Maine Legislature, Session 128, LD 0592

One Hundred and Twenty-Eighth Legislature 
Advance Journal and Calendar 
54th Legislative Day 
In Senate Chamber, Tuesday, June 13, 2017. 
Senate called to Order by President Michael D. Thibodeau of Waldo County. 
Prayer by Reverend Dr. Thomas Blackstone, Pleasant Street United Methodist Church in 
Waterville. 
Pledge of Allegiance led by Senator Eric L. Brakey of Androscoggin County. 
Reading of the Journal of Monday, June 12, 2017. 
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Michael D. Thibodeau 
Senate President 
http://legislature.maine.gov/senate
Heather J.R. Priest 
Secretary of the Senate 
Tuesday, June 13, 2017 
ORDERS 
Joint Orders 
(4-1)  On motion by Senator WHITTEMORE of Somerset, the following Joint Order: 
S.P. 592 
ORDERED, the House concurring, that, notwithstanding Joint Rule 353, the Task Force on 
Health Care Coverage for All of Maine, referred to in this order as "the task force," is established 
as follows. 
1.  Purpose.  It is the intent of the Legislature to ensure that all residents of the State have 
access to and coverage for affordable, quality health care.  It is the intent of the Legislature to 
study the design and implementation of options for a health care plan that provides coverage for 
all residents of the State; and be it further 
2.  Appointments; composition.  The task force consists of members appointed as follows: 
A.  Four members of the Senate, appointed by the President of the Senate, including 2 
members of the party holding the largest number of seats in the Senate and 2 members of the 
party holding the 2nd largest number of seats in the Senate, of whom at least one member is a 
member of the Joint Standing Committee on Insurance and Financial Services and at least 
one member is a member of the Joint Standing Committee on Health and Human Services; 
B.  Four members of the House of Representatives, appointed by the Speaker of the House of 
Representatives, including 2 members of the party holding the largest number of seats in the 
House of Representatives and 2 members of the party holding the 2nd largest number of seats 
in the House of Representatives, of whom at least 3 members are members of the Joint 
Standing Committee on Insurance and Financial Services or the Joint Standing Committee on 
Health and Human Services; 
C.  One member representing the interests of hospitals, appointed by the President of the 
Senate; 
D.  One member representing the interests of health care providers, appointed by the Speaker 
of the House of Representatives; 
E.  Two members representing the interests of health insurance carriers, one appointed by the 
President of the Senate and one appointed by the Speaker of the House of Representatives; 
F.  Two members representing the interests of consumers, one appointed by the President of 
the Senate and one appointed by the Speaker of the House of Representatives; 
G.  One member representing the interests of employers with fewer than 50 employees, 
appointed by the Speaker of the House of Representatives; and  
H.  One member representing the interests of the employers with 50 or more employees, 
appointed by the President of the Senate. 
The President of the Senate and the Speaker of the House of Representatives shall invite to 
participate as members of the task force the Commissioner of Health and Human Services or the 
commissioner's designee and the Superintendent of Insurance or the superintendent's designee. 
Tuesday, June 13, 2017 
3.  Chairs.  The first-named Senator is the Senate chair of the task force, and the first-named 
member of the House of Representatives is the House chair of the task force.  Notwithstanding 
Joint Rule 353, the chairs may appoint, as nonvoting members, individuals with expertise in 
health care policy, health care financing or health care delivery.  Any additional members 
appointed pursuant to this section are not entitled to compensation or reimbursement under 
section 6. 
4.  Appointments; convening.  All appointments must be made no later than 15 days 
following passage of this order.  The appointing authorities shall notify the Executive Director of 
the Legislative Council once all appointments have been made.  When the appointment of all 
members has been completed, the chairs of the task force shall call and convene the first meeting 
of the task force.  If 15 days or more after the passage of this order a majority of but not all 
appointments have been made, the chairs may request authority and the Legislative Council may 
grant authority for the task force to meet and conduct its business. 
5.  Duties; design options.  The task force shall propose at least 3 design options, including 
implementation plans, for creating a system of health care that ensures all residents of the State 
have access to and coverage for affordable, quality health care.  The design options must meet 
the principles and goals outlined in this order.  The proposals designed under this order must 
contain the analysis and recommendations as provided for in this section. 
A.  The proposal must include the following design options: 
(1)  A design for a government-administered and publicly financed universal payer 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 
of only supplemental health services; 
(2)  A design for a universal health benefits system with integrated delivery of health care 
and integrated payment systems for all individuals that is centrally administered by State 
Government or an entity under contract with State Government; and 
(3)  A design for a public health benefits option administered by State Government or an 
entity under contract with State Government that allows individuals to choose between 
the public option and private insurance coverage and allows for fair and robust 
competition among public and private plans. 
Additional options may be designed by the task force, taking into consideration the 
parameters described in this section. 
Each design option must include sufficient detail to allow the task force to report back to the 
Legislature to enable the Legislature to consider the adoption of one design and to determine 
an implementation plan for that design during the First Regular Session of the 129th 
Legislature, including the submission of any necessary waivers pursuant to federal law. 
B.  In creating the design options under paragraph A, the task force shall review and consider 
the following fundamental elements: 
(1)  The findings and reports from previous studies of health care reform in the State, 
including the December 2002 document titled "Feasibility of a Single-Payer Health Care 
Model for the State of Maine" produced by Mathematica Policy Research, Inc., and 
studies and reports provided to the Legislature; 
(2)  The State's current health care reform efforts; 
Tuesday, June 13, 2017 
(3)  The health care reform efforts in other states, including any efforts in other states to 
develop state innovation waivers for universal health coverage plans as an alternative to 
the federal Patient Protection and Affordable Care Act; 
(4)  The federal Patient Protection and Affordable Care Act or any other successor federal 
legislation; the federal Employee Retirement Income Security Act of 1974, as amended; 
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; and 
(5)  The health care systems adopted in other countries. 
C.  Each design option under paragraph A must maximize federal funds to support the system 
and must be composed of the following components: 
(1)  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 mechanisms for 
cost reduction and cost containment; 
(2)  Coordinated regional delivery systems; 
(3)  Health system planning and regulation and public health; 
(4)  Financing and estimated costs, including federal financing.  Each 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 maximization of federal 
revenues or by 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 United States Department of Health and Human Services, 
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 the United States Department of Health and Human Services, 
Centers for Medicare and Medicaid Services to waive provisions of the federal Patient 
Protection and Affordable Care Act, if necessary, to implement the proposals 
contained within the design option in order to maximize federal funds; 
(5)  A method to address compliance of the proposed design option with federal law.  
Unless specifically authorized by federal law, the proposed design option must provide 
coverage supplemental to coverage available under the Medicare program of the federal 
Social Security Act, Title XVIII and the federal TRICARE program, 10 United States 
Code, Chapter 55; 
Tuesday, June 13, 2017 
(6)  A benefit package or packages of health services that meet the requirements of state 
and federal law and provide for the integration of physical and mental health care, 
including access to and coverage for primary care, preventive care and wellness services; 
specialty care; chronic care and chronic disease management; acute episodic care; 
palliative and end-of-life care; hospital services; prescription drugs and durable medical 
equipment; maternity, newborn and pediatric care; laboratory services; mental health and 
substance use disorder services; and dental, vision and health care; 
(7)  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 a private nonprofit insurer or 
3rd-party administrator, through private insurers or from a combination of methods; 
(8)  Enrollment processes; 
(9)  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 and 
utilization reviews; 
(10)  Appeals processes for decisions made by entities or agencies administering 
coverage for health services; 
(11)  Integration of the workers' compensation system; 
(12)  A recommendation for budgets and 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: 
(a)  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 any combination of these entities.  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; 
(b)  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 
(c)  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 payers of health services by ensuring that the 
amount paid to health care professionals and providers is sufficient.  Payment amounts 
must be sufficient to provide reasonable access to health services, provide 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; 
(13)  Mechanisms for cost reduction and cost containment and for oversight to ensure 
accountability and transparency of all financial transactions; 
(14)  A regional health system that ensures that the delivery of health services to the 
residents 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 
(15)  An overall approach to funding that is broadly based to ensure financial stability. 
Tuesday, June 13, 2017 
D.  The proposal must include a method to address compliance of the proposed design 
options under paragraph A with federal law, if necessary, including the federal Patient 
Protection and Affordable Care Act or any other successor federal legislation; the federal 
Employee Retirement Income Security Act of 1974, as amended; and Titles XVIII, XIX and 
XXI of the federal Social Security Act. 
E.  The proposal must include an analysis of: 
(1)  The impact of each design option on the State's current private and public insurance 
system; 
(2)  The expected net fiscal impact of each design option; 
(3)  The impact of each design option on the State's economy; 
(4)  The benefits and drawbacks of alternative timing for the implementation of each 
design option, including the sequence and rationale for the phasing in of the major 
components; and 
(5)  The benefits and drawbacks of each design option and of not changing the current 
system. 
6.  Compensation.  The legislative members of the task force are entitled to receive the 
legislative per diem, as defined in the Maine Revised Statutes, Title 3, section 2, and 
reimbursement for travel and other necessary expenses related to their attendance at authorized 
meetings of the task force.  Public members not otherwise compensated by their employers or 
other entities that they represent are entitled to receive reimbursement of necessary expenses and, 
upon a demonstration of financial hardship, a per diem equal to the legislative per diem for their 
attendance at authorized meetings of the task force. 
7.  Quorum.  A quorum is a majority of the voting members of the task force, including 
those members invited to participate who have accepted the invitation to participate. 
8.  Staffing.  The Legislative Council shall provide staff support for the task force.  To the 
extent needed when the Legislature is in session, the Legislative Council may contract for such 
staff support if sufficient funding is available. 
9.  Consultants; additional staff assistance.  The task force may solicit the services of one 
or more outside consultants to assist the task force to the extent resources are available.  Upon 
request, the Department of Health and Human Services, the Department of Professional and 
Financial Regulation, Bureau of Insurance and the University of Maine System shall provide any 
additional staffing assistance to the task force to ensure the task force and its consultant or 
consultants have the information necessary to create the design options required by this order. 
10.  Reports.  The task force may submit an initial report, including suggested legislation, 
prior to January 1, 2018.  No later than November 1, 2018, the task force shall submit a final 
report that includes its findings and recommendations, including suggested legislation, for 
introduction to the First Regular Session of the 129th Legislature. 
11.  Additional funding; sources.  The task force may apply for and receive funds, grants or 
contracts from public and private sources to support its activities.  No General Fund 
appropriations may be used to support its activities. 
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