An Act To Promote Universal Health Care, Including Dental, Vision and Hearing Care
Maine Legislature, Session 129, LD 0407
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BROOKS, BELLOWS, MELARAGNO
Amends: 5 MRSA §12004-G, 24-A MRSA §7504

Legislative Document
No. 407
H.P. 316
House of Representatives, January 29, 2019
An Act To Promote Universal Health Care, Including Dental, Vision 
and Hearing Care
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative BROOKS of Lewiston.
Cosponsored by Senator BELLOWS of Kennebec and
Representative: MELARAGNO of Auburn.
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  5 MRSA §12004-G, sub-§14-I is enacted to read:
14-I.  
Sec. A-2.  24-A MRSA c. 95 is enacted to read:
CHAPTER 95
HEALTHY MAINE ACT
§7501.  Short title
This chapter may be known and cited as "the Healthy Maine Act."
§7502.  Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Beneficiary.  "Beneficiary" means an individual whose primary residence is in the 
State.
2.  Board.  "Board" means the board of trustees of Healthy Maine.
3.  Children's health insurance program.  "Children's health insurance program" 
means the children's health benefit plan established in Title 22, section 3174-T.
4.  Healthy Maine.  "Healthy Maine" means the body created in section 7503.
5.  MaineCare.  "MaineCare" means the medical assistance program authorized in 
Title XIX of the federal Social Security Act, as amended, and administered under Title 
22, chapter 855.
6.  Provider.  "Provider" means a health care professional licensed by the State and 
includes individuals and hospitals and other health care facilities licensed or certified by 
the State. "Provider" includes an individual or entity that provides services, medical 
interventions, pharmaceuticals or equipment used to treat beneficiaries.
§7503.  Healthy Maine; establishment; governance
Healthy Maine is created as a body corporate and politic and a public instrumentality 
of the State to finance health care services for residents of the State, to administer state 
and federal health care funds and to institute fiscally sound payment policies that improve 
and maintain high standards for value, quality and healthy outcomes for all beneficiaries.
Health Care
Healthy Maine 
Board
Expenses Only
24-A MRSA §7504
§7504.  Board of trustees of Healthy Maine
1.  Establishment.  The board of trustees of Healthy Maine is established to oversee 
the operations of Healthy Maine.
2.  Terms.  Members of the board serve 4-year terms, and members may serve a 
maximum of 3 consecutive 4-year terms. Members reaching the end of their terms may 
serve until replacements are named.
3.  Removal of member.  A member of the board may be removed for cause by a 
majority vote of the other members.
4.  Duties of the board.  The board shall:
A.  Adopt bylaws, procedures, rules and policies, and ratify, amend or reject those 
bylaws, procedures, rules and policies adopted by the board;
B.  Hire staff to administer the operations of Healthy Maine, including a chief 
executive officer, a chief financial officer and a chief medical officer;
C.  Establish a central purchasing authority responsible for negotiating favorable 
prices for prescription drugs, medical equipment and other products and services 
required by Healthy Maine;
D.  Provide funds to the superintendent for the operation of separate ombudsman 
offices for beneficiaries and providers, each of which must have the capacity to 
investigate and respond to inquiries and complaints and make recommendations to 
the board.  Funding provided pursuant to this paragraph must be sufficient to allow 
the timely completion of all investigations;
E.  Establish and fund an office for the investigation and prevention of fraud. The 
office may bring civil actions in the name of Healthy Maine to recover any money or 
the value of any benefits obtained by fraud or mistake and may refer fraudulent 
conduct to a district attorney for criminal prosecution;
F.  Establish procedures for managing surplus funding by maintaining necessary 
operating reserves, increasing benefits or issuing refunds to members;
G.  Establish procedures for ensuring financial sustainability by adjusting payments 
and benefits;
H.  Adopt rules for independent annual performance and financial audits;
I.  Adopt rules that protect beneficiary confidentiality while allowing for publicly 
available research of Healthy Maine's databases;
J.  Adopt rules to ensure transparency in its operations and decision making. The 
rules must be at least as strict as the requirements in the laws governing freedom of 
access set forth in Title 1, chapter 13;
K.  Approve and make publicly available an annual budget;
L.  Facilitate creation of efficient medical records and billing records systems that:
(1)  Can be easily accessed by providers and beneficiaries;
(2)  Allow Healthy Maine to maintain a central database of medical records 
suitable for management and cross-sectional and longitudinal research purposes;
(3)  Ensure the confidentiality of beneficiaries' medical records in compliance 
with all federal and state health care laws, regulations and rules concerning the 
confidentiality of patient medical records; and
(4)  Are easily portable to and interoperable with all other medical records 
systems in use throughout the State;
M.  Administer all state funds for health care services provided to beneficiaries;
N.  Establish policies and procedures to pay benefits for health care services rendered 
to a beneficiary who is temporarily living or traveling in another state; and
O.  Establish an appeals procedure that allows beneficiaries and providers to 
challenge coverage and payment decisions. Final action on an appeal is subject to 
judicial review according to state law for the review of final agency actions.
5.  Authority of the board.  The board may:
A.  Authorize reasonable compensation and expense reimbursement for members of 
the board;
B.  Seek waivers from state and federal laws, rules and regulations;
C.  Seek and accept gifts, grants and donations on behalf of Healthy Maine;
D.  Adopt rules as necessary for the proper administration and enforcement of this 
chapter; and
E.  Exercise other powers necessary and proper to fulfill Healthy Maine's 
responsibilities.
§7505.  Health care services
1.  Required services.  Healthy Maine shall contract with providers to pay for health 
care services to beneficiaries, which must include:
A.  Ambulatory patient services, including primary and specialty care;
B.  Hospitalization;
C.  Prescription drugs and durable medical equipment;
D.  Mental health and substance use disorder services, including behavioral health 
treatment;
E.  Emergency and urgent care;
F.  Preventive and wellness services and chronic disease management;
G.  Rehabilitative and habilitative services and devices;
H.  Pediatric services, including oral, vision and hearing care;
I.  Laboratory services;
J.  Maternity and newborn care;
K.  Palliative and end-of-life care; and
L.  Dental, vision and hearing care.
2.  Additional services.  The board may authorize payment for services not specified 
in subsection 1.
3.  Healthy Maine responsible for payment.  Healthy Maine shall pay for health 
care services to beneficiaries in accordance with this subsection.
A.  Healthy Maine shall pay for health care services to beneficiaries regardless of the 
cause of their injuries or illnesses.
B.  Beginning July 1, 2022, Healthy Maine shall assume responsibility for payment 
of all reasonable and necessary medical expenses incurred by workers who suffer 
injuries or illnesses arising out of and in the course of their employment and whose 
employers are required under the Maine Workers' Compensation Act of 1992 to 
provide workers' compensation insurance for their employees. Workers suffering 
from injuries or illnesses arising out of and in the course of their employment in 
accordance with this paragraph are entitled to the same benefits and have the same 
rights and responsibilities as other beneficiaries.
C.  For individuals eligible for MaineCare, the children's health insurance program 
and any other federal health care programs to be administered by Healthy Maine, the 
benefit package under Healthy Maine must include:
(1)  The benefits required by federal law;
(2)  Any optional MaineCare benefits authorized under state law or services 
covered under the children's health insurance program for which these individuals 
are eligible; and
(3)  Any additional benefits provided in Healthy Maine's benefit package.
D.  An individual who loses eligibility for state or federal benefits under MaineCare 
or the children's health insurance program must receive the same benefits as any other 
beneficiary of Healthy Maine.
4.  Deductibles prohibited.  Healthy Maine may not charge deductibles to 
beneficiaries.
5.  Waiver of copayments; primary and preventive care services.  The board shall 
adopt rules for waiving copayments when copayments will cause financial hardship for a 
beneficiary. The board may not require copayments for designated primary and 
preventive care services.
6.  Approval required.  A provider may not require a beneficiary to make a 
copayment or submit to any other cost-sharing arrangement without Healthy Maine's 
approval.
7.  Choice of provider.  Healthy Maine shall allow beneficiaries to choose their own 
primary care providers.
8.  Access to services.  Healthy Maine may provide funding and other support to 
improve access to health care services for all beneficiaries regardless of where they live 
in the State and may provide funding and other support for statewide access to emergency 
and trauma care services.
§7506.  Healthy Maine secondary payor; state health plan; subrogation rights
1.  Secondary payor.  Healthy Maine serves as a secondary payor to any health 
insurance plan in which a beneficiary may be responsible for a beneficiary's health care 
expenses. The total of Healthy Maine's payment and all other payments may not exceed 
the amount that Healthy Maine would pay if it were the only payor.
2.  State health plan.  Healthy Maine serves as a state health plan that pays for 
designated supplemental health care services for Medicare beneficiaries, except that 
Healthy Maine may not pay for services:
A.  That are covered by Medicare Parts A, B and D;
B.  That are covered by a Medicare Advantage plan that a beneficiary has with an 
entity other than Healthy Maine; or
C.  That would have been paid by Medicare Part B or D had the beneficiary 
purchased those optional Medicare coverages, unless:
(1)  Healthy Maine has an agreement with the federal Department of Health and 
Human Services, Centers for Medicare and Medicaid Services that requires it to 
pay for services that would have been paid under Medicare Part B or D; or
(2)  Healthy Maine offers a Medicare Advantage plan and the beneficiary 
voluntarily enrolls in that plan.
3.  Rights of subrogation.  Healthy Maine has full rights of subrogation, ahead of the 
rights of a workers' compensation or other insurer or health care plan, including the right 
to bring an independent lawsuit or to intervene in a lawsuit filed by a beneficiary, in order 
to recover health care costs from collateral sources for which the beneficiary has a right 
of action for compensation against the person or entity that caused the beneficiary's 
illness or injury. Healthy Maine may assert a lien against any proceeds recovered by the 
beneficiary.
Healthy Maine may recover health care payments from any other collateral source, such 
as a health insurance plan, health benefit plan or other payor that is primary to Healthy 
Maine.
§7507.  Effective date
This chapter takes effect July 1, 2022.
PART B
Sec. B-1.  Transition.  The Department of Health and Human Services and any 
other affected department or agency of the State shall assist Healthy Maine in seeking all 
waivers, exemptions and agreements from State Government and the Federal 
Government that are necessary to transfer health care funding from the Federal 
Government and from any state departments and agencies to Healthy Maine.
Sec. B-2.  Interim meetings; implementing legislation.  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 are authorized to jointly meet as needed during the 2019 
legislative interim to oversee planning and implementation related to the establishment of 
Healthy Maine.  At these meetings, the Commissioner of Health and Human Services and 
the Superintendent of Insurance shall brief the committees on planning issues, progress, 
challenges and the timeline for implementation.  The committees shall provide 
opportunities for health care consumers, providers and advocates to speak to the 
committees.  The committees shall jointly submit legislation to the Second Regular 
Session of the 129th Legislature by January 15, 2020 to implement Part A of this Act.  
The committees shall include in the legislation provisions to:
1.  Fund the operation of Healthy Maine;
2.  Transfer responsibility for administering the MaineCare program and the 
children's health insurance program established in the Maine Revised Statutes, Title 22, 
section 3174-T from the Department of Health and Human Services to Healthy Maine;
3.  Transfer responsibility for administering any other state or federal health care 
program to Healthy Maine;
4.  Obtain all waivers, exemptions and agreements from State Government and the 
Federal Government that are necessary to transfer health care funding from the Federal 
Government and from any state departments and agencies to Healthy Maine;
5.  Transfer to Healthy Maine all state and federal funds associated with programs for 
which Healthy Maine will assume responsibility;
6.  Enable Healthy Maine to receive the appropriate federal fund contribution in lieu 
of the federal premium tax credits, cost-sharing subsidies and small business tax credits 
provided in the federal Patient Protection and Affordable Care Act or its successor acts;
7.  Repeal or amend, as appropriate, those provisions of the Maine Workers' 
Compensation Act of 1992 and any other provisions of law that concern the provision of 
medical care for workers who suffer injuries or illnesses arising out of and in the course 
of their employment and for the payment of premiums for medical benefits, whether by 
employers or insurers covered under the laws governing workers' compensation or that 
otherwise conflict with Title 24-A, chapter 95;
8.  Ensure that the State's expenditures for health care services, including the State's 
responsibility for providing matching funds for MaineCare and other federally supported 
health care programs, do not fall below the expenditure levels for health care services in 
the year preceding July 1, 2022;
9.  Determine the process for selecting or electing the members of the board of 
trustees of Healthy Maine established in Title 24-A, section 7504; and
10.  Effectuate a smooth and efficient transfer of the programs and responsibilities 
and enable affected departments and agencies to assist Healthy Maine in the assumption 
of its duties.
Sec. B-3.  Transfer of state and federal funds; responsibility for 
distribution.  No later than July 1, 2022, the State shall transfer to Healthy Maine all 
state and federal funds for MaineCare, the children's health insurance program established 
in the Maine Revised Statutes, Title 22, section 3174-T and any other program to be 
administered by Healthy Maine. The State may retain any funds necessary to meet 
payment obligations that exist as of the date of transfer. Upon receipt of this funding, 
Healthy Maine is responsible for paying for all benefits and services previously paid by 
State Government and the Federal Government with those funds, and Healthy Maine 
shall assume responsibility for the proper administration and distribution of state and 
federal funds pursuant to state and federal law.
Sec. B-4.  Phase-in; delivery of service models.  Healthy Maine shall assume 
payment for health care services in a manner designed to minimize disruptions to existing 
delivery and payment systems.  Healthy Maine shall phase in payment reforms and a 
unified billing system and shall employ payment models that optimize quality, value, 
patient experience and healthy outcomes for beneficiaries.
SUMMARY
This bill establishes a single-payer health care system in the State, effective July 1, 
2022, that finances health care services for most Maine residents.  The bill directs 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 to jointly submit during the 2019 legislative 
interim legislation to fully implement the single-payer system.