An Act To Advance Health Equity, Improve the Well-being of All Maine People and Create a Health Trust
Maine Legislature, Session 130, LD 1693
Committee: Health and Human Services
Sponsors: TALBOT ROSS, VITELLI, EVANS, MEYER, MILLETT, NEWELL, PERRY, CHIPMAN, HICKMAN
Amends: 5 MRSA §12004-G, 22 MRSA §1515, 22 MRSA §1511, 22 MRSA §414, 22 MRSA §1551, 22 MRSA §1560-D, 22 MRSA §1560-E, 36 MRSA §4365, 36 MRSA §4365-F, 36 MRSA §4365-G, 36 MRSA §4366-A, 36 MRSA §4381

Legislative Document
No. 1693
H.P. 1258
House of Representatives, May 10, 2021
An Act To Advance Health Equity, Improve the Well-being of All 
Maine People and Create a Health Trust
Received by the Clerk of the House on May 6, 2021.  Referred to the Committee on Health 
and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint Rule 
401.
ROBERT B. HUNT
Clerk
Presented by Representative TALBOT ROSS of Portland.
Cosponsored by Senator VITELLI of Sagadahoc and
Representatives: EVANS of Dover-Foxcroft, MEYER of Eliot, MILLETT of Cape Elizabeth, 
NEWELL of the Passamaquoddy Tribe, PERRY of Calais, Senators: CHIPMAN of 
Cumberland, HICKMAN of Kennebec.
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  5 MRSA §12004-G, sub-§14-J is enacted to read:
14-J.  
Health 
Trust for a Healthy Maine Board
Expenses Only
MRSA 
§1515
Sec. A-2.  22 MRSA c. 260-A, sub-c. 1 is enacted by adding before section 1511 
the following to read:
SUBCHAPTER 1
FUND FOR A HEALTHY MAINE
Sec. A-3.  22 MRSA §1511, sub-§2, as enacted by PL 1999, c. 401, Pt. V, §1, is 
amended to read:
2.  Sources of fund.  The State Controller shall credit to the fund:
A.  All If the Trust for a Healthy Maine established in section 1515 is repealed or 
dissolved, all money received by the State in settlement of or in relation to the lawsuit 
CV-97-134;
B.  Money from any other source, whether public or private, designated for deposit into 
or credited to the fund; and
C.  Interest earned or other investment income on balances in the fund.; and
D.  If the Trust for a Healthy Maine established in section 1515 is repealed or dissolved, 
all money transferred from the trust to the fund.
Sec. A-4.  22 MRSA c. 260-A, sub-c. 2 is enacted to read:
 SUBCHAPTER 2
TRUST FOR A HEALTHY MAINE ACT
§1513.  Short title
This subchapter may be known and cited as "the Trust for a Healthy Maine Act."
§1514.  Definitions
As used in this subchapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Administrative costs.  "Administrative costs" means staffing, overhead and related 
operational costs, including costs for a coordinator, professional assistance and bond 
premiums, incurred by the trust in carrying out its duties under this subchapter.
2.  Board.  "Board" means the Trust for a Healthy Maine Board established under Title 
5, section 12004-G, subsection 14-J.
3. Community health worker.  "Community health worker" means a person who 
provides outreach and public health services to a social group using the person's 
understanding of the experiences, socioeconomic needs, language or culture of that social 
group.
4. Community resilience.  "Community resilience" means the capacity of individuals, 
communities, institutions, businesses and systems within a community to survive, adapt 
and grow no matter what kinds of chronic stresses and acute shocks they experience.
5.  Coordinator.  "Coordinator" means the coordinator of the Trust for a Healthy 
Maine under section 1519, subsection 2.
6.  Designated agent.   "Designated agent" means an entity with which the department 
has entered an agency relationship for the purpose of applying for federal funds to support 
public health research and programming and that is authorized by the Federal Government 
to receive those funds.
7.  Disbursement.  "Disbursement" means a decision of the trust governing how 
settlement funds are to be distributed by the trust for the purposes set forth in this 
subchapter.
8.  Health equity.  "Health equity" means the attainment of the highest level of health 
for any social group in this State, regardless of whether a social group is subject to a 
structural inequity.
9.  Medical care.  "Medical care" means direct health care, including but not limited 
to care provided under the MaineCare program and the prescription drug program 
established under section 254-D. "Medical care" does not include treatments provided 
under the Tobacco Prevention and Control Program established in section 272 or the 
delivery of preventive health screenings or services in a school setting.
10.  Settlement funds.   "Settlement funds" means any money received by the State or 
any component of the State in settlement of or in relation to the lawsuit State of Maine v. 
Philip Morris, et al., Kennebec County Superior Court, Docket No. CV-97-134.
11. Social determinants of health. "Social determinants of health" means the 
conditions in which people are born, grow, live, work and age, as well as the social 
structures and economic systems that shape these conditions, including the social 
environment, physical environment and health services.
12. Social group.  "Social group" means a group of people in this State that share 
similar social, economic, demographic, geographic or other characteristics, including, but 
not limited to, race, ethnicity, gender, gender identity, sexual orientation, class, zip code, 
age or disability.
13.  State health plan.  "State health plan" means the most recent plan for improving 
public health and health equity prepared by the Department of Health and Human Services, 
Maine Center for Disease Control and Prevention for accreditation by a nonprofit public 
health accreditation board dedicated to advancing the continuous quality improvement of 
tribal, state, local and territorial health departments or any successor plan identified by the 
Maine Center for Disease Control and Prevention.
14. Structural inequity.  "Structural inequity" means the systemic disadvantage of one 
social group in the State compared to other social groups in the State as a result of law, 
policy, culture or other social structure, including, but not limited to, poverty, 
discrimination, powerlessness or access to job opportunities, quality education, housing or 
health care.
15. Systemic racism.  "Systemic racism" means the laws and institutionalized policies, 
practices or social structures that maintain and perpetuate domination by and advantages 
for the race that is socially constructed as being white to the detriment of or with the purpose 
of imposing influence or control over any other race that is socially constructed to be non-
white, including through color-blind discourse or derogatory and inaccurate stereotypes.
16.  Trust.  "Trust" means the Trust for a Healthy Maine established in section 1515, 
subsection 1.
17.  Trustee.  "Trustee" means a member of the board.
18.  Trust fund.  "Trust fund" means the Trust for a Healthy Maine Trust Fund 
established in section 1520-E, subsection 1.
§1515.  Trust for a Healthy Maine; Trust for a Healthy Maine Board
1.  Establishment; purposes.  The Trust for a Healthy Maine is established for the 
purposes of receiving all settlement funds and other funds, redistributing that money to 
state agencies or designated agents of the State to fund tobacco use prevention and control 
at levels recommended by the United States Department of Health and Human Services, 
Centers for Disease Control and Prevention and to ensure adequate resources for other 
disease prevention efforts and promoting public health. The purposes of the trust also 
include supporting state agencies in planning and delivering public health and prevention 
programs and services, supporting accreditation of the Department of Health and Human 
Services, Maine Center for Disease Control and Prevention and supporting public health 
workforce development. The trust also provides public health expertise and evidence-based 
information to the Legislature.
2.  Governance; board.  The trust is created as a body corporate and politic and a 
public instrumentality of the State and is governed by the Trust for a Healthy Maine Board 
in accordance with this subchapter.
3.  Trustees; appointment.  The board consists of 15 trustees in accordance with this 
subsection. A person who stands to benefit from the tobacco products, as defined in section 
1551, subsection 3, alcohol or marijuana industry is not eligible to serve as a trustee.
A. The Director of the Maine Center for Disease Control and Prevention within the 
Department of Health and Human Services or the director's designee serves as an ex 
officio voting trustee.
B. The Governor shall appoint 3 trustees in accordance with this paragraph:
(1) A person who has clinical expertise or public health expertise, or both, in the 
science and prevention of addiction as a brain disease, selected from 
recommendations provided by a statewide organization dedicated to supporting 
physicians, advancing the quality of medicine and promoting the health of citizens 
in the State;
(2) A person who is an employer with experience recruiting and retaining a healthy 
workforce; and
(3) A person who has experience as a member of an advisory board of a local 
community health coalition, selected from recommendations provided by a 
statewide network of community coalitions working to enhance physical, social, 
emotional, environmental and economic health in the State.
C. The Governor shall appoint trustees from nominations made in accordance with this 
paragraph within 30 days of receiving the nominations.  
(1) The President of the Senate shall, for each of the following 3 qualifications, 
submit to the Governor within 30 days of a vacancy 3 names for consideration:
(a) A person who has expertise in epidemiology and infectious disease or in 
hospital-based prevention, screening and early prevention of infectious 
disease, selected from recommendations provided by the integrated health care 
delivery systems in the State and by a statewide hospital organization that 
provides advocacy, information and education in its mission to improve the 
health of patients and communities;
(b) A person who has clinical expertise or public health expertise, or both, in 
rural primary care, selected from recommendations provided by a statewide 
organization that represents community health centers in the State; and
(c) A person who has expertise in systemic racism and structural inequity and 
is serving on the Permanent Commission on the Status of Racial, Indigenous 
and Maine Tribal Populations, in accordance with Title 5, section 25002.
(2)  The Speaker of the House of Representatives shall, for each of the following 2 
qualifications, submit to the Governor within 30 days of a vacancy 3 names for 
consideration:
(a) A person who has expertise in public health policy related to the leading 
causes of chronic disease, selected from recommendations provided by a 
statewide, nonprofit membership organization that promotes a healthy State 
through advocacy, education, community connection and coalition-building; 
and
(b) A person who has expertise in preventing the use of tobacco products and 
other addictive substances by youth and young adults.
(3)  The member of the Senate who is the leader of the party with the 2nd-largest 
number of members in the Senate shall, for each of the following 2 qualifications, 
submit to the Governor within 30 days of a vacancy 3 names for consideration:
(a) A person who has expertise in trauma, community resilience and social 
determinants of health, selected from recommendations provided by a 
statewide network dedicated to building community strengths and reducing the 
effects of trauma; and
(b) A person who represents a statewide association of public health 
professionals.
(4)  The member of the House of Representatives who is the leader of the party 
with the 2nd-largest number of members in the House shall, for each of the 
following 2 qualifications, submit to the Governor within 30 days of a vacancy 3 
names for consideration:
(a) A person who is employed as a member of the senior staff or faculty in a 
public health academic program; and
(b) A person who has expertise in maternal and child health issues, including 
early childhood education and out-of-school child care, or school-based health.
(5)  The chiefs of the 4 federally recognized Indian tribes in the State shall, for each 
of the following 2 qualifications, submit to the Governor within 30 days of a 
vacancy 3 names for consideration:
(a) A person who has expertise in environmental health; and
(b) A person who has expertise in health equity or health disparity issues.
The trustees appointed pursuant to paragraphs B and C must be reviewed by the joint 
standing committee of the Legislature having jurisdiction over public health matters and 
approved by the Senate.
4.  Terms; vacancies.  Trustees serve 3-year terms. Trustees may serve no more than 
consecutive terms. A trustee shall serve on the board until a replacement is appointed and 
qualified.  If a trustee is unable to complete a term, the Governor shall consult with the 
board and appoint a replacement for the remainder of the unexpired term. The replacement 
trustee must hold the same qualifications, set forth in subsection 3, as those of the departing 
trustee.
5.  Chair; officers.  The board shall elect a chair, a vice-chair, a secretary and a 
treasurer from among the trustees. Each officer serves a one-year term in that office and is 
eligible for reelection.
6.  Meetings; quorum.  The board shall meet at least 4 times each year at regular 
intervals and may meet at other times at the call of the chair or the Governor. A majority 
of the trustees constitutes a quorum. Meetings of the board are public proceedings as 
provided by Title 1, chapter 13, subchapter 1. Notwithstanding any provision of law to the 
contrary, a trustee who is not physically present may participate by telephone or other 
remote access technology in accordance with procedures established by the board.
7.  Election of subcommittees.  The board may elect an executive committee of not 
fewer than 5 trustees who, between meetings of the board, may transact such business of 
the trust as the board authorizes. The board may also elect a planning committee.
8.  Liaison to Legislature.  The chair is the trust's liaison to the joint standing 
committee of the Legislature having jurisdiction over public health matters.
9.  Advisory groups.  The board may establish advisory groups as needed to gather 
technical knowledge on any aspect of public health policy, infrastructure or funding 
disbursement and to make recommendations to the board. Advisory groups may include 
persons who are not trustees.
10.  Removal of trustee for disciplinary reasons.  The board shall develop the process 
of removal and replacement of trustees for disciplinary reasons.
11.  Expenses; reimbursement.  Trustees are not entitled to compensation for service 
on the board, except that, in accordance with Title 5, section 12004-G, subsection 14-J, the 
trust may reimburse travel and other board-related expenses.
12.  Fiduciary duties.  A trustee has a fiduciary duty to the people of the State in the 
administration of the trust. Upon accepting appointment as a trustee, each trustee shall 
acknowledge the fiduciary duty to use the trust fund only for the purposes set forth in this 
subchapter. It is the duty of each trustee to ensure that the purposes of the trust set forth in 
this subchapter are fulfilled.
13.  Conflict of interest.  A trustee is deemed to be an executive employee for purposes 
of Title 5, sections 18, 18-A and 19. In the operation or dissolution of the trust, a trustee, 
employee of the trust, officer of the trust or a spouse or dependent child of any of those 
individuals may not receive any direct personal benefit from the activities of the trust, 
except that the trust may pay reasonable compensation for services rendered and otherwise 
hold, manage and dispose of the trust's property in furtherance of the purposes of the trust.  
This subsection does not prohibit corporations or other entities with which a trustee is 
associated by reason of ownership or employment from participating in activities funded 
directly or indirectly by the trust if ownership or employment is made known to the board 
and the trustee abstains from all matters directly relating to that participation immediately 
upon discovery of the association.
§1516.  Powers and duties
1.  Powers.  The trust may:
A.  Receive all settlement funds;
B.  Receive money from any other source, whether public or private, designated for 
deposit into or credited to the trust;
C.  Receive funds transferred from the Fund for a Healthy Maine under subchapter 1;
D.  Through funding disbursement plans under section 1517, disburse funds; and
E.  Make recommendations to the Governor, the Legislature and other public officials 
regarding improving public health outcomes and promoting public health awareness 
and understanding.
2.  Duties.  The trust shall:
A.  Administer the trust and the trust fund;
B.  Promote the visibility and understanding of public health issues among children 
and adults;
C.  Participate in the development and promotion of a state health plan by the 
Department of Health and Human Services, Maine Center for Disease Control and 
Prevention or another planning entity and provide funding for the planning process if 
necessary;
D.  Promote multilevel planning and coordination that includes state, district, 
community and municipal decision-making and advisory boards; and
E.  Take other actions necessary and appropriate to fulfill the purposes of this 
subchapter.
§1517.  Funding disbursement plan
1.  Funding disbursement plan.   By December 31, 2022 and every year thereafter, 
the board shall develop and approve a funding disbursement plan to disburse settlement 
funds and other funds it may hold or receive in the subsequent biennium. The funding 
disbursement plan must advance the purposes of this subchapter and be based on the most 
recent state health plan and the most recent data available to the board.
2.  Input from interested parties.  Prior to adopting a funding disbursement plan 
pursuant to subsection 1 or substantially amending an existing funding disbursement plan, 
the trust shall hold at least one public hearing to receive input from interested parties, 
including but not limited to the Department of Health and Human Services, Maine Center 
for Disease Control and Prevention, other state agencies, organizations engaged in smoking 
cessation and public health efforts, other nongovernmental organizations, interested 
stakeholders, patients and members of the public.  The board shall establish the procedure 
and timelines for seeking input from interested parties.  The board shall also determine 
what circumstances, consistent with this subsection, would require the board to initiate a 
public hearing.  When considering the input of interested parties, the trust must consider 
principles of zero-based budgeting, as defined in Title 35-A, section 102, subsection 25, 
and long-term returns on investment.
3.  Funding disbursement plans.  The funding disbursement plan approved by the 
board pursuant to subsection 1 for fiscal year 2023-24 must disburse an amount equal to 
0.30 of the settlement funds projected to be received in fiscal year 2023-24 for the purpose 
of providing medical care. The funding disbursement plan approved by the board for fiscal 
year 2024-25 and subsequent years may not disburse funds for the purpose of providing 
medical care. When approving other elements of the funding disbursement plans, the board 
shall consider funding levels in the most recent fiscal year and disburse funding in amounts 
that minimize disruption of existing programs and ensure smooth and efficient transitions 
to the funding levels required under subsection 4.
4.  Designated disbursements.  Each funding disbursement plan approved by the 
board must disburse funds in accordance with the following designated disbursements:
A.  An amount of the settlement funds received in the previous fiscal year must be 
disbursed to the Department of Health and Human Services, Maine Center for Disease 
Control and Prevention or its designated agent for purposes of providing evidence-
based tobacco prevention and control programs in the State in accordance with the 
following:
(1) For fiscal year 2023-24, an amount that is at least 0.70 of the level 
recommended by the United States Department of Health and Human Services, 
Centers for Disease Control and Prevention; and
(2) For fiscal year 2024-25 and in subsequent fiscal years, an amount that when 
combined with amounts from other funding sources received by the Department of 
Health and Human Services, Maine Center for Disease Control and Prevention 
yields a total amount that is at least the level recommended by the United States 
Department of Health and Human Services, Centers for Disease Control and 
Prevention;
B.  An amount of the settlement funds received in the previous fiscal year must be 
disbursed to the Department of the Attorney General in accordance with the following:
(1) Beginning in fiscal year 2023-24, an amount equal to 0.005 of the settlement 
funds; and
(2) Beginning in fiscal year 2024-25 and in subsequent years, an amount equal to 
the amount the Department of the Attorney General received in accordance with 
subparagraph (1) adjusted by the Chained Consumer Price Index, as defined in 
Title 36, section 5402;
C.  An amount of the settlement funds received in the previous fiscal year must be 
disbursed to the administration fund established pursuant to section 1519, subsection 1 
in accordance with the following:
(1) Beginning in fiscal year 2023-24, an amount equal to 0.003; and
(2) Beginning in fiscal year 2024-25 and in subsequent years, an amount equal to 
the amount the administration fund received in accordance with subparagraph (1) 
adjusted by the Chained Consumer Price Index as defined in Title 36, section 5402;
D.  An amount not to exceed 0.05 of the settlement funds received in the previous fiscal 
year may be disbursed to the internal stabilization account established in subsection 6;
E.  An amount not to exceed 0.05 of the settlement funds received in the previous fiscal 
year may be disbursed to the internal flexible account established in subsection 7; and
F.  The funds remaining after making the disbursements required by paragraphs A to 
C and authorized by paragraphs D and E must be disbursed to the health equity and 
health improvement account established in subsection 5.
The designated disbursements approved by the board may not disburse settlement funds 
for the purpose of providing medical care.
5.  Health equity and health improvement account.  A health equity and health 
improvement account is established and funded with settlement funds in accordance with 
subsection 4, paragraph F. 
A. The funding disbursement plan approved by the board must disburse funds from the 
health equity and health improvement account to prioritize the advancement of health 
equity and the elimination of structural inequity. For fiscal year 2023-24, the funding 
disbursement plan must disburse an amount equal to or greater than 0.15 of the funds 
in the health equity and health improvement account. For fiscal year 2024-25 and 
subsequent years, the funding disbursement plan must disburse an amount equal to or 
greater than 0.20 of the funds in the health equity and health improvement account. 
Funds disbursed in accordance with this paragraph must be distributed to achieve all 
or some of the following:
(1) Improving data collection, analysis and reporting, particularly for, among and 
co-led by populations experiencing health disparities, which includes social 
determinants of health, community resilience, racial impacts and health equity;
(2) Enhancing health improvement and health equity planning at the local, district 
and state levels that addresses and confronts systemic racism and structural 
inequity;
(3) Supporting public-private partnerships at the local and district levels, including 
comprehensive community health coalitions, as defined in section 411, and 
organizations that prioritize health equity and derive meaningful leadership from 
the communities they serve;
(4) Supporting the expansion, recruitment, retention and presence of the public 
health workforce at local, district and state levels, including supporting a robust 
network of community health workers and government employees in the State 
dedicated to addressing systemic racism and structural inequity; and
(5) Providing training and technical assistance for local health officers, boards of 
health, community and municipal leaders, community organizations, community 
partnerships and other organizations providing public health services or serving 
the functions of the State's public health and safety system.
B. Funds remaining in the health equity and health improvement account after the 
disbursements required in paragraph A must be for state entities or their designated 
agents that, in the board's sole determination, will use the funds efficiently and 
effectively to promote the purposes of this subchapter, implement evidence-based 
prevention and screening strategies to address the priorities of the state health plan, 
support efforts by the Department of Health and Human Services, Maine Center for 
Disease Control and Prevention to prevent disease and promote public health and 
implement strategies for building and sustaining public health capacity and 
infrastructure at the state and local levels.  These funds may not be disbursed for the 
purpose of providing medical care.
6.  Internal stabilization account.   An internal stabilization account is established 
within the trust. In order to prevent disruptions from year to year in the amounts disbursed 
pursuant to designated disbursements under subsection 4 and to ensure continuity in the 
event of fluctuations in the amount of settlement funds received by the State, the board may 
draw upon the internal stabilization account to make additional disbursements. The trust 
may not cause the balance in the internal stabilization account at any one time to exceed 
the amount of settlement funds received by the trust in the most recent year. The funds 
within the internal stabilization account are nonlapsing and carry forward from year to year 
for future use consistent with this subsection and do not revert to the trust fund.
7.  Internal flexible account.   An internal flexible account is established within the 
trust. The funds in the internal flexible account may be drawn upon by the board for the 
purpose of rapidly addressing emerging public health threats, promptly implementing 
innovative promising practices or addressing other immediate unmet needs identified by 
the board in the period between approval of funding disbursement plans, consistent with 
the purposes of this subchapter. Trustees shall consult regularly with the commissioner 
regarding emerging funding needs. Year-end balances remaining in the internal flexible 
account lapse to the trust fund and are available for a subsequent year's funding 
disbursement plan.
8.  Informational copies of funding disbursement plans.   Upon final approval by 
the board of a funding disbursement plan, the trust shall transmit informational copies of 
the funding disbursement plan to the Governor and to the joint standing committee of the 
Legislature having jurisdiction over public health matters. A funding disbursement plan 
does not require approval of the Governor or the joint standing committee of the Legislature 
having jurisdiction over public health matters.
9.  Report.   The trust shall produce annually a report on the results of the tobacco 
prevention and control programs funded pursuant to subsection 4, paragraph A and all other 
activities of the trust. The report must include an accounting of the funding disbursement 
plan created pursuant to this section, including identification of recipients, activities and 
amounts disbursed. The report must include information and outcomes from the trust's 
investments pursuant to subsection 4, paragraph C.  The report may include information on 
actual health and economic outcomes from funding disbursed to date and projected 
outcomes from undertakings funded by the trust but not yet complete. The report may also 
include recommendations for changes to the laws relating to activities under the jurisdiction 
of the trust. The board must approve the report prior to its release. Upon release, the trust 
shall transmit copies of the report to the Governor and to the joint standing committee of 
the Legislature having jurisdiction over public health matters. The board shall establish 
policies and practices for reporting in accordance with this subsection.
10. Audit. The trust must be audited at least annually by an independent certified public 
auditor. A copy of the audit must be provided to the Governor and to the joint standing 
committee of the Legislature having jurisdiction over public health matters. 
§1518.  Restrictions; construction
The trust's activity is restricted to receiving and disbursing funds and any actions 
necessary and appropriate to receive and disburse funds. The trust may not create, manage 
or operate public health or health delivery programs. Nothing in this subchapter may be 
construed to empower the trust to direct, manage or oversee any program, fund or activity 
of any other state agency.
§1519.  Administration
1.  Administration fund.   The board shall establish an administration fund to be used 
solely to defray administrative costs approved by the board or the coordinator. The trust 
may annually deposit funds authorized to be used for administrative costs under this 
subchapter into the administration fund. Any interest on funds in the administration fund 
must be credited to the administration fund, and any funds unspent in any fiscal year carry 
forward and remain in the administration fund to be used to defray administrative costs. In 
any year, the board may not disburse to the administration fund an amount greater than the 
amount allowed pursuant to section 1517, subsection 4, paragraph C. The board may also 
use the administration fund to contract for reasonable professional assistance to help review 
input received from interested parties, to develop the funding disbursement plan under 
section 1517 and to allow the board to fulfill its responsibilities under this subchapter.  The 
board shall define the roles and responsibilities of any professional assistance in accordance 
with this subsection.
2.  Coordinator.   The board shall appoint, using a full and competitive search process, 
a qualified full-time coordinator of the trust. The coordinator serves at the pleasure of the 
board. The coordinator must have demonstrated experience in research and analysis of 
public health issues, coordination of public health programs or administrative support of a 
board in the public health sector, public health finance or policy or closely related 
experience. The coordinator shall assist the board in gathering and disseminating 
information, preparing for meetings, analyzing public health issues at the direction of the 
board, communicating with stakeholders, writing reports and such other board support and 
administrative functions as the board may assign. The board shall establish the rate and 
amount of compensation of the coordinator. The coordinator may exercise any powers 
lawfully delegated to the coordinator by the board.
3.  Bylaws.   The board shall adopt bylaws for the governance of its affairs consistent 
with this subchapter.
4.  Coordination with other entities.   Consistent with the requirements of this 
subchapter and other applicable law, the board shall coordinate the development of its 
funding disbursement plans with the Statewide Coordinating Council for Public Health, 
established under Title 5, section 12004-G, subsection 14-G, and other state agencies and 
authorities the missions of which relate to the purposes of this subchapter in order to 
minimize inefficiency and duplication and to ensure consistency and effectiveness. 
Notwithstanding any provision of law to the contrary, upon request of the trust and upon 
the approval of the commissioner or director of the state agency receiving the request, other 
state agencies, officials and employees shall cooperate and assist in the administration of 
the trust as needed to further the purposes of this subchapter.
5.  Recommendations. The trust may receive and shall consider any recommendations 
made by the Governor, other state agencies, the joint standing committee having oversight 
under section 1520-A and other interested entities and individuals.
§1520.  Rulemaking
The trust shall adopt rules regarding establishing and administering the trust, receiving 
public input and developing and approving funding disbursement plans. Rules adopted 
pursuant to this section are routine technical rules pursuant to Title 5, chapter 375, 
subchapter 2-A.
§1520-A.  Legislative oversight
The trust is subject to the oversight of the joint standing committee of the Legislature 
having jurisdiction over public health matters.
§1520-B.  Construction by court
The court shall liberally construe this subchapter to give the greatest possible effect to 
the powers and duties accorded to the trust.
§1520-C.  Freedom of access; confidentiality
The proceedings of the board and records of the trust are subject to the freedom of 
access laws under Title 1, chapter 13, subchapter 1.
§1520-D.  Liability
1.  Bond.   All officers, trustees, employees and other agents of the trust entrusted with 
the custody of funds of the trust or authorized to disburse the funds of the trust must be 
bonded either by a blanket bond or by individual bonds with a minimum of $100,000 
coverage for each person, or equivalent fiduciary liability insurance, conditioned upon the 
faithful performance of their duties. The premiums for the bond or bonds are administrative 
costs of the trust.
2.  Indemnification.   Each trustee must be indemnified by the trust against expenses 
actually and necessarily incurred by the trustee in connection with the defense of any action 
or proceeding in which the trustee is made a party by reason of being or having been a 
trustee and against any final judgment rendered against the trustee in that action or 
proceeding.
§1520-E.  Trust for a Healthy Maine Trust Fund
1.  Establishment.   The Trust for a Healthy Maine Trust Fund is established as a 
nonlapsing fund administered exclusively by the trust solely for the purposes established 
in this subchapter.
2.  Tobacco settlement funds.   Notwithstanding any provision of law to the contrary, 
the State Controller shall credit to the trust fund all settlement funds immediately upon 
receipt by the State.
3.  Administration of trust fund.   The trust fund may not be used for any purposes 
other than those set forth in this subchapter, and money in the trust fund is held in trust for 
the purposes of this subchapter. All money received by the trust must be deposited in the 
trust fund for distribution by the trust in accordance with this subchapter. The trust is 
authorized to receive settlement funds and may also seek and accept funding from other 
public or private sources if the trust determines that such acceptance advances the purposes 
of this subchapter. Any balance in the trust fund not spent in any fiscal year does not lapse 
but must carry forward in the trust fund available to be used immediately for the purposes 
of this subchapter, upon the sole direction of the trust. Any interest or investment income 
earned by the trust fund must be credited to the trust fund. The trust may use administrative 
services of the Department of Administrative and Financial Services for the management 
of the trust fund, but the role of the Department of Administrative and Financial Services 
is nondiscretionary and the Department of Administrative and Financial Services shall 
carry out all lawful instructions of the trust for all matters relating to accessing the trust 
fund without the requirement of an additional legislative authorization or a financial order.
4.  Working capital advance.   The State Controller is authorized to provide an annual 
advance from the General Fund to the trust fund to provide money for disbursements from 
the trust fund. The money must be returned to the General Fund as the first priority from 
the amounts credited to the trust fund pursuant to subsection 2.
5.  Transfer of funds upon repeal or dissolution of the trust fund.   If the trust fund 
is repealed or dissolved for any reason, the State Controller shall transfer the balance of 
funds in the trust fund to the Fund for a Healthy Maine established in section 1511.
Sec. A-5.  Staggered terms.  Notwithstanding the Maine Revised Statutes, Title 22, 
section 1515, subsection 4, at the initial meeting of the Trust for a Healthy Maine Board, 
trustees shall draw lots to determine trustees' initial term lengths so that the initial terms of 
trustees expire after one year, the initial terms of 4 trustees expire after 2 years and the 
initial terms of 5 trustees expire after 3 years.
Sec. A-6.  Initial appointments.  Notwithstanding the Maine Revised Statutes, Title 
22, section 1515, subsection 3, paragraph C, the President of the Senate, Speaker of the 
House, member of the Senate who is the leader of the party with the 2nd-largest number of 
members in the Senate, member of the House of Representatives who is the leader of the 
party with the 2nd-largest number of members in the House and the chiefs of the 4 federally 
recognized Indian tribes in the State shall make the initial nominations of trustees for the 
Trust for a Healthy Maine Board to the Governor within 60 days of the effective date of 
this legislation.
Sec. A-7.  Transfer from Fund for a Healthy Maine.  The State Controller, no 
later than July 1, 2023, shall transfer all settlement funds, as defined in the Maine Revised 
Statutes, Title 22, section 1514, subsection 10, in the Fund for a Healthy Maine and a pro 
rata share of investment income in the Fund for a Healthy Maine to the Trust for a Healthy 
Maine Trust Fund.
PART B
Sec. B-1.  22 MRSA §414 is enacted to read:
§414.  Office of Health Equity
1.  Office established.  The Office of Health Equity is established within the 
department.  The office is staffed by at least one full-time employee. 
2.  Purpose.  The Office of Health Equity shall:
A.  Upon request, advise the commissioner, the Governor's Office of Policy Innovation 
and the Future and other state agencies, the Legislature and the Governor on health 
systems, policies and practices, including intradepartmental and interdepartmental 
training;
B.  Provide recommendations to the public and State Government and private and 
philanthropic partners to advance health equity, as defined in section 1514, subsection 
8, in all sectors and settings; 
C.  Produce and update a state health equity plan to:
(1)  Create systems, policies and practices to achieve health equity, as defined in 
section 1514, subsection 8, in all policies across State Government, including 
robust surveillance and evaluation; and
(2)  Establish policies to ensure all state contractors and vendors have a health 
equity plan in place as a criteria for funding; and 
D.  Produce an annual report, known as the Maine Health Equity Report Card, which 
includes health programs and services, outcomes and social determinants of health 
equity, as defined in section 1514.
PART C
Sec. C-1.  Obesity prevention standards in early care and education.  The 
Department of Education shall adopt rules to revise its nutrition, physical activity, screen 
time and sugary drink standards to increase obesity prevention in early care and education 
in accordance with this section.
1.  Early care and education nutrition standards must be consistent with the meal 
patterns of the most recent version of the United States Department of Agriculture, Food 
and Nutrition Service standards for the child and adult care food program established in 42 
United States Code, Section 1766.
2.  Physical activity standards must be consistent with the standards in the most recent 
version of the publication "Caring for Our Children" developed as part of a collaboration 
between the American Academy of Pediatrics, the American Public Health Association and 
the National Resource Center for Health and Safety in Child Care and Early Education.
3.  Screen time standards must be consistent with the standards in the most recent 
version of the publication "Caring for Our Children" developed as part of a collaboration 
between the American Academy of Pediatrics, the American Public Health Association and 
the National Resource Center for Health and Safety in Child Care and Early Education.
4.  Sugary drink standards must be consistent with the standards in the publication 
"Consensus Statement.  Healthy Beverage Consumption in Early Childhood: 
Recommendations from Key National Health and Nutrition Organizations" dated 
September 2019.
Rules adopted pursuant to this section are routine technical rules as defined in the 
Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.
Sec. C-2.  Obesity prevention standards in public schools.  The Department of 
Education shall adopt rules to revise its school nutrition and physical activity standards to 
increase obesity prevention in public schools in accordance with this section. 
1.  School nutrition standards must:
A.  Require, at a minimum, the standards established by the United States Department 
of Agriculture in Final Rule: National School Lunch Program and School Breakfast 
Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, 
Hunger-Free Kids Act of 2010, 7 Code of Federal Regulations, Parts 210 and 220 
(2016);
B.  Require, at a minimum, the standards established in the most recent version of the 
publication "A Guide to Smart Snacks in School" issued by the United States 
Department of Agriculture, Food and Nutrition Service for school meals and foods sold 
or available in schools outside of federally reimbursable school meals programs;
C.  Require reasonably scheduled meal periods and minimum meal times, in alignment 
with the standards set by the federal Healthy, Hunger-Free Kids Act of 2010, Public 
Law 111-296, that ensure sufficient time to eat; and
D.  Require that all school meals served under the programs described in the Maine 
Revised Statutes, Title 20-A, section 6602, subsection 1, paragraph C meet standards 
consistent with those of breakfast and lunch served during the school year.
2.  Physical activity standards must be consistent with the standards in the most recent 
version of the publication "Comprehensive School Physical Activity Programs" developed 
by the United States Department of Health and Human Services, Centers for Disease 
Control and Prevention in collaboration with SHAPE America.
3.  Contingent upon state funding, the department shall make all students, regardless 
of household income, eligible to receive a breakfast and lunch at the public school free of 
charge.  A student in a public school online learning program must be eligible to receive a 
breakfast and lunch from the public school free of charge.
4.  Contingent upon state funding, the department shall develop and provide technical 
assistance and incentives for public schools to meet nutrition standards more stringent than 
required under law or rule.
5.  The department shall require the phasing out of artificial food dyes that cause 
adverse behavioral effects in children.
6.  Contingent upon state funding, the department shall provide kitchen equipment 
grants for upgrades, repairs and maintenance.  
Rules adopted pursuant to this section are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A.
PART D
Sec. D-1.  22 MRSA §1551, sub-§1-D, as enacted by PL 2017, c. 308, §1, is 
amended to read:
1-D.  Electronic smoking device.  "Electronic smoking device" has the same meaning 
as in section 1541, subsection 1‑A means any device that may be used to deliver any 
aerosolized or vaporized substance to the person inhaling from the device, including, but 
not limited to, an electronic cigarette, electronic cigar, electronic pipe, vape pen or 
electronic hookah.  "Electronic smoking device" includes any component, part or accessory 
of the device and also includes any substance that may be aerosolized or vaporized by that 
device, whether or not the substance contains nicotine.  "Electronic smoking device" does 
not include drugs, devices or combination products authorized for sale by the United States 
Food and Drug Administration, as those terms are defined in the Federal Food, Drug, and 
Cosmetic Act.
Sec. D-2.  22 MRSA §1551, sub-§1-E is enacted to read:
1-E.  Flavored tobacco product.  "Flavored tobacco product" means any tobacco 
product that imparts a taste or smell, other than the taste or smell of tobacco, that is 
distinguishable by an ordinary consumer either prior to or during the consumption of a 
tobacco product, including, but not limited to, any taste or smell relating to fruit, menthol, 
mint, wintergreen, chocolate, cocoa, vanilla, honey or any candy, dessert, beverage, herb 
or spice.
Sec. D-3.  22 MRSA c. 262-A, sub-c. 5, as amended, is amended by amending the 
subchapter headnote to read:
SUBCHAPTER 5
FLAVORED CIGARS TOBACCO PRODUCTS
Sec. D-4.  22 MRSA §1560-D, as amended by PL 2011, c. 380, Pt. II, §2, is repealed.
Sec. D-5.  22 MRSA §1560-E is enacted to read:
§1560-E.  Flavored tobacco products
1.  Prohibition on sale or distribution of flavored tobacco products.  A tobacco 
retailer may not sell or distribute or offer to sell or distribute in this State any flavored 
tobacco product. A public statement or claim made or disseminated by the retailer or 
manufacturer of a tobacco product, or by a person authorized or permitted by the retailer 
or manufacturer to make or disseminate public statements concerning a tobacco product, 
that a tobacco product has or produces a taste or smell other than tobacco constitutes 
presumptive evidence that the tobacco product is a flavored tobacco product.
2.  Violation.  A tobacco retailer who violates this section commits a civil violation for 
which a fine may be imposed under subsection 3.
3.  Fines.  The fines that apply to violations of this section are as set out in this 
subsection.
A.  A tobacco retailer who violates subsection 1 commits a civil violation for which a 
fine of $1,000 may be adjudged.
B.  A tobacco retailer who violates subsection 1 after having previously been convicted 
of a violation of that subsection commits a civil violation for which a fine of $5,000 
may be adjudged.
PART E
Sec. E-1.  36 MRSA §4365, as amended by PL 2005, c. 457, Pt. AA, §1 and affected 
by §8, is further amended to read:
§4365.  Rate of tax
A tax is imposed on all cigarettes imported into this State or held in this State by any 
person for sale at the rate of 100 200 mills for each cigarette.  Payment of the tax is 
evidenced by the affixing of stamps to the packages containing the cigarettes.
Sec. E-2.  36 MRSA §4365-F, as enacted by PL 2005, c. 457, Pt. AA, §3 and 
affected by §8, is repealed.
Sec. E-3.  36 MRSA §4365-G is enacted to read:
§4365-G.  Application of cigarette tax rate increase effective November 1, 2021
The following provisions apply to cigarettes held for resale on November 1, 2021.
1.  Stamped rate.  Cigarettes stamped at the rate of 100 mills per cigarette and held 
for resale after October 31, 2021 are subject to tax at the rate of 200 mills per cigarette.
2.  Liability.  A person possessing cigarettes for resale is liable for the difference 
between the tax rate of 200 mills per cigarette and the tax rate of 100 mills per cigarette in 
effect before November 1, 2021.  Stamps indicating payment of the tax imposed by this 
section must be affixed to all packages of cigarettes held for resale as of November 1, 2021, 
except that cigarettes held in vending machines as of that date do not require that stamp.
3.  Vending machines.  Notwithstanding any provision of this chapter to the contrary, 
it is presumed that all cigarette vending machines are filled to capacity on November 1, 
2021, and the tax imposed by this section must be reported on that basis. A credit against 
this inventory tax must be allowed for cigarettes stamped at the rate of 200 mills per 
cigarette placed in vending machines before November 1, 2021.
4.  Payment.  Payment of the tax imposed by this section must be made to the assessor 
by January 1, 2022, accompanied by forms prescribed by the assessor.
Sec. E-4.  36 MRSA §4366-A, sub-§2, as amended by PL 2009, c. 361, §23, is 
further amended to read:
2.  Provided to sellers.  The State Tax Assessor shall provide stamps to a licensed 
distributor upon submission by the licensed distributor of a cigarette tax return in a form 
prescribed by the assessor. The stamps must be of a design suitable to be affixed to 
packages of cigarettes as evidence of the payment of the tax imposed by this chapter.  The 
assessor may permit a licensed distributor to pay for the stamps within 30 days after the 
date of purchase, if a bond satisfactory to the assessor in an amount not less than 50% of 
the sale price of the stamps has been filed with the assessor conditioned upon payment for 
the stamps.  Such a distributor may continue to purchase stamps on a 30-day deferral basis 
only if it remains current with its cigarette tax obligations. The assessor may not sell 
additional stamps to a distributor that has failed to pay in full within 30 days for stamps 
previously purchased until such time as the overdue payment is received.  The assessor 
shall sell cigarette stamps to licensed distributors at the following discounts from their face 
value:
D.  For stamps at the face value of 100 mills, the discount rate is 1.15%.
Sec. E-5.  36 MRSA §4381 is amended to read:
§4381.  Tax credited to General Fund; Fund for a Healthy Maine
The revenue derived from the tax imposed by this chapter shall must be credited to the 
General Fund of the State, except that the State Controller shall credit 50% of the net tax 
revenue to the Fund for a Healthy Maine established under Title 22, section 1511 to be 
segregated into a separate account under Title 22, section 1511, subsection 11, with the use 
of funds in the account restricted to the purposes described in Title 22, section 1511, 
subsection 6.
Sec. E-6.  Appropriations and allocations.  The following appropriations and 
allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Maine Center for Disease Control and Prevention 0143
Initiative: Appropriates funds for one Comprehensive Health Planner II position to act as 
the Obesity Care Coordinator in the Maine Center for Disease Control and Prevention.
GENERAL FUND
2021-22
2022-23
POSITIONS - LEGISLATIVE COUNT
1.000
1.000
Personal Services
$89,627
$92,480
All Other
$6,398
$6,398
__________
__________
GENERAL FUND TOTAL
$96,025
$98,878
Maine Center for Disease Control and Prevention 0143
Initiative: Appropriates funds to implement evidence-based programming relating to the 
reduction of unhealthy weight and obesity.
GENERAL FUND
2021-22
2022-23
All Other
$154,000
$151,000
__________
__________
GENERAL FUND TOTAL
$154,000
$151,000
Maine Center for Disease Control and Prevention 0143
Initiative: Appropriates funds for district public health improvement plans.
GENERAL FUND
2021-22
2022-23
All Other
$900,000
$900,000
__________
__________
GENERAL FUND TOTAL
$900,000
$900,000
Office of Health Equity N365
Initiative: Appropriates funds for one Comprehensive Health Planner II position to act as 
the Health Equity Coordinator in the Office of Health Equity.
GENERAL FUND
2021-22
2022-23
POSITIONS - LEGISLATIVE COUNT
1.000
1.000
Personal Services
$89,627
$92,480
All Other
$6,398
$6,398
__________
__________
GENERAL FUND TOTAL
$96,025
$98,878
Office of Health Equity N365
Initiative: Appropriates funds to implement data collection and reporting in the Office of 
Health Equity.
GENERAL FUND
2021-22
2022-23
All Other
$154,000
$151,000
__________
__________
GENERAL FUND TOTAL
$154,000
$151,000
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF
DEPARTMENT TOTALS
2021-22
2022-23
GENERAL FUND
$1,400,050
$1,399,756
__________
__________
DEPARTMENT TOTAL - ALL FUNDS
$1,400,050
$1,399,756
Sec. E-7.  Effective date. This Part takes effect November 1, 2021.
SUMMARY
Part A establishes the Trust for a Healthy Maine to receive money paid to the State 
pursuant to the tobacco settlement and from other sources and to distribute that money to 
state agencies or designated agents of the State to fund tobacco use prevention and control, 
ensure adequate resources for other disease prevention efforts, promote public health, plan 
and deliver public health and prevention programs and services, support accreditation of 
the Department of Health and Human Services, Maine Center for Disease Control and 
Prevention and support public health workforce development.  The trust is governed by a 
15-member board of trustees composed of the Director of the Maine Center for Disease 
Control and Prevention and 14 members appointed by the Governor.
Part B establishes the Office of Health Equity within the Department of Health and 
Human Services.  The office is tasked with providing advice to the Commissioner of Health 
and Human Services, the Governor's Office of Policy Innovation and the Future and other 
state agencies, the Legislature and the Governor on health systems, policies and practices; 
providing recommendations to advance health equity in all sectors and settings; producing 
and updating a state health equity plan; and producing an annual Maine Health Equity 
Report Card. 
Part C requires the Department of Education to revise its nutrition, physical activity, 
screen time and sugary drink standards to increase obesity prevention in early care and 
education and to revise its school nutrition and physical activity standards to increase 
obesity prevention in public schools and requires those standards to match those specified 
by various national organizations and federal agencies. 
Part D prohibits the sale and distribution of flavored tobacco products, including 
flavored cigars and electronic smoking devices.
Part E increases the tax on cigarettes from 100 mills to 200 mills per cigarette effective 
November 1, 2021 and eliminates the provision that allows the sale of cigarette stamps to 
licensed distributors at a discount.  The amount of increased revenue from the cigarette tax 
is credited to the Fund for a Healthy Maine.  Part E also provides funding for the health 
initiatives in the bill.