An Act To Establish a Single-payor Health Care System To Be Effective in 20 IT
Maine Legislature, Session 125, LD 1397
Committee Amendment CA_A_H431 (House)

COMMITTEE AMENDMENT "A" to H.P. 1026, L.D. 1397, Bill, "An Act To 
Establish a Single-payor Health Care System To Be Effective in 20 IT' 
Amend the bill by striking out the title and substituting the following: 
'Resolve, To Study the Design and Implementation of a Single-payor Health Care 
Plan That Is in Compliance with the Federal Patient Protection and Affordable 
Care Act' 
Amend the bill by striking out everything after the title and before the summary and 
inserting the following: 
'Sec. 1. 
Maine Single-payor Health Care Plan Advisory Committee 
established. Resolved: 
That the Maine Single-payor Health Care Plan Advisory 
Committee, referred to in this section as "the committee," is established to advise the 
Legislature on the design and implementation of a single-payor health care plan in the 
State that is in compliance with the federal Patient Protection and Affordable Care Act; 
and be it further 
Sec. 2. Committee membership. Resolved: That the committee consists of 13 
members appointed as follows: 
1. Seven members must be Legislators. Three of those members must be appointed 
by the President of the Senate, representing the 2 political parties having the largest 
number of members in the Senate, and 4 members must be appointed by the Speaker of 
the House of Representatives, representing the 2 political parties having the largest 
number of members in the House; and 
2. Six members must be representatives of the public. Three of those members must 
be appointed by the President of the Senate, and 3 of those members must be appointed 
by the Speaker of the House of Representatives. The public members must represent 
statewide organizations from the following groups: consumers, uninsured 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, 
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COMMITTEE AMENDMENT"~ "to H.P. 1026, L.D. 1397 
hospitals, community health centers, the family planning system and the business 
community, including a representative of small business; and be it further 
Sec. 3. Chairs. Resolved: That the first-named Senate member is the Senate 
chair and the first-named House of Representatives member is the House chair of the 
committee; and be it further 
Sec. 4. 
Appointments; convening of committee. 
Resolved: 
That all 
appointments must be made no later than 30 days following the effective date of this 
resolve. The appointing authorities shall notify the Executive Director of the Legislative 
Council once all appointments have been completed. After appointment of all members, 
the chairs shall call and convene the first meeting. If 30 days or more after the effective 
date of this resolve a majority of but not all appointments have been made, the chairs may 
request authority and the Legislative Council may grant authority for the Committee to 
meet and conduct its business. The first meeting must be held within 45 days of the 
effective date of this resolve; and be it further 
Sec. 5. Duties. Resolved: That the committee shall solicit the services of one or 
more outside consultants to work with the committee to propose by December 7, 2011 a 
design option, including an implementation plan, for creating a single system of health 
care that ensures all residents of the State have access to and coverage for affordable, 
high-quality health services through a public-private single-payor system that meets the 
principles and goals outlined in this section. By November 1,2011, the consultant shall 
release a draft of the design option to the public and provide 15 days for public review 
and the submission of comments on the design options. The consultant shall review and 
consider the public comments and revise the draft design option as necessary prior to the 
final submission to the committee. The proposal must contain the analysis and 
recommendations as provided for in this section. 
1. The proposal must include a design for a government-administered and publicly 
financed single-payor health benefits system that is decoupled from employment, that 
prohibits insurance coverage for the health services provided by the system and that 
allows for private insurance coverage only of supplemental health services. 
2. In creating the designs, the consultant shall review and consider the following 
fundamental elements: 
A. The findings and reports from previous studies of health care reform in the State, 
including the December 2002 document titled "Feasibility Study of a Single-Payer 
Health Plan Model for the State of Maine" produced by Mathematica Policy 
Research, Inc., and studies and reports provided to the committee; 
B. Existing health care systems or components thereof in other states or countries as 
models; 
C. The State's current health care reform efforts; and 
D. The federal Patient Protection and Affordable Care Act, as amended by the 
federal Health Care and Education Reconciliation Act of 2010; the federal Employee 
Retirement Income Security Act of 1974; and the Medicare program, the Medicaid 
program and the State Children's Health Insurance Program under Titles XVIII, XIX 
and XXI, respectively, of the federal Social Security Act. 
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COMMIITEE AMENDMENT 'A" to H.P. 1026, L.D. 1397 
3. The design option must maximize the federal funds to support the system and be 
composed of the following components as described in this subsection: 
A. A payment system for health services that includes one or more packages of 
health services providing for the integration of physical and mental health services; 
budgets, payment methods and a process for determining payment amounts; and 
cost-reduction and cost-containment mechanisms; 
B. Coordinated regional delivery systems; 
C. Health system planning, regulation and public health; 
D. Financing and estimated costs, including federal financings; and 
E. A method to address compliance of the proposed design option or options with 
federal law. 
4. The design option must include the following components: 
A. A payment system for health services; 
B. A benefit package or packages of health services providing for the integration of 
physical and mental health, including access to and coverage for primary care, 
preventive care, chronic care, acute episodic care, palliative care, hospice care, 
hospital services, prescription drugs and mental health and substance abuse services; 
C. 
A method for administering payment for health services, which may include 
administration by a government agency, under an open bidding process soliciting 
bids from insurance carriers or 3rd-party administrators, through private insurers, or 
from a combination thereof; 
D. Enrollment processes; 
E. 
Integration of pharmacy best practices and cost control programs and other 
mechanisms to promote evidence-based prescribing, clinical efficacy and cost 
containment, such as a single statewide preferred drug list, prescriber education or 
utilization reviews; 
F. 
Appeals processes for decisions made by entities or agencies administering 
coverage for health services; 
G. A recommendation for budgets, payment methods and a process for determining 
payment amounts. Payment methods for mental health services must be consistent 
with mental health parity. The design option must consider: 
(1) Recommending a global health care budget when it is appropriate to ensure 
cost containment by a health care facility, a health care provider, a group of 
health care professionals or a combination thereof. Any recommendation must 
include a process for developing a global health care budget, including 
circumstances under which an entity may seek an amendment of its budget; 
(2) Payment methods to be used for each health care sector that are aligned with 
the goals of this section and provide for cost containment, provision of 
high-quality, evidence-based health services in a coordinated setting, patient self-
management and healthy lifestyles; and 
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(3) What process or processes are appropriate for determining payment amounts 
with the intent to ensure reasonable payments to health care professionals and 
providers and to eliminate the shift of costs between the payors of health services 
by ensuring that the amount paid to health care professionals and pro"iders is 
sufficient. Payment amounts must be sufficient to provide reasonable access to 
health services, provide sufficient uniform payments to health care professionals 
and assist in creating financial stability for health care professionals. Payment 
amounts for mental health services must be consistent with mental health parity; 
H. Cost-reduction and cost-containment mechanisms; 
I. A coordinated regional health system that ensures that the delivery of health 
services to the citizens of the State is coordinated in order to improve health 
outcomes, improve the efficiency of the health system and improve patients' 
experiences of health services; and 
J. Health system planning and regulation and public health. 
5. The design option must consider financing and estimated costs, including federal 
financing. The design option must provide: 
A. An estimate of the total costs of the design option, including any additional costs 
for providing access to and coverage for health services to the uninsured and 
underinsured, any estimated costs necessary to build a new system and any estimated 
savings from implementing a single system; 
B. Financing proposals for sustainable revenue, including by maximizing federal 
revenues, or reductions from existing health care programs, services, state agencies or 
other sources necessary for funding the cost of the new system; 
C. A proposal to the federal Centers for Medicare and Medicaid Services to waive 
provisions of Titles XVIII, XIX and XXI of the federal Social Security Act if 
necessary to align the federal programs with the proposals contained within the 
design option in order to maximize federal funds or to promote the simplification of 
administration, cost containment or promotion of health care reform initiatives; and 
D. A proposal to participate in a federal insurance exchange established by the 
federal Patient Protection and Affordable Care Act, as amended by the federal Health 
Care and Education Reconciliation Act of 2010 in order to maximize federal funds 
and, if applicable, a waiver from these provisions when available. 
6. The proposal must include a method to address compliance of the proposed design 
option with federal law if necessary, including the federal Patient Protection and 
Affordable Care Act, as amended by the federal Health Care and Education 
Reconciliation Act of 2010; the Employee Retirement Income Security Act of 1974, 
referred to in this subsection as "ERISA"; and Titles XVIII, XIX and XXI of the federal 
Social Security Act. In the case of ERISA, the consultant may propose a strategy to seek 
an ERISA exemption from the United States Congress if necessary for the design option. 
7. The proposal must include an analysis of: 
A. The impact of the design option on the State's current private and public insurance 
system; 
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B. The expected net fiscal impact, including tax implications, on individuals and on 
businesses from the modifications to the health care system proposed in the design; 
C. The impact of the design option on the State's economy; 
D. The benefits and drawbacks of alternative timing for the implementation of the 
design, including the sequence and rationale for the phasing in of the major 
components; and 
E. The benefits and drawbacks of the design option and of not changing the current 
system; and be it further 
Sec. 6. Staff assistance. Resolved: 
That, subject to available funding, the 
committee shall propose to the Legislative Council a recommendation to obtain the 
services of one or more outside consultants who have demonstrated experience in 
designing health care systems that have expanded coverage and contained costs to 
provide the committee the expertise necessary to perform the analysis and propose the 
design option required by this resolve. Upon request, the Department of Health and 
Human Services and the Department of Professional and Financial Regulation, Bureau of 
Insurance shall provide staffing assistance to the committee to ensure the committee and 
its consultant or consultants have the information necessary to create the design option. 
The Legislative Council shall also provide necessary staffing services to the committee; 
and be it further 
Sec. 7. Report. Resolved: That, no later than December 7,2011, the committee 
shall submit a report that includes its findings and recommendations, including suggested 
legislation, to the Joint Standing Committee on Insurance and Financial Services. The 
Joint Standing Committee on Insurance and Financial Services may report out a bill 
based on the committee's report to the Second Regular Session of the 125th Legislature; 
and be it further 
Sec. 8. Outside funding. Resolved: That the committee shall determine the 
funding amount necessary and request approval from the Legislative Council to seek 
funding contributions to fully fund the costs of the study. All funding is subject to 
approval by the Legislative Council in accordance with its policies. 
If sufficient 
contributions to fund the study have not been received within 30 days after the effective 
date of this resolve, no meetings are authorized and no expenses of any kind may be 
incurred or reimbursed; and be it further 
Sec. 9. 
Appropriations and allocations. 
Resolved: 
That the following 
appropriations and allocations are made. 
LEGISLATURE 
Study Commissions - Funding 0444 
Initiative: Provides an allocation to authorize the expenditure of any outside funding 
received to fund the costs of an advisory committee and consultants to study the design 
and implementation of a single-payor health care plan. 
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OTHER SPECIAL REVENUE FUNDS 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
SUMMARY 
2011-12 
$1,540 
$63,350 
$64,890 
2012-13 
$0 
$0 
$0 
This amendment is the minority report. The amendment replaces the bill and changes 
it into a resolve. The amendment establishes the Maine Single-payor Health Care Plan 
Advisory Committee to advise the Legislature on the design and implementation of a 
single-payor health care plan in the State that is in compliance with the federal Patient 
Protection and Affordable Care Act. 
' 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: OS/24111 
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LD 1397 
LR 25(02) 
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Af Act To Establish a Single-payor Health Care System To Be Effective in 2017 
Fiscal Note for Bill as Amended by Committee Amendment ,~" 
Committee: Insurance and Financial Services 
Appropriations! Allocations 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
FY 2011-12 
FY2012-13 
$64,890 
$0 
Projections 
FY 2013-14 
$0 
Projections 
FY 2014-15 
$0 
An allocation of Other Special Revenue Funds totaling $64,890 in fiscal year 2011-12 to the Legislature is included to 
authorize the expenditure of any outside funding received to fund the cost of the Maine Single-payor Health Care Plan 
Advisory Committee and the costs of consultants. This study and related costs are contingent on the receipt of outside 
funding sufficient to fund the costs of the study. If sufficient funding is received, the Legislature will be able to 
absorb the costs associated with staffing the advisory committee during the interim between legislative sessions. 
The Department of Health and Human Services and the Department of Professional and Financial Regulation, Bureau 
of Insurance will also be able to absorb the costs associated with providing asistance and information to the advisory 
committee and its consultants. 
LR0025(02) - Fiscal Note - Page 1 of 1