An Act To Implement the Recommendations of the Commission To Study Transparency, Costs and Accountability of Health Care System Financing
Maine Legislature, Session 126, LD 1760
Committee: Insurance and Financial Services
Amends: 22 MRSA §1718, 22 MRSA §1718-A, 22 MRSA §1718-B, 22 MRSA §8704

Legislative Document 
No. 1760 
S.P. 698 
In Senate, February 4, 2014 
An Act To Implement the Recommendations of the Commission To 
Study Transparency, Costs and Accountability of Health Care 
System Financing 
Reported by Senator GRATWICK of Penobscot for the Joint Standing Committee on 
Insurance and Financial Services pursuant to Joint Rule 353. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed pursuant to Joint Rule 218. 
DAREK M. GRANT 
Secretary of the Senate 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA §1718, as repealed and replaced by PL 2009, c. 71, §3, is 
amended to read: 
§1718.  Consumer information 
Each hospital or ambulatory surgical center licensed under chapter 405 shall, upon 
request by an individual, provide the average charge for any inpatient service or 
outpatient procedure provided by the licensee.  For emergency services, the hospital must 
provide the average charges for facility and physician services according to the level of 
emergency services provided by the hospital and based on the time and intensity of 
services provided.  The hospital or ambulatory surgical center shall prominently display a 
notice informing individuals of an individual's authority to request information on the 
average charges described in this paragraph from the hospital or ambulatory surgical 
center. 
Sec. 2.  22 MRSA §1718-A, as enacted by PL 2013, c. 332, §1 and affected by §3, 
is amended to read: 
§1718-A.  Consumer information regarding health care practitioner prices 
Each health care practitioner, as defined in section 1711-C, subsection 1, paragraph 
F, shall maintain a price list of the health care practitioner's most frequently provided 
health care services and procedures. The prices stated must be the prices that the health 
care practitioner charges clients directly, when there is no insurance coverage for the 
services or procedures or when reimbursement by an insurance company is denied. The 
prices stated must be accompanied by the applicable standard medical codes listed by 
diagnosis. For purposes of this section, "frequently provided health care services and 
procedures" means those health care services and procedures that were provided by the 
health care practitioner at least 50 times in the preceding calendar year. Health care 
practitioners shall inform clients about the availability of the price list and provide copies 
of the price list upon request.  Health care practitioners shall make available written 
information on health claims data that may be obtained through the publicly accessible 
website of the Maine Health Data Organization established pursuant to chapter 1683 
prominently display in a location that is readily accessible to clients information on the 
price transparency tools available from the publicly accessible website of the Maine 
Health Data Organization established pursuant to chapter 1683 to assist consumers with 
obtaining estimates of costs associated with health care services and procedures. Health 
care practitioners shall make printed copies of the information described in this paragraph 
available to clients upon their request. This section does not apply to pharmacists. 
Sec. 3.  22 MRSA §1718-B is enacted to read: 
§1718-B.  Individualized health care cost estimate 
Upon the request of a client, each health care practitioner and health care facility, as 
defined in section 1711-C, subsection 1, paragraphs F and D, respectively, shall provide 
an individualized cost estimate for the client's anticipated health care services and 
procedures that must include all health care charges that the practitioner or facility 
reasonably anticipates to charge directly to the client. For purposes of this section, "cost 
estimate" includes the practitioner's or facility's costs at the unit for which services and 
procedures are billed, as well as any negotiated discounts, and any costs reasonably 
anticipated to be charged by that practitioner or facility for the client associated with a 
service or procedure, including hospital, physician, pharmacy and laboratory fees, and 
must identify the client's out-of-pocket cost. The cost estimate must be accompanied by a 
description of the service or procedure and the applicable standard medical codes or 
current procedural terminology code. 
Sec. 4.  22 MRSA §8704, sub-§7, as amended by PL 2011, c. 494, §8, is further 
amended to read: 
7.  Annual report.  The board shall prepare and submit an annual report on the 
operation of the organization and the Maine Health Data Processing Center as authorized 
in Title 10, section 681, including any activity contracted for by the organization or 
contracted services provided by the center, with resulting net earnings, as well as on 
collaborative activities with other health data collection and management organizations 
and stakeholder groups on their efforts to improve consumer access to health care quality 
and price information and price transparency initiatives, to the Governor and the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters and the joint standing committee of the Legislature having jurisdiction over 
insurance and financial services matters no later than February 1st of each year.  The 
report must include an annual accounting of all revenue received and expenditures 
incurred in the previous year and all revenue and expenditures planned for the next year.  
The report must include a list of persons or entities that requested data from the 
organization in the preceding year with a brief summary of the stated purpose of the 
request. 
SUMMARY 
This bill implements the recommendations of the Commission To Study the 
Transparency, Costs and Accounting of Health Care System Financing. The bill requires 
health care practitioners and health care facilities to provide clients, upon request, with an 
individualized cost estimate for anticipated health care services associated with that 
specific entity's services.  It directs health care practitioners to expand public awareness 
of the Maine Health Data Organization and its website by displaying at practitioners' 
offices information on the Maine Health Data Organization and how consumers can 
become more informed of the costs associated with health care procedures. It amends the 
laws governing the information that hospitals and ambulatory surgical centers are 
required to make available to consumers by adding a requirement that these entities 
prominently display a notice informing consumers of their ability to request and receive 
information on the average charges for any inpatient service or outpatient procedure 
provided by the hospital or center upon request. It amends the annual statutory reporting 
requirement for the Maine Health Data Organization to include language requiring the 
Maine Health Data Organization to include in its report an update on its collaborative 
efforts with other health data organizations to improve consumer access to information on 
health care quality and price and health care transparency initiatives in this State. The bill 
also amends the statutory provisions governing the Maine Health Data Organization 
annual report to require that the joint standing committee of the Legislature having 
jurisdiction over insurance and financial services matters, in addition to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters, 
be provided with the annual report.