on the patient's personal 
preferences as expressed after the patient is well informed of the available options' and 
understands how such choices may be affected by the patient's personal circumstances 
and values. 
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Sec. 5. ,24-A MRSA §4301-A, sub-§15-B is enacted to read: 
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IS-B. Primary care provider. "Primary care provider" means a licensed medical or 
osteopathic physician, physiCian's assistant or certified nurse practitioner who practices 
family medicine, general practice, internal medicine or pediatrics and who serves as the 
principal access to health care for patients. "Primary care provider" may also include a 
specialist in obstetrics or gynecology when the provider serves as the principal access to 
health care for patients. 
Sec. 6. 24:'A MRSA §4301-A, sub-§17-A is enacted to read: 
17-A. Shared decision malting. "Shared decision making" means a process that 
enables either a patient or a patient's representative on the patient's behalf to select 
options for preference-sensitive health care services after exchanging with a health care 
provider the information necessary to understand the uncertainties and side effects of 
each option in the context of the patient's individual condition, age, health status, attitude 
and values. 
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Sec. 7. 24-A MRSA §4303, sub-§3-B, as amended by PL 2007, c. 199, Pt. B, §8, 
is further amepded to read: 
3-D. Prohibition on financial incentives. Acarrier pffering or renewing a managed 
care plan may not offer or pay any type of material inducement, bonus or other financial 
incentive to a participating provider to deny, reduce, withhold, limit or delay specific 
medically necessary health' care services covered under the plan to an enrollee. This 
subsection may not be construed to prohibit contracts that contain incentive plans that 
involve general payments such as capitation payments or risk-sharing agreements that are 
made with respect to providers or groups of providers or that are made with respect to 
groups of enrollees. This subsection may not be construed to prohibit or limit shared 
decision making as provided in subsection 12. 
Sec. 8. 24-A MRSA §4303, sub-§12 is enacted to read: 
12. Shared decision malting. A carrier shall implement a shared decision making 
program in accordance with this subsection . 
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15. 
A. A carrier shall implement protocols for shared decision making for preference-
sensitive health care services identified and developed by the Maine Quality Forum 
as required by section 6951. A carrier may contract for shared decision-making 
services with 3rd parties approved by the Maine Quality Forum or may authorize 
providers to do so. 
B. A carrier shall compensate participating providers for shared decision-making 
services rendered to each eligible patient or patient's representative who elects to use 
the shared decision-making· process. 
A carrier shall compensate primary care 
providers for shared decision making even if the preference-sensitive health care 
service being considered by a patient is a service provided by a specialist. 
C. A carrier shall report to the Maine Quality Forum and the Maine Health Data 
Organization upon request such data as may be required to evaluate the effectiveness 
of the program. 
Sec. 9. 24-A MRS A §6951, sub-§12 is enacted to read: 
12. Shared decision making. The forum shall implement a' program for shared 
decision making for use by health insurance carriers and the MaineCare program. The 
forum shall develop and maintain a list of preference-sensitive health care services and 
publish an accepted protocol for shared decision maldng for each selected health care 
service. The forum shall also identify approved patient decision aids relating to each 
health care service and identify approved vendors who offer shared decision-making 
services. 
In conjunction with the Maine Health Data Organization, the forum shall 
collect data as necessary from health insurance carriers and the MaineCare program to 
evaluate whether shared decision making is effective in reducing health care costs and' 
unnecessary utilization of services. 
The forum may adopt rules as necessary to' 
implement the program. Rules adopted pursuant to this subsection are routine technical 
rules as defined in TitleS, chapter 375, subchapter 2-A. As used in this subsection, the 
terms "patient decision aid," "preference-sensitive health care serviceII' and '''shared 
decision making" have the same meanings as in section 4301-A. 
Sec. 10. Report on shared decision making. On or before January 31, 2012, 
the Maine Quality Forum, in conjunction with the Maine Health Data Organization, shall 
submit a report evaluating the shared decision-making program established pursuant to 
the Maine Revised Statutes, Title 24-A, section 6951, subsection 12 and used by health 
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. insurance carriers and the MaineCare program and the effectiveness of the program in 
reducing health care costs and urmecessary utilization of servIces. The report must be 
submitted to the joint standing coriunittee of the Legislature having jurisdiction over 
health insurance matters. 
SUMMARY 
This bill requires health insurance carriers and the MaineCare program to implement 
shared decision making as.a strategy for improving the quality of medical care and for 
controlling the unnecessary utilization of preference-sensitive health care services. Under 
the bill, the Maine Quality Forum is responsible for determining'which medical services 
are preference-sensitive and for approving protocols and decision-making aids to assist 
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health care providers in consulting with patients. 
If a provider follows the shared 
decision-making protocol, the health care provider may use compliance with the protocol 
as proof of informed consent when relevant to defending a medical malpractice action. 
The bill requires the Maine Quality Forum and the Maine Health Data Organization to 
evaluate the shared decision-making program and report -to the_Legislature by January 31, 
2012. 
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