An Act To Establish the Commission on Health Care Cost and Quality
Maine Legislature, Session 126, LD 0230
Committee: Health and Human Services
Sponsors: GRAHAM, LACHOWICZ, GATTINE, HICKMAN, MONAGHAN-DERRIG, PEOPLES, PRINGLE, SANBORN
Amends: 5 MRSA §12004-G, 24-A MRSA §4320-H, 24-A MRSA §6951, 24-A MRSA §6952, 3 MRSA §251

Legislative Document 
No. 230 
H.P. 191 
House of Representatives, February 5, 2013 
An Act To Establish the Commission on Health Care Cost and 
Quality 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Representative GRAHAM of North Yarmouth. 
Cosponsored by Senator LACHOWICZ of Kennebec and 
Representatives: GATTINE of Westbrook, HICKMAN of Winthrop, MONAGHAN-DERRIG 
of Cape Elizabeth, PEOPLES of Westbrook, PRINGLE of Windham, SANBORN of Gorham. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  3 MRSA c. 12 is enacted to read: 
CHAPTER 12 
COMMISSION ON HEALTH CARE COST AND QUALITY  
§251.  Commission on Health Care Cost and Quality 
1.  Appointment; composition.  The Commission on Health Care Cost and Quality, 
established in Title 5, section 12004-G, subsection 14-I and referred to in this chapter as 
"the commission," consists of 20 members appointed pursuant to this subsection. 
A.  The President of the Senate shall appoint 8 members: 
(1)  Two individuals with expertise in health care delivery, one of whom 
represents hospitals; 
(2)  One individual with expertise in long-term care; 
(3)  One individual with expertise in mental health; 
(4)  One individual with expertise in public health care financing; 
(5)  One individual with expertise in private health care financing; 
(6)  One individual with expertise in health care quality; and 
(7)  One individual with expertise in public health. 
B.  The Speaker of the House of Representatives shall appoint 7 members: 
(1)  Two representatives of consumers of health care; 
(2)  One individual with expertise in the health insurance industry; 
(3)  Two individuals with expertise in business, one of whom represents a 
business or businesses with fewer than 50 employees; 
(4)  One representative of the Department of Health and Human Services, Maine 
Center for Disease Control and Prevention who works collaboratively with other 
organizations to improve the health of the citizens of the State; and 
(5)  One individual with expertise in health disparities, representing the State's 
racial and ethnic minority communities. 
C.  Five members of the commission must be members of the Legislature who serve 
on the joint standing committee of the Legislature having jurisdiction over health and 
human services matters or the joint standing committee of the Legislature having 
jurisdiction over insurance and financial services matters: 
(1)  Two members of the Senate appointed by the President of the Senate, 
including one member recommended by the Senate Minority Leader; and 
(2)  Three members of the House of Representatives appointed by the Speaker of 
the House, including one member recommended by the House Minority Leader. 
Prior to making appointments to the commission, the President of the Senate and the 
Speaker of the House shall seek nominations from the public, from statewide associations 
representing hospitals, physicians and health care consumers and from individuals and 
organizations with expertise in health care delivery systems, health care financing, health 
care quality and public health. 
2.  Terms.  Except for members who are Legislators, members of the commission 
serve 5-year terms.  A member may not serve more than 2 consecutive terms.  Members 
who are Legislators serve 2-year terms coterminous with their elected terms.  Except for a 
member who is a Legislator, a member may continue to serve after expiration of the 
member's term until a successor is appointed. 
3.  Compensation.  Members of the commission are entitled to compensation 
according to the provisions of Title 5, chapter 379.  Members of the commission who are 
Legislators are entitled to receive the legislative per diem as defined in section 2 and 
reimbursement for travel for attendance at meetings of the commission. 
4.  Quorum.  A quorum is a majority of the members of the commission. 
5.  Chair.  The commission shall annually choose one of its members to serve as 
chair for a one-year term. 
6.  Meetings.  The commission shall meet at least 4 times a year at regular intervals 
and may meet at other times at the call of the chair. Meetings of the commission are 
public proceedings as provided by Title 1, chapter 13, subchapter 1. 
7.  Duties; State Health Plan.  The commission shall develop and issue the biennial 
State Health Plan, referred to in this chapter as "the plan," in accordance with the 
requirements in section 252.  The first plan must be issued by October 2015. In 
developing the plan, the commission shall undertake the following activities to the extent 
data and resources are available: 
A.  Collect and coordinate data on health systems development in the State; 
B.  Synthesize relevant research; 
C.  Conduct at least 2 public hearings on the plan each biennium; 
D.  Conduct a systemic review of cost drivers in the State's health care system, 
including, but not limited to, market failure, supply and demand for services, provider 
charges and costs, public and commercial payor policies, consumer behavior, cost 
and pricing of pharmaceuticals and the need for and availability and cost of capital 
equipment and services; 
E.  Collect and report on health care cost indicators, including the cost of services and 
the cost of health insurance.  The commission shall report on both administrative and 
service costs.  These indicators must, at a minimum, include: 
(1)  The annual rate of increase in the unit cost, adjusted for case mix or other 
appropriate measure of acuity or resource consumption, of key components of the 
total cost of health care, including without limitation hospital services, surgical 
and diagnostic services provided outside of a hospital setting, primary care 
physician services, specialized medical services, the cost of prescription drugs, 
the cost of long-term care and home health care and the cost of laboratory and 
diagnostic services; 
(2)  The interaction of indicators, including, but not limited to, cost shifting 
among public and private payors and cost shifting to cover uncompensated care 
of persons unable to pay for items or services, and the effect of these practices on 
the total cost paid by all payment sources for health care; 
(3)  The administrative costs of health insurance and other health benefit plans, 
including the relative costliness of private insurance as compared to Medicare 
and MaineCare, and the potential for measures and policies that would tend to 
encourage greater efficiency in the administration of public and private health 
benefit plans provided to consumers in the State; 
(4)  Geographic distribution of services with attention to appropriate allocation of 
high-technology resources; 
(5)  Regional variation in quality and cost of services; and 
(6)  Overall growth in utilization of health care services; 
F.  Identify specific potential reductions in total health care spending without shifting 
costs onto consumers and without reducing access to needed items and services for 
all persons, regardless of individual ability to pay. In identifying specific potential 
reductions pursuant to this paragraph, the commission shall recommend methods to 
reduce the rate of increase in overall health care spending and the rate of increase in 
health care costs to a level that is equivalent to the rate of increase in the cost of 
living to make health care and health coverage more affordable for people in the 
State; 
G.  Review and evaluate strategies for payment reform in the State’s health care 
system to assess whether proposed payment reform efforts follow the guiding 
principles described in section 252, subsection 2 and identify any statutory or 
regulatory barriers to implementation of payment reform; 
H.  Review pilot projects for payment reform submitted to the Department of 
Professional and Financial Regulation, Bureau of Insurance pursuant to Title 24-A, 
section 4320-H and assess whether the pilot projects follow the principles adopted by 
the commission; and 
I.  Beginning October 1, 2014 and annually thereafter, make specific 
recommendations relating to paragraphs A to F to the joint standing committee of the 
Legislature having jurisdiction over insurance and financial services matters and the 
joint standing committee of the Legislature having jurisdiction over health and human 
services matters and to any appropriate state agency. 
8.  Staff support.  The Legislative Council shall provide staff support to the 
commission except that the Legislative Council staff support is not authorized when the 
Legislature is in regular or special session. The commission may invite the Department of 
Health and Human Services, Maine Center for Disease Control and Prevention; the 
Maine Health Data Organization; and other agencies of State Government to provide 
additional staff support or assistance to the commission. In addition, the commission may 
contract for administrative, professional and clerical services if funding permits. 
9.  Data.  The commission may solicit health care cost and quality data and 
information from both the public and private sectors to help inform the commission's 
work, including, but not limited to, the Department of Health and Human Services, Maine 
Center for Disease Control and Prevention; the Maine Health Data Organization; the 
Maine Quality Forum, established in Title 24-A, section 6951; a statewide health care 
management association; and a statewide public health association. 
10.  Outside funding for commission activities.  The commission may seek outside 
funds to provide staff support, consulting or other services to fund the costs of carrying 
out the duties and requirements of the commission.  Contributions to support the work of 
the commission may not be accepted from any party having a pecuniary or other vested 
interest in the outcome of the matters being studied.  Any person, other than a state 
agency, desiring to make a financial or in-kind contribution shall certify to the Legislative 
Council that it has no pecuniary or other vested interest in the outcome of the 
commission’s activities.  Such a certification must be made in the manner prescribed by 
the Legislative Council.  All contributions are subject to approval by the Legislative 
Council.  All funds accepted must be forwarded to the Executive Director of the 
Legislative Council along with an accounting record that includes the amount of the 
funds, the date the funds were received, from whom the funds were received and the 
purpose of and any limitation on the use of the funds.  The Executive Director of the 
Legislative Council shall administer any funds received by the commission. 
§252.  State Health Plan 
1.  Purpose.  The State Health Plan developed by the commission must set forth 
recommendations for a comprehensive, coordinated approach to the development of 
health care facilities and resources in the State based on statewide cost, quality and access 
goals and strategies to ensure access to affordable health care, maintain a rational system 
of health care and promote the development of the health care workforce. 
2.  Requirements.  The plan must: 
A.  Assess health care cost, quality and access in the State; 
B.  Develop benchmarks to measure health care cost, quality and access goals and 
report on progress toward meeting those goals; 
C.  Recommend annual priorities among health care cost, quality and access goals; 
D.  Recommend priorities for the capital investment needs of the health care system 
in the State; 
E.  Outline strategies to: 
(1)  Promote health systems change; 
(2)  Address the factors influencing health care cost increases; and 
(3)  Address the major threats to public health and safety in the State, including, 
but not limited to, lung disease, diabetes, cancer and heart disease; 
F.  Develop principles for payment reform strategies that: 
(1)  Support integrated, efficient and effective systems of health care delivery and 
payment; 
(2)  Promote a patient-centered approach to the payment and delivery of health 
care services; 
(3)  Encourage and reward the prevention and management of disease; 
(4)  Promote the quality of care over volume of care to measurably lower costs; 
and 
(5)  Support payments and processes that are transparent, easy to understand and 
simple to administer for patients, providers, purchasers and other stakeholders; 
and 
G.  Provide recommendations to help purchasers and providers make decisions that 
improve public health and build an affordable, high-quality health care system. 
Sec. 2.  5 MRSA §12004-G, sub-§14-I is enacted to read: 
14-I.   
Sec. 3.  24-A MRSA §4320-H, sub-§1, ¶B, as reallocated by RR 2011, c. 1, §43, 
is amended to read: 
B.  Prior to approving a pilot project, the superintendent shall consider whether the 
proposed pilot project is consistent with the principles for payment reform developed 
by the Advisory Council on Health Systems Development established under former 
Title 2, section 104 and the Commission on Health Care Cost and Quality established 
in Title 3, section 251. 
Sec. 4.  24-A MRSA §6951, sub-§8-A is enacted to read: 
8-A.  State Health Plan.  The forum shall make recommendations for inclusion in 
the State Health Plan described in Title 3, section 252, including recommendations based 
on the technology assessment reviews under subsection 6. 
Sec. 5.  24-A MRSA §6952, sub-§7, ¶D, as amended by PL 2011, c. 90, Pt. J, 
§24, is further amended to read: 
D.  Make recommendations regarding quality assurance and quality improvement 
priorities for inclusion in the State Health Plan described in Title 3, section 252; and 
Sec. 6.  Staggered terms.  Notwithstanding the Maine Revised Statutes, Title 3, 
section 251, subsection 2, the initial appointments of members of the Commission on 
Health Care Cost and Quality who are not Legislators must include 5 members appointed 
by the President of the Senate to 3-year terms, 4 members appointed by the Speaker of 
Health Care 
Commission on 
Health Care Cost 
and Quality 
Expenses and 
Legislative Per 
Diem 
MRSA §251 
the House of Representatives to 4-year terms, 3 members appointed by the President of 
the Senate to 5-year terms and 3 members appointed by the Speaker of the House of 
Representatives to 5-year terms.  The Executive Director of the Legislative Council shall 
call the first meeting of the commission as soon as all appointments are made. 
SUMMARY 
This bill establishes the Commission on Health Care Cost and Quality to monitor the 
accessibility, cost and quality of health care in the State. The bill also reestablishes the 
State Health Plan and requires the commission to develop the plan on a biennial basis.