An Act To Increase Health Care Quality through the Promotion of Health Information Exchange and the Protection of Patient Privacy
Maine Legislature, Session 125, LD 1331
Committee Amendment CA_A_H458 (House)

COMMITTEE AMENDMENT" if" to H.P. 977, L.D. 1331, Bill, "An Act To 
Increase Health Care Quality through the Promotion of Health Information Exchange and 
the Protection of Patient Privacy" 
Amend the bill by striking out all of section 1 and inserting the following: 
'Sec. 1. 5 MRS A §19201, sub-§2-B is enacted to read: 
2-B. Health care facility. 
"Health care facility" or "facility" means a facility, 
institution or entity licensed pursuant to Title 22 that offers health care to persons in this 
State, including a home health care provider and hospice program. "Health care facility" 
or "facility" includes a pharmacy licensed pursuant to Title 32.' 
Amend the bill in section 4 in subsection 11 by striking out the first 2 paragraphs 
(page 1, lines 16 to 28 in L.D.) and inserting the following: 
'11. Access by health information exchange or other entity. To a statewide health 
information exchange designated by the State that provides and maintains an individual 
protection mechanism by which an individual may choose to opt in to allow that 
statewide health information exchange to disclose that individual's health care 
information covered under this section to a health care provider or health care facility for 
purposes of treatment, payment and health care operations, as those terms are defined in 
Code of Federal Regulations, Section 164.501. A state-designated statewide health 
information exchange also must satisfy the requirement in Title 22, section 1711-C, 
subsection 18, paragraph C of providing a general opt-out provision to an individual at all 
times. 
A state-designated statewide health information exchange may disclose an individual's 
health care information covered under this section even if the individual has not chosen to 
opt in to allow the state-designated statewide health information exchange to disclose the 
individual's health care information when in a health care provider's judgment disclosure 
is necessary to:' 
Amend the bill in section 5 in subsection 6 by striking out the first 2 paragraphs (page 
1, lines 35 to 38 and page 2, lines 1 to 10 in L.D.) and inserting the following: 
COMMITTEE AMENDMENT 
.. ,. 
~. 
COMMITTEE AMENDMENT"iJ" to H.P. 977, L.D. 1331 
'6. Access by health information exchange or other entity. Nothing in this section 
precludes the disclosure of a medical record containing HIV information to a 
state-designated statewide health information exchange that provides and maintains an 
individual protection mechanism by which an individual may choose to opt in to allow 
the state-designated statewide health information exchange to disclose that individual's 
health care information covered under this section to a health care provider or health care 
facility consistent with the rules and regulations contained in the federal Health Insurance 
Portability and Accountability Act of 1996, Public Law 104-191, for purposes of 
treatment, payment and health care operations, as those terms are difined in 45 Code of 
Federal Regulations, Section 164.501. A state-designated statewide health information 
exchange also must satisfy the requirement in Title 22, section 1711-C, subsection 18, 
paragraph C of providing a general opt-out provision to an individual at all times. 
A state-designated statewide health information exchange may disclose an individual's 
health care information covered under this section even if the individual has not chosen to 
opt in to allow the state-designated statewide health information exchange to disclose the 
individual's health care information when in a health care provider's judgment disclosure 
is necessary to:' 
Amend the bill in section 6 in paragraph A by striking out all of subparagraph (2) and 
inserting the following: 
'(2) For a disclosure outside of the office, practice or organizational affiliate of 
the health care practitioner or facility, authorization is not required, except that in 
non emergency circumstances authorization is 
required for health care 
information derived from mental health services provided by: 
(a) A clinical nurse specialist licensed under the provisions of Title 32, 
chapter 31; 
(b) A psychologist licensed under the provisions of Title 32, chapter 56; 
(c) A social worker licensed under the provisions of Title 32, chapter 83; 
(d) A counseling professional licensed under the provisions of Title 32, 
chapter 119; or 
(e) A physician specializing in psychiatry licensed under the provisions of 
Title 32, chapter 36 or 48. 
This subparagraph does not prohibit the disclosure of health care information 
between a, licensed pharmacist and a health care practitioner or facility providing 
mental health services for the purpose of dispensing medication to an individualt~ 
This subparagraph does not prohibit the disclosure without authorization of 
health care information covered under this section to a state-designated statewide 
health information exchange that satisfies the requirement in subsection 18, 
paragraph C of providing a general opt-out provision to an individual at all times 
and that provides and maintains an individual protection mechanism by which an 
individual may choose to opt in to allow the state-designated statewide health 
information exchange to disclose that individual's health care information 
covered under Title 34-B, section 1207;' 
COMMITTEE AMENDMENT 
.. ,. 
~. 
l3 
COMMITTEE AMENDMENT "f}" to H.P. 977, L.D. 1331 
Amend the bill in section 7 in paragraph B in the 2nd line (page 3, line 8 in L.D.) by 
inserting after the following; "including a" the following; 'state-designated statewide' 
Amend the bill in section 8 by striking out all of subsection 18 and inserting the 
following: 
'18. Participation in a health information exchange. The following provisions 
apply to participation in a state-designated statewide health information exchange. 
A. A health care practitioner may not deny a patient health care treatment and a 
health insurer may not deny a patient a health insurance benefit based solely on the 
provider's or patient's decision not to participate in a state-designated statewide health 
information exchange. Except when otherwise required by federal law, a payor of 
health care benefits may not require participation in a state-designated statewide 
health information exchange as a condition of participating in the payor's provider 
network. 
B. 
Recovery for professional negligence is not allowed against any health care 
practitioner or health care facility on the grounds of a health care practitioner's or a 
health care facility's nonparticipation in a state-designated statewide health 
information exchange arising out of or in connection with the provision of or failure 
to provide health care services. In any civil action for professional negligence or in 
any proceeding related to such a civil action or in any arbitration, proof of a health 
care practitioner's, a health care facility's or a patient's participation or 
nonparticipation in a state-designated statewide health information exchange is 
inadmissible as evidence of liability or nonliability arising out of or in connection 
with the provision of or failure to provide health care services. This paragraph does 
not prohibit recovery or the admission of evidence of reliance on information in a 
state-designated statewide electronic health information exchange when there was 
participation by both the patient and the patient's health care practitioner. 
C. A state-designated statewide health information exchange to which health care 
information is disclosed under this section shall provide an individual protection 
mechanism by which an individual may opt out from participation to prohibit the 
state-designated statewide health information exchange from disclosing the 
individual's health care information to a health care practitioner or health care 
facility.' 
Amend the bill in section 11 in paragraph I by striking out the first 2 paragraphs 
(page 4, lines 20 to 33 in L.D.) and inserting the following: 
'I. Nothing in this subsection precludes the disclosure of any information, except 
psychotherapy notes as defined in 45 Code of Federal Regulations, Section 
164.501 (20 1 0), concerning a client to a state-designated statewide health information 
exchange that provides and maintains an individual protection mechanism by which a 
client may choose to opt in to allow the state-designated statewide health information 
exchange to disclose that client's health care information covered under this section to 
a health care practitioner or health care facility for purposes of treatment, payment 
and health care operations, as those terms are defined in 45 Code of Federal 
Regulations, Section 164.501. 
A state-designated statewide health information 
COMMITTEE AMENDMENT 
.. ,. 
~. 
COMMITIEE AMENDMENT "A" to H.P. 977, L.D. 1331 
exchange also must satisfy the requirement in Title 22, section 1711-C, subsection 
18, paragraph C of providing a general opt-out provision to a client at all times. 
A state-designated statewide health information exchange may disclose a client's 
health care information covered under this section even if the client has not chosen to 
opt in to allow the state-designated statewide health information exchange to disclose 
the individual's health care information when, in a health care provider's judgment, 
disclosure is necessary to:' 
SUMMARY 
This amendment specifies that a health information exchange is a state-designated 
statewide health information exchange. It also changes the definition of "health care 
facility" from the definition used in the laws regarding certificates of need to a general 
definition that includes all facilities licensed under the Maine Revised Statutes, Title 22, 
including a home health care provider and hospice program and also pharmacies licensed 
pursuant to Title 32. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: OS/25/11 
::t;vac:.. 
LD 1331 
LR 1235(02) 
An Act To Increase Health Care Quality through the Promotion of Health Information Exchange and 
the Protection of Patient Privacy 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment ,~" 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Any additional costs to the Department of HeaIth and Human Services are expected to be minor and can be absorbed 
within existing budgeted resources. 
LRI235(02) - Fiscal Note - Page 1 of 1