An Act To Align the Federal Affordable Care Act's Health Care Coverage Opportunities and Hospital Charity Care
Maine Legislature, Session 127, LD 0343
Committee Amendment CA_A_H260 (House)
Amends: 22 MRSA §1715

COMMITTEE AMENDMENT" A" to H.P. 237, L.D. 343, Bill, "An Act To Align 
the Federal Affordable Care Act's Health Care Coverage Opportunities and Hospital 
Charity Care" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 22 MRSA §1715, sub-§l, as corrected by RR 2001, c. 2, Pt. A, §34, is 
amended to read: 
1. Access requirements. Any person, including, but not limited to~ an affiliated 
interest as defined in section 396~L, that is subject to the requirements of this subsection, 
shall provide the services listed in paragraph C to individuals who are eligible for ehaffiy 
eare financial assistance. in accordance with a eharity care financial assistance policy 
adopted by the affiliate or provider that is consistent with lUles applicable to hospitals 
under section 1716. A person is subject to this subsection if that person: 
A. Is either a direct provider of major ambulatory service, as defined in section 382, 
subsection 8-A, or is or has been required to obtain a certificate of need under section 
or former section 304 or 304~A; 
B. 
Provides outpatient services as defined in section 382, subsection 9-A; and 
C. Provides one or more of the following services: 
(1) Imaging services, including, but not limited to, magnetic resonance imaging, 
computerized tomography, mammography and radiology: For purposes of this 
section, imaging services do not include: 
(a) Screening procedures that are not related to· the diagnosis or treatment of 
a specific condition; or 
(b) Services when: 
(i) The services are owned by a community health center, a physician or 
group of physicians; 
COMMITTEE AMENDMENT 
COMMlTTEE AMENDMENT" fJr .. to H.P. 237, L.D. 343 
Oi) 
The services are offered solely to the patients of that center, 
physician or group ofp}~ysicians; and 
(iii) 
Referrals for the purpose of performing those services are not 
accepted from other physicians; 
(2) 
Laboratory services performed by a hospital or by a medical laboratory 
licensed in accordance with the Maine Medical Laboratory Commission, or 
licensed by an equivalent out-of-state licensing authority, excluding those 
licensed laboratories. owned by community health centers, a physician or group of 
physicians where the laboratory services are offered solely to the patients of that 
center, physician or group of physicians; 
(3) 
Cardiac diagnostic services, including, but not limited to, cardiac 
catheterization 
and 
angiography 
but 
excluding 
electrocardiograms 
and 
electrocardiograph stress testing; 
(4) Lithotripsy services; 
(5) Services provided by free-standing ambulatory surgery facilities certified to 
participate in the Medicare program; or 
(6) Any other service perfonned in an out-patient setting requiring the purchase 
of medical equipment costing in the aggregate $500,000 or more and for which 
the charge per unit of service is $250 or more. 
Sec. 2. 22 MRS A §1716, as enacted by PL 1995, c. 653, Pt. B, §7 and affected by 
2] 
§8 and enacted by c. 696, Pt. A, §36, is amended to read: 
§1716. Financia1 assistance policies 
The department shall adopt reasonable guidelines for rules requll'1ng financial 
assistance policies to be adopted' and implemented by hospitals with respect to the 
provision of health care services to patients who are determined unable to pay for the 
services received. The department shall adopt inoome guidelines that are oonsistent with 
the guidelines applioable to the Hill Burton Program established under 42 United States 
Code, Section 291, et seq. (1995). The guidelines and polioies rules must include the 
requirement that upon admission or, in cases of emergency admission, before discharge 
of a patient, hospitals must investigate the coverage of the patient by any insurance or 
state or federal programs of medical assistance. 
The guidelines rules must include 
provisions for notice to the pl)blic and the opportunity for a fair hearing regarding 
eligibility for oharity sare financial assistance. The rules must require that hospitals 
provide free, medically necessary hospital services for patients without insurance 
coverage whose income is egual to or less than 138% of the federal poverty level. Rules 
adopted pursuant to this section must be consistent with federal financial assistance 
policy reguirements under section 501(1') of the United States Internal Revenue Code and 
any federal regulations implementing those requirements. 
Rules adopted pursuant to this section are routine technicalmles as defined in Title 5, 
chapter 375, subchapter 2-A. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A .. to H.P. 237, L.D. 343 
Sec. 3. 22 MRS A §1718-C, as enacted by PL 2013, c. 560, §2, is amended to 
read: 
§1718-C. Estimate of the total price of a single medical encounter for an uninsured 
patient 
Upon the request of an uninsured patient, a health care entity, as defined in section 
1718-B, subsection 1, paragraph B, shall provide within a reasonable time of the request 
an estimate of the total price of medical services to be rendered directly by that health 
care entity during a single medical encounter. If the health care entity is unable to provide 
an accurate estimate of the total price of a specific medical service because the amount of 
the medical service to be consumed during the medical encounter is unknown in advance, 
the health care entity shall provide it brief description of the basis for determining the 
total price of that particular medical service. If a single medical encounter will involve 
medical services to be rendered by one or more 3rd-party health care entities, the health 
care entity shall identify each 3rd-party health care entity to enable the uninsured patient 
to seek an estimate of the total price of medical services to be rendered directly by each 
health care entity to that patient. When providing an estimate as required by this section, 
a health care entity shall also notify the uninsured patient of any charity care financial 
assistance policy adopted by the health care entity. 
Sec. 4. Resolve 2005, c. 148 is repealed. 
Sec.S. Effective date. This Act takes effect January 1, 2016. 1 
SUMMARY 
This amendment, which is the minority report of the committee, replaces the concept 
draft and amends the laws regarding hospital charity care guidelines as follows. 
I. It changes the term "charity care" to "financial assistance" in a'number of statutory 
sections to better align state statute with the federal Patient Protection and Affordable 
Care Act. 
2. It requires the Department of Health and Human Services to adopt rules rather 
than guidelines to regulate hospital financial assistance policies. 
3. It provides for hospital financial assistance to patients without insurance coverage 
whose income is equal to or less than 138% of the federal poverty level. 
The amendment also repeals Resolve 2005, chapter 148, which required the 
establishment of hospital free care guidelines for patients below 150% of the federal 
poverty level. 
The amendment provides an cffcctivc datc of January 1, 2016. 
COMMITTEE AMENDMENT