An Act To Establish Transparency in Primary Health Care Spending
Maine Legislature, Session 129, LD 1353
Committee Amendment CA_A_S156 (Senate)

COMMITTEE AMENDMENT " k," to S.P. 421, L.D. 1353, Bill, "An Act To 
Establish Transparency in Primary Health Care Spending" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MR.SA §6903, sub-§13-B is enacted to read: 
13-B. Primary care. "Primary care" means regular check-ups, wellness and general 
health care provided by a provider with whom a patient has initial contact for a health 
issue, not including an urgent care or emergency health issue, and by whom the patient 
may be referred to a specialist. 
Sec. 2. 24-A MR.SA §6951, sub-§12 is enacted to read: 
12. Primary care reporting. Beginning January 15, 2020 and annually thereafter, 
the forum shall submit to the Department of Health and Human Services and the joint 
standing committee of the Legislature having jurisdiction over health coverage and health 
insurance matters a report on primary care spending using claims data from the Maine 
Health Data Organization and information on the methods used to reimburse primary care 
providers requested annually from payors, as defined in Title 22, section 8702, subsection 
8. The report must include: 
A. Of their respective total medical expenditures, the percentage paid for primary 
care by commercial insurers, the MaineCare program, Medicare, the organization that 
administers health insurance for state employees and the Maine Education 
Association benefits trust and the average percentage of total medical expenditures 
paid for primary care across all payors; and 
B. The methods used by commercial insurers, the MaineCare program, Medicare, the 
organization that administers health insurance for state employees and the Maine 
Education Association benefits trust to pay for primary care. 
Sec. 3. Maine Quality Forum to conduct health spending reporting study. 
The Maine Quality Forum, established in the Maine Revised Statutes, Title 24-A, section 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"!:,.. "toS.P.421,L.D.1353 i .:,.,. \ SL,:'. 
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6951, shall consult with other state and national agencies and organizations to determine 
the best practices for reporting spending on primary care services by insurers. For 
pmposes of this section, "primary care" means regular check-ups, wellness and general 
health care provided by a health care provider with whom a patient has initial contact for 
a health issue, not including an urgent care or emergency health issue, and by whom the 
patient may be referred to a specialist.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
O 
This amendment replaces the bill. The amendment requires the Maine Quality Forum 
to submit an annual report, beginning January 15, 2020, to the Department of Health and 
Human Services and the joint standing committee of the Legislature having jurisdiction 
over health coverage and health insurance matters, based on claims data reported to the 
Maine Health Data Organization and information on methods of reimbursement for 
primary care reported by insurers. The annual report is required to include the percentage 
of total medical expenditures paid for primary care by commercial insurers, the 
MaineCare program, Medicare, the organization that administers health insurance for 
state employees and the Maine Education Association benefits trust, the average 
percentage of total medical expenditures paid for primary care across all payors and the 
methods used by these organizations to pay for primary care. The amendment also 
requires the Maine Quality Forum to consult with other state and national agencies and 
organizations on best practices in health care spending reporting. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
c 
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Approved: 05/18/19 ha~ 
LD 1353 
LR1705(02) 
An Act To Establish Transparency in Primary Health Care Spending 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment ''ff' ( ::> ,, / "'> (.?_:_) 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Any additional costs to the Maine Quality Forum to meet the requirements in this bill are expected to be minor and 
can be absorbed within existing budgeted resources. 
LRI 705(02) - Fiscal Note - Page I of I