An Act To II
Maine Legislature, Session 125, LD 0121
Committee Amendment CA_A_H459 (House)
Amends: 22 MRSA §411, 22 MRSA §412, 22 MRSA §413

COMMITTEE AMENDMENT "A" to H.P. 103, L.D. 
Amend the Laws Regarding Public Health Infrastructure" 
121, Bill, "An Act To 
II 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §411, as enacted by PL 2009, c. 355, §5, is amended to read: 
§41l. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. 
Accreditation. 
"Accreditation" means a national federally recognized 
credentialing process resulting in the approval of a public health system or a municipal 
health department by a national federally recognized review board certifying that a public 
health system or a municipal health department has met specific performance 
requirements and standards. Accreditation provides quality assurance, credibility and 
accountability to the public, to govemment officials and to public health fund sources. 
As applicable to a tribal health department or health clinic, "accreditation" means a 
recognized credentialing process by a national federally recognized review board for 
Indian health. 
2. 
Comprehensive community health coalition. 
"Comprehensive community 
health coalition" means a multi sector coalition that serves a defined local geographic area 
and is composed of designated organizational representatives and interested community 
members who share a commitment to improving their communities' health and quality of 
life and that includes public health in its core mission. 
3. District coordinating council for public health. "District coordinating council 
for public health" means a representative districtwide body of local public health 
stakeholders working toward collaborative public health planning and coordination to 
ensure effectiveness and efficiencies in the public health system. 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT" f1" to H.P. 103, L.D. 121 
4. District public health unit. "District public health unit" means a unit of public 
health staff set up whenever possible in a district in department offices. A staff must 
include when possible public health nurses, field epidemiologists, drinking water 
engineers, health inspectors and district public health liaisons. 
5. District. "District" means one of the 8 districts of the department, including 
Aroostook District, composed of Aroostook County; Penquis District, composed of 
Penobscot County and Piscataquis County; Downeast District, composed of Washington 
County and Hancock County; Midcoast District, composed of Waldo County, Lincoln 
County, Knox County and Sagadahoc County; Central District, composed of Kennebec 
County and Somerset County; Western District, composed of Androscoggin County, 
Franklin County and Oxford County; Cumberland District, composed of Cumberland 
County; and York District, composed of York County, and the tribal district, composed of 
any lands belonging to the Indian tribes in the State and including any member of a tribe 
living outside of tribal lands. 
6. Essential public health services. "Essential public health services" means core 
public health functions as Eiefisea Ham time te time 9y the United States Centers fer 
Disease Centre I and Pre'lentien identified by a national public health performance 
standards program, a national federally recognized review board or a national federally 
recognized review board for Indian health that help provide the guiding framework for 
the work and accreditation of public health systems or municipal health departments. 
7. Health risk assessment. "Health risk assessment" means a customized process 
by which an individual confidentially responds to questions and receives a feedback 
report to help that individual understand the individual's personal risks of developing 
preventable health problems, know what preventive actions the individual can take and 
learn what local and state resources are available to help the individual take these actions. 
8. Healthy Maine Partnerships. "Healthy Maine Partnerships" means a statewide 
system of comprehensive community health coalitions that meet the standards for 
department funding that is established under section 412, including the tribal district. 
8-A. Indian tribe. "Indian tribe" or "tribe" means a federally recognized Indian 
nation. tribe or band in the State, 
9. Local health officer. "Local health officer" means a municipal employee who 
has knowledge of the employee's community and meets educational, training and 
experience standards as set by the department in rule to comply with section 451. 
10. Municipal health department. "Municipal health department" means a health 
department or division that is established pursuant to municipal charter or ordinance in 
accordance with Title 30-A, chapter 141 and accredited by a national federally 
recognized credentialing process. 
ll. Statewide Coordinating Council for Public Health. "Statewide Coordinating 
Council for Public Health" means the council established under Title 5, section 12004-G, 
subsection 14-G. 
12. Tribal district. "Tribal district" means an administrative district established in a 
memorandum of understanding or legal contract among all Indian tribes in the State that 
is recognized by the department. The tribal district's jurisdiction includes tribal lands, 
COMMITTEE AMENDMENT 
COMMIITEE AMENDMENT "Fl "to H.P. 103, L.D. 121 
tribal health departments or health clinics and members of the tribes anywhere in the 
State. 
13. Tribal health department or health clinic. "Tribal health department or health 
clinic" means a health department or health clinic managed by an Indian tribe that is 
eligible for funds from the United States Department of the Interior, Bureau of Indian 
Affairs. Indian Health Service and other federal funds. 
For the pwposes of this 
subsection. each director of a tribal health department or health clinic has a tribal role and 
a role defined by the Indian Health Service that is equivalent to the role of a director of an 
accreditation-eligible municipal health department. 
Sec. 2. 22 MRSA §412, as amended by PL 2011, c. 90, Pt. J, §§7 to 9, is further 
II 
amended to read: 
§412. Coordination of public health infrastructure components 
1. Local health officers. Local health officers shall provide a link between the 
Maine Center for Disease Control and Prevention and every municipality. Duties oflocal 
health officers are set out in section 454-A. 
2. Healthy Maine Partnerships. Healthy Maine Partnerships is established to 
provide appropriate essential public health services at the local level, including 
coordinated community-based public health promotion, active community engagement in 
local, district and state public health priorities and standardized community-based health 
assessment .. that inform and link to districtwide and statewide public health system 
activities. 
Healthy Maine Partnerships must include interested community members; leaders of 
formal and informal civic groups; leaders of youth, parent and older adult groups; leaders 
of hospitals, health centers, mental health and substance abuse providers; emergency 
responders; local government officials; leaders in early childhood development and 
education; leaders of school administrative units and colleges and universities; 
community, social service and other nonprofit agency leaders; leaders of issue-specific 
networks, coalitions and associations; business leaders; leaders of faith-based groups; and 
law enforcement representatives. Where a service area of Healthy Maine Partnerships 
includes a tribal health department or health clinic. Healthy Maine Partnerships shall seek 
a membership or consultative relationship with leaders and members of Indian tribes or 
designees of health departments or health clinics of Indian tribes. 
The department and other appropriate state agencies shall provide funds as available to 
coalitions in Healthy Maine Partnerships that meet measurable criteria as set by the 
department for comprehensive community health coalitions. As funds are available. a 
minimum of one tribal comprehensive community health coalition must be provided 
funding as a member of a Healthy Maine Partnerships coalition. The tribal district is 
eligible for the same funding opportunities offered to any other district. The tribal district 
or a tribe is eligible to partner with any coalition in Healthy Maine Partnerships for 
collaborative funding opportunities that are approved by the tribal district coordinating 
council or a tribal health director. 
3. District public health units. District public health units shall help to improve the 
efficiency of the administration and coordination of state public health programs and 
COMMITTEE AMENDMENT 
COMMlTIEE AMENDMENT ,,~" to D.P. 103, L.D. 121 
I 
policies and communications at the district and local levels and shall ensure that state 
policy reflects the different needs of each district. Tribal public health programs and 
services delivered by the tribal district or a tribal health department or health clinic must 
help improve the efficiency of the administration and coordination of publicly and 
privately funded public health programs and policies and communications at local, 
district. state and federal levels. 
4. District coordinating councils for public health. The Maine Center for Disease 
Control and Prevention, in consultation with Healthy Maine Partnerships, shall maintain a 
district coordinating council for public health in each of the 8 .2 districts as resources 
permit. If the district jurisdiction includes tribal lands and tribal members. and is not the 
tribal district. the district coordinating council for public health may not represent the 
tribe or tribes but shall consider Indian health status and pursue a consultative 
I3 
relationship with the tribe or tribes. Tribal representatives may choose to participate in 
the district coordinating council for public health as members or function in a 
consultative relationship. 
The tribal district shall have a tribal district coordinating 
council. 
A. A district coordinating council for public health shall: 
(I) Participate as appropriate in district-level activities to help ensure the state 
public health system in each district is ready and maintained for accreditation; 
and 
(4) Ensure that the essential public health services and resources are provided for 
in each district in the most efficient, effective and evidence-based manner 
possible. 
A-I. The tribal district coordinating council shall: 
(I) Participate as appropriate in department district-level activities to help ensure 
the tribal public health system in the tribal district is ready and maintained for 
tribal public health accreditation; and 
(2) Ensure that the national goals and strategies for health in tribal lands and the 
tribal district health goals and strategies are aligned and that tribal district health 
goals and strategies are appropriately tailored for each tribe and tribal health 
I 
department or health clinic. 
B. 
The Maine Center for Disease Control and Prevention, in consultation with 
Healthy Maine Partnerships,shall ensure the invitation of persons to participate on a 
district coordinating council for public health and shall strive to include persons who 
represent the Maine Center for Disease Control and Prevention, county governments, 
municipal governments, tribal ge'/emmeRts Indian tribes and their tribal health 
departments or health clinics, city health departments, local health officers, hospitals, 
health systems, emergency management agencies, emergency medical services, 
Healthy Maine Partnerships, school districts, institutions of higher education, 
physicians and other health care providers, clinics and community health centers, 
voluntary health organizations, family planning organizations, area agencies on 
aging, mental health services, substance abuse services, organizations seeking to 
improve environmental health and other community-based organizations. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A "to H.P. 103, L.D. 121 
C. In districts, other than the tribal district. that contain tribal members, population 
health assessments and health improvement plans and strategies developed by 
municipal health departments. Healthy Maine Partnerships and district coordinating 
councils for public health must consider Indian health issues and disparities. Data 
used for these assessments must be sound and at the most local level available. 
Assessments must include any quantitative or qualitative data the tribes agree to 
share. Tribal health assessments and tribal health improvement plans and strategies 
may focus exclusively on tribal members but may be conducted only at any tribe's 
discretion. 
D. Population and personal health programs. interventions and services that formally 
II 
include or focus on tribal members must be developed in close consultation with 
tribes and must be culturally competent in design and implementation. In addition. 
tribes must be consulted prior to their inclusion in any grant applications. 
A district coordinating council for public health, after consulting with the Maine Center 
for Disease Control and Prevention, shall develop membership and governance structures 
that are subject to approval by the Statewide Coordinating Council for Public Health 
except that approval of the Statewide Coordinating Council for Public Health is not 
required for the membership and governance structures of the tribal district coordinating 
council. 
5. Municipal and tribal health departments. Municipal health departments or 
tribal health departments or health clinics may enter into data-sharing agreements with 
the department for the exchange of public health data determined by the department to be 
necessary for protection of the public health. 
A data-sharing agreement under this 
subsection must protect the confidentiality and security of individually identifiable health 
information as required by state and federal law. 
5-A. Tribal district. The tribal district shall deliver components of essential public 
health services through the tribal district's public health liaisons. who are tribal 
employees, and report to the tribes, the department's office of minority health and any 
other sources of funding. Responses to federal and state requests for applications may be 
issued by one tribe, 2 or more tribes collectively or the tribal district as the recipient of 
funds. The directors of the tribal health departments or health clinics serve as the tribal 
district coordinating council for public health in an advisory role to the tribal district. The 
council may establish subcommittees to work on specific projects approved by the 
council. 
6. 
Statewide Coordinating Council for Public Health. 
The Statewide 
Coordinating Council for Public Health, established under Title 5, section 12004-G, 
subsection 14-G, is a representative statewide body of public health stakeholders for 
collaborative public health planning and coordination. 
A. The Statewide Coordinating Council for Public Health shall: 
(1) Participate as appropriate to help ensure the state public health system is 
ready and maintained for accreditation; aREi 
(4) Assist the Maine Center for Disease Control and Prevention in planning for 
the essential public health services and resources to be provided in each district 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT "A" to H.P. 103, L.D. 121 
and across the State in the most efficient, effective and evidence-based manner 
possible,~ 
(5) Receive reports from the tribal district coordinating council for public health 
regarding readiness for tribal public health systems for accreditation if offered; 
and 
(6) Participate as appropriate and as resources permit to help support tribal 
public health systems to prepare for and maintain accreditation if assistance is 
requested from any tribe. 
The Maine Center for Disease Control and Prevention shall provide staff support to 
the Statewide Coordinating Council for Public Health as resources permit. Other 
agencies of State Government as necessary and appropriate shall provide additional 
staff support or assistance to the Statewide Coordinating Council for Public Health as 
resources permit. 
B. Members of the Statewide Coordinating Council for Public Health are appointed 
as follows. 
(1) Each district coordinating council for public health, including the tribal 
district coordinating council, shall appoint one member. 
(2) The Director of the Maine Center for Disease Control and Prevention or the 
director's designee shall serve as a member. 
(3) The commissioner shall appoint an expert in behavioral health from the 
department to serve as a member. 
(4) The Commissioner of Education shall appoint a health expert from the 
Department of Education to serve as a member. 
(5) 
The Commissioner of Environmental Protection shall appoint an 
environmental health expert from the Department of Environmental Protection to 
serve as a member. 
(6) The Director of the Maine Center for Disease Control and Prevention, in 
collaboration with the cochairs of the Statewide Coordinating Council for Public 
Health, shall convene a membership committee. 
After evaluation of the 
appointments to the Statewide Coordinating Council for Public Health, the 
membership committee shall appoint no more than 10 additional members and 
ensure that the total membership has at least one member who is a recognized 
content expert in each of the essential public health services and has 
representation from populations in the State facing health disparities. 
The 
membership committee shall also strive to ensure diverse representation on the 
Statewide Coordinating Council for Public Health from county governments, 
municipal governments, tribal governments, tribal health departments or health 
clinics, city health departments, local health officers, hospitals, health systems, 
emergency management agencies, emergency medical services, Healthy Maine 
Partnerships, school districts, institutions of higher education, physicians and 
other health care providers, clinics and commUnity health centers, voluntary 
health organizations, family planning organizations, area agencies on aging, 
COMMITTEE AMENDMENT 
COMMITIEE' AMENDMENT" A" to H.P. 103, L.D. 121 
mental health services, substance abuse services, organizations seeking to 
improve environmental health and other community-based organizations. 
C. The term of office of each member is 3 years. All vacancies must be filled for the 
balance of the unexpired term in the same manner as the original appointment. 
D. Members of the Statewide Coordinating Council for Public Health shall elect 
annually a chair and cochair. The chair is the presiding member of the Statewide 
Coordinating Council for Public Health. 
E. 
The Statewide Coordinating Council for Public Health shall meet at least 
quarterly, must be staffed by the department as resources permit and shall develop a 
governance structure, including determining criteria for what constitutes a member in 
good standing. 
F. The Statewide Coordinating Council for Public Health shall report annually to the 
joint standing committee of the Legislature having jurisdiction over health and human 
services matters and the Governor's office on progress made toward achieving and 
maintaining accreditation of the state public health system and on districtwide and 
statewide streamlining and other strategies leading to improved efficiencies and 
effectiveness in the delivery of essential public health services. 
Sec. 3. 22 MRSA §413, as enacted by PL 2009, c. 355, §5, is amended to read: 
§413. Universal wellness initiative 
The Maine Center for Disease Control and Prevention, the Statewide Coordinating 
Council for Public Health, the district coordinating councils for public health and Healthy 
Maine Partnerships shall undertake a universal wellness initiative to ensure that all people 
of the State, including members of Indian Tribes, have access to resources and evidence-
based interventions in order to know, understand and address health risks and to improve 
health and prevent disease. A particular focus must be on the uninsured and others facing 
health disparities. 
1. Resource toolkit for the uninsured. The Maine Center for Disease Control and 
Prevention and the Governor's office shall develop a resource toolkit for the uninsured 
with information on access to disease prevention, health care and other methods for 
health improvement. Healthy Maine Partnerships, the district coordinating councils for 
public health, the Maine Center for Disease Control and Prevention and the Statewide 
Coordinating Council for Public Health shall promote and distribute the toolkit materials, 
in particular through small businesses, schools, school-based health centers, tribal health 
departments or health clinics, and other health centers. Healthy Maine Partnerships, each 
district coordinating council for public health and the Statewide Coordinating Council for 
Public Health shall report annually to the Maine Center for Disease Control and 
Prevention on strategies employed for promotion of the toolkit materials. 
2. Health risk assessment. Healthy Maine Partnerships, the district coordinating 
councils for public health, the Statewide Coordinating Council for Public Health and the 
Maine Center for Disease Control and Prevention shall promote an evidence-based health 
risk assessment that is available to all people of the State, with a particular emphasis on 
outreach to the uninsured popUlation, members of Indian tribes and others facing health 
disparities. These health risk assessments and their promotion must provide linkages to 
. Page 7 - 12SLR0338(02)-1 
COMMITTEE AMENDMENT 
COMMTITEE AMENDMENT ~" 
to H.P. 103, L.D. 121 
existing local disease prevention efforts and be collaborative with and not duplicative of 
existing efforts. 
3. Report card on health. The Maine Center for Disease Control and Prevention, in 
consultation with the Statewide Coordinating Council for Public Health, shall develop, 
distribute and publicize an annual brief report card on health status statewide and for each 
district by June 1st of each year. The report card must include major diseases, evidence-
based health risks and determinants that impact health. 
The Maine Center for Disease Control and Prevention and the Governor's Office of 
Health Policy and Finance shall provide staff support to implement the universal wellness 
initiative in this section as resources permit. Other agencies of State Government as 
necessary and appropriate shall provide additional staff support or assistance.' 
SUMMARY 
The bill extends to the federally recognized Indian nations, tribes and bands in the 
State and to their health departments and health clinics the laws on comprehensive 
community health coalitions, district and state coordinating councils for public health, 
district public health units, Healthy Maine Partnerships, the universal wellness initiative 
and health risk assessment. 
This amendment replaces the bill. It creates a new tribal district in the public health 
infrastructure system composed of any lands belonging to Indian tribes in the State and 
including any member of a tribe living outside of tribal lands. It allows the tribal district 
to apply for Healthy Maine Partnerships funding. It allows for clear data assessments for 
the tribal district and tribal members that are separate from data available for other 
districts. 
FISCAL NOTE REQUIRED 
(See attached)· 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: OS/24111 
;J!vac:.. 
LD 121 
LR338(02) 
An Act To Amend the Laws Regarding Public Health Infrastructure 
Fiscal Note for Bill as Amended by Committee Amendment ,~" 
Committee: Health and Human Services 
Fiscal Note Required: No 
Fiscal Note 
No net fiscal impact 
Assumes any additional state costs resulting from the bill would be met by a re-distribution of existing budgeted 
resources. Any net increase in payments would require an additional appropriation and/or allocation of state funds. 
LR0338(02) -Fiscal Note - Page 1 of 1