An Act To Support Universal Health Care
Maine Legislature, Session 130, LD 1045
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BROOKS, ARFORD, EVANS, GRAMLICH, MORALES, SACHS
Amends: 5 MRSA §12004-G, 24-A MRSA §7510

Legislative Document
No. 1045
H.P. 773
House of Representatives, March 10, 2021
An Act To Support Universal Health 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 Representatives: ARFORD of Brunswick, EVANS of Dover-Foxcroft, 
GRAMLICH of Old Orchard Beach, MORALES of South Portland, SACHS of Freeport.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §12004-G, sub-§14-J is enacted to read:
14-J.   
Health Care 
Maine Health Care Board Compensation 
determined under 24-A 
MRSA §7510, sub-§3 
24-A MRSA 
§7510 
Sec. 2.  24-A MRSA c. 97 is enacted to read:
CHAPTER 97
MAINE HEALTH CARE ACT
§7501.  Short title
This chapter may be known and cited as "the Maine Health Care Act."
§7502.  Maine Health Care Plan
1.  Plan established; requirements.  The Maine Health Care Plan is established in 
order to keep residents of this State healthy and provide the best quality of health care.  The 
Maine Health Care Plan must:
A.  Ensure all residents of this State are covered uniformly and unrelated to their 
employment status;
B.  Cover all necessary care, including dental, vision and hearing, mental health, 
chemical dependency treatment, prescription drugs, medical equipment and supplies, 
long-term care and home care;
C.  Allow patients to choose their providers;
D.  Reduce costs by cutting administrative bureaucracy, not by restricting or denying 
care;
E.  Set premiums based on ability to pay and eliminate cost sharing;
F.  Focus on preventive care and early intervention to improve health;
G.  Ensure that there are enough health care providers to guarantee timely access to 
care;
H.  Continue the State's leadership in medical education, research and technology;
I.  Provide adequate and timely payments to providers;
J.  Address imbalances in access to health care in urban and rural areas;
K.  Address socioeconomic and racial disparities in access to health care; and
L.  Use a simple funding and payment system.
2.  Purpose.  The Maine Health Care Plan must provide all medically necessary health 
care services for all residents of this State in a manner that meets the requirements of this 
chapter.
3.  Definitions. As used in this chapter, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "Institutional provider" means an inpatient hospital, nursing facility, rehabilitation 
facility or other health care facility that provides overnight care.
B.  "Maine Health Care Board" or "board" means the Maine Health Care Board as 
established in section 7510.
C.  "Maine Health Care Fund" or "fund" means the Maine Health Care Fund as 
established pursuant to section 7506.
D.  "Maine Health Care Plan" or "plan" means the Maine Health Care Plan as 
established in subsection 1.
E.  "Medically necessary" means, with regard to services or supplies, needed to 
promote health and to prevent, diagnose or treat a particular patient's medical condition 
and meeting accepted standards of medical practice within a provider's professional 
peer group and geographic region.
F.  "Noninstitutional provider" means an individual provider, group practice, clinic, 
outpatient surgical center, imaging center or other health care facility that does not 
provide overnight care.
§7503.  Eligibility
1.  Residency.  All residents of this State are eligible for the Maine Health Care Plan.
2.  Enrollment; identification.  The Maine Health Care Board shall establish a 
procedure to enroll residents and provide each with identification that may be used by 
health care providers to confirm eligibility for services.  The application for enrollment 
must be no more than 2 pages.
3.  Residents temporarily out of state.  The Maine Health Care Plan must provide 
health care coverage to residents of this State who are temporarily out of the State who 
intend to return and reside in the State.  Coverage for emergency care obtained out of the 
State must be at prevailing local rates.  Coverage for nonemergency care obtained out of 
the State must be according to rates and conditions established by the board.  The board 
may require that a resident be transported back to the State when prolonged treatment of 
an emergency condition is necessary and when that transport will not adversely affect a 
patient's care or condition.
4.  Visitors.  Nonresidents visiting the State must be billed by the board for all services 
received under the Maine Health Care Plan.  The board may enter into intergovernmental 
arrangements or contracts with other states and countries to provide reciprocal coverage 
for temporary visitors.
5.  Nonresident employed in State.  The board shall extend eligibility for the plan to 
nonresidents employed in this State under a premium schedule set by the board.
6.  Business outside of State employing residents of State.  The board shall apply for 
a federal waiver to collect the employer contribution mandated by federal law.
7.  Retiree benefits.  All persons who are eligible for retiree medical benefits under an 
employer-employee contract remain eligible for those benefits as long as the contractually 
mandated payments for those benefits are made to the Maine Health Care Fund, which 
assumes financial responsibility for care provided under the terms of the contract along 
with additional health care benefits covered by the Maine Health Care Plan.  Retirees who 
elect to reside out of the State are eligible for benefits under the terms and conditions of the 
retirees' employer-employee contract.  The board may establish financial arrangements 
with states and foreign countries in order to facilitate meeting the terms of the contracts 
described in this subsection.  Payments for care provided by providers out of the State to 
retirees of this State must be reimbursed at rates established by the Maine Health Care 
Board.  Providers who accept any payment from the Maine Health Care Plan for a covered 
service may not bill the patient for the covered service.
8.  Presumptive eligibility.  The following provisions apply.
A.  An individual is presumed eligible for coverage under the Maine Health Care Plan 
if the individual arrives at a health care facility unconscious, comatose or otherwise 
unable, because of the individual's physical or mental condition, to document eligibility 
or to act on the individual's own behalf.  If the patient is a minor, the patient is presumed 
eligible, and the health care facility shall provide care as if the patient were eligible.
B.  An individual is presumed eligible for coverage under the Maine Health Care Plan 
when brought to a health care facility licensed in this State for emergency care and 
treatment in accordance with any provision of law providing for involuntary care and 
treatment.
C.  Any individual involuntarily committed to an acute psychiatric facility or to a 
hospital with psychiatric beds in accordance with any provision of law providing for 
involuntary commitment is presumed eligible for coverage under the Maine Health 
Care Plan.
D.  All health care facilities subject to state and federal provisions governing 
emergency medical treatment shall comply with those provisions.
9.  Data.  Data collected because an individual applies for or is enrolled in the Maine 
Health Care Plan are confidential, but may be released to:
A.  Providers for purposes of confirming enrollment and processing payments for 
benefits; or
B.  The State Auditor for purposes of the duties of that office.
§7504.  Benefits
1.  General provisions.  Any eligible individual may choose to receive services under 
the Maine Health Care Plan from any participating provider.
2.  Covered benefits.  Covered health care benefits in this chapter include all medically 
necessary care, subject to the limitations specified in this chapter.  Covered health care 
benefits for Maine Health Care Plan enrollees include:
A.  Inpatient and outpatient health care facility services;
B.  Inpatient and outpatient professional health care provider services;
C.  Diagnostic imaging, laboratory services and other diagnostic and evaluative 
services;
D.  Medical equipment, appliances and assistive technology, including prosthetics, 
eyeglasses and hearing aids and repair, technical support and customization needed for 
individual use;
E.  Inpatient and outpatient rehabilitative care;
F.  Emergency care services;
G.  Emergency transportation;
H.  Necessary transportation for health care services for persons with disabilities or 
who may qualify as persons with low income;
I.  Child and adult immunizations and preventive care;
J.  Health and wellness education;
K.  Hospice care;
L.  Care in a skilled nursing facility;
M.  Home health care including health care provided in an assisted living facility;
N.  Mental health services;
O.  Substance use disorder treatment;
P.  Dental care;
Q.  Vision care;
R.  Hearing care;
S.  Prescription drugs;
T.  Podiatric care;
U.  Chiropractic care;
V.  Acupuncture;
W.  Therapies that are shown by the United States Department of Health and Human 
Services, National Institutes of Health, National Center for Complementary and 
Integrative Health to be safe and effective;
X.  Blood and blood products;
Y.  Dialysis;
Z.  Adult day care;
AA.  Rehabilitative and habilitative services;
BB.  Ancillary health care or social services covered by the State's public health 
programs prior to establishment of the Maine Health Care Plan;
CC.  Case management and care coordination;
DD.  Language interpretation and translation for health care services, including sign 
language and Braille or other services needed for individuals with communication 
barriers; and
EE.  Those health care and long-term supportive services covered under the laws of 
this State for persons receiving medical assistance from the State, including home and 
community-based services provided under the MaineCare program or funded by the 
State.
3.  Benefit expansion.  The Maine Health Care Board may expand health care benefits 
beyond the minimum benefits described in this section when expansion meets the intent of 
this chapter and when there are sufficient funds to cover the expansion.
4.  Cost sharing for the room and board portion of long-term care.  The Maine 
Health Care Board shall develop income and asset qualifications based on state medical 
assistance standards for covered benefits.  All health care services for long-term care in a 
skilled nursing facility or assisted living facility are fully covered but room and board costs 
may be charged to patients who do not meet income and asset qualifications.
5.  Exclusions.  The following health care services may be excluded from coverage by 
the Maine Health Care Plan:
A.  Health care services determined to have no medical benefit by the board;
B.  Treatments and procedures primarily for cosmetic purposes, unless:
(1)  Required to correct a congenital defect or restore or correct a part of the body 
that has been altered as a result of injury, disease or surgery; or
(2)  Determined to be medically necessary by a qualified, licensed health care 
provider in the Maine Health Care Plan; and
C.  Services of a health care provider or facility that is not licensed or accredited by the 
State, except for approved services provided to a resident of this State who is 
temporarily out of the State and for approved services provided to a resident of this 
State if the services of a health care provider or facility in the State are not available to 
provide those services.
§7505.  Patient care
1.  Primary care.  All patients are entitled to have a primary care provider and have 
access to care coordination.
2.  Referrals not required.  Referrals are not required for a patient to see a health care 
specialist.  If a patient sees a specialist and does not have a primary care provider, the Maine 
Health Care Plan may assist with choosing a primary care provider.
3.  Electronic registry.  The board may establish an electronic registry to assist patients 
in identifying appropriate providers.
§7506.  Maine Health Care Fund
1.  General provisions.  The board shall establish the Maine Health Care Fund to 
implement the Maine Health Care Plan and to receive premiums and other sources of 
revenue.  The fund must be administered by a director appointed by the Maine Health Care 
Board.
A.  All money collected, received and transferred according to this chapter must be 
deposited in the Maine Health Care Fund.
B.  Money deposited in the Maine Health Care Fund must be used to finance the Maine 
Health Care Plan.
C.  All claims for health care services rendered must be made to the Maine Health Care 
Fund.
D.  All payments made for health care services must be disbursed from the Maine 
Health Care Fund.
E.  Premiums and other revenues collected each year must be sufficient to cover that 
year's projected costs.
2.  Accounts.  The Maine Health Care Fund must have operating, capital and reserve 
accounts.
3.  Operating account.  The operating account in the Maine Health Care Fund 
comprises the accounts specified in this subsection.
A.  The medical services account must be used to provide for all medical services and 
benefits covered under the Maine Health Care Plan.
B.  The prevention account must be used to establish and maintain primary community 
prevention programs, including preventive screening tests.
C.  The plan administration, evaluation, planning and assessment account must be used 
to monitor and improve the plan's effectiveness and operations.  The board may 
establish grant programs including demonstration projects for this purpose.
D.  The training and development account must be used to incentivize the training and 
development of health care providers and the health care workforce needed to meet the 
health care needs of the population.
E.  The health service research account must be used to support research and innovation 
as determined by the Maine Health Care Board.
4.  Capital account.  The capital account in the Maine Health Care Fund must be used 
to pay for capital expenditures for institutional providers.
5.  Reserve account.  The Maine Health Care Plan must at all times hold in the reserve 
account an amount estimated in the aggregate to provide for the payment of all losses and 
claims for which the Maine Health Care Plan may be liable and to provide for the expense 
of adjustment or settlement of losses and claims.  Money currently held in reserve by state, 
city and county health programs must be transferred to the Maine Health Care Fund when 
the Maine Health Care Plan replaces those programs.  The board shall adopt rules to insure 
the Maine Health Care Plan against unforeseen expenditures or revenue shortfalls not 
covered by the reserve account.  The board may borrow money to cover temporary 
shortfalls.
§7507.  Revenue sources
1.  Maine Health Care Plan premium.  The Maine Health Care Board shall:
A.  Determine the aggregate cost of providing health care according to this chapter;
B.  Develop an equitable and affordable premium structure based on income, including 
unearned income, and a business health tax based on payroll;
C.  In consultation with the State Tax Assessor, develop an efficient means of collecting 
premiums and the business health tax developed under paragraph B;
D.  Coordinate with existing, ongoing funding sources from federal and state programs;
E.  Base the premium structure developed under paragraph B on ability to pay; and
F.  On or before January 15, 2022, submit to the Governor and the Legislature a report 
on the premium structure and business health tax developed under paragraph B to 
finance the Maine Health Care Plan.
2.  Federal receipts.  All federal funding received by the State, including the premium 
subsidies under the federal Affordable Care Act, is appropriated to the Maine Health Care 
Fund to be used to administer the Maine Health Care Plan under this chapter.  Federal 
funding that is received for implementing and administering the Maine Health Care Plan 
must be used to provide health care for residents of this State.
3.  Funds from outside sources.  Institutional providers operating under Maine Health 
Care Plan operating budgets may raise and expend funds from sources other than the Maine 
Health Care Plan including private donors.  Contributions to institutional providers in 
excess of $500,000 must be reported to the board.
4.  Governmental payments.  The Governor and, if required under federal law, the 
Commissioner of Health and Human Services and the Commissioner of Economic and 
Community Development shall seek all necessary waivers, exemptions, agreements and 
legislation so that all applicable federal payments to the State, including the premium tax 
credits under the federal Affordable Care Act, are paid directly to the Maine Health Care 
Fund.  When all required waivers, exemptions, agreements and legislation are obtained, the 
Maine Health Care Plan assumes responsibility for all health care benefits and health care 
services previously paid for with federal funds.  In obtaining the waivers, exemptions, 
agreements or legislation, the Governor and, if required, commissioners shall seek from the 
Federal Government a contribution for health care services in the State that reflects: 
medical inflation, the state gross domestic product, the size and age of the population of 
the State, the number of residents of the State living below the poverty level and the number 
of individuals in this State eligible for Medicare and services from the United States 
Department of Veterans Affairs and that does not decrease in relation to the federal 
contributions to other states as a result of the waivers, exemptions, agreements or savings 
from implementation of the Maine Health Care Plan.
5.  Federal preemption.  The board shall seek to secure a repeal or a waiver of any 
provision of federal law that preempts any provision of this chapter.  The Commissioner of 
Health and Human Services shall provide all necessary assistance.  In the application for 
an innovation waiver under Section 1332 of the federal Affordable Care Act, the board 
shall request to waive any provisions of the federal Social Security Act and any of the 
following provisions of the federal Affordable Care Act to the extent necessary to 
implement this Act:
A.  In 42 United States Code, Sections 18021 to 18024;
B.  In 42 United States Code, Sections 18031 to 18033;
C.  In 42 United States Code, Section 18071; and
D.  In 26 United States Code, Sections 36B and 5000A.
The request for a waiver of the federal Social Security Act must seek authorization for the 
Maine Health Care Plan to operate as a Medicare Advantage plan for eligible individuals.
In the event that a repeal or a waiver of law or regulations cannot be secured, the board 
shall adopt rules, or seek conforming state legislation or state plan amendments, consistent 
with federal law, in an effort to best fulfill the purposes of this chapter.
6.  Secondary to federal government programs.  The Maine Health Care Plan's 
responsibility for providing care is secondary to existing federal government programs for 
health care services to the extent that funding for these programs is not transferred to the 
Maine Health Care Fund or that the transfer is delayed beyond the date on which initial 
benefits are provided under the Maine Health Care Plan.
7.  No cost sharing.  Except as provided in section 7504, subsection 4, no deductible, 
copayment, coinsurance or other cost sharing may be imposed with respect to covered 
benefits.
§7508.  Subrogation
1.  Collateral source.  When other payers for health care have been terminated, health 
care costs must be collected from collateral sources whenever medical services provided to 
an individual are, or may be, covered services under a policy of insurance, or other 
collateral source available to that individual, or when the individual has a right of action 
for compensation permitted under law.
A.  As used in this section, "collateral source" includes:
(1)  Health insurance policies and the medical components of automobile, 
homeowner's and other forms of insurance;
(2)  Medical components of workers' compensation;
(3)  Pension plans;
(4)  Employer plans;
(5)  Employee benefit contracts;
(6)  Government benefit programs;
(7)  A judgment for damages for personal injury;
(8)  The state of last domicile for individuals moving to the State for medical care 
who have extraordinary medical needs; and
(9)  Any 3rd party who is or may be liable to an individual for health care services 
or costs.
B.  As used in this section, "collateral source" does not include:
(1)  A contract or plan that is subject to federal preemption; or
(2)  Any governmental unit, agency or service to the extent that subrogation is 
prohibited by law.  An entity described in paragraph A is not excluded from the 
obligations imposed by this section by virtue of a contract or relationship with a 
governmental unit, agency or service.
C.  The board shall negotiate waivers, seek federal legislation or make other 
arrangements to incorporate collateral sources into the Maine Health Care Plan.
2.  Notification.  When an individual who receives health care services under the 
Maine Health Care Plan is entitled to coverage, reimbursement, indemnity or other 
compensation from a collateral source, the individual shall notify the health care provider 
and provide information identifying the collateral source, the nature and extent of coverage 
or entitlement and other relevant information.  The health care provider shall forward this 
information to the board.  The individual entitled to coverage, reimbursement, indemnity 
or other compensation from a collateral source shall provide additional information as 
requested by the board.
3.  Reimbursement.  The Maine Health Care Board shall seek reimbursement from 
the collateral source for services provided to the individual and may institute appropriate 
action, including legal proceedings, to recover the reimbursement.  Upon demand, the 
collateral source shall pay to the Maine Health Care Fund the sums it would have paid or 
expended on behalf of the individual for the health care services provided by the Maine 
Health Care Plan.
A.  In addition to any other right to recovery provided in this section, the board has the 
same right to recover the reasonable value of health care benefits from a collateral 
source as provided to the Commissioner of Health and Human Services.
B.  If a collateral source is exempt from subrogation or the obligation to reimburse the 
Maine Health Care Plan, the board may require that an individual who is entitled to 
medical services from the source first seek those services from that source before 
seeking those services from the Maine Health Care Plan.
C.  To the extent permitted by federal law, the board has the same right of subrogation 
over contractual retiree health care benefits provided by employers as other contracts, 
allowing the Maine Health Care Plan to recover the cost of health care services 
provided to individuals covered by the retiree benefits, unless arrangements are made 
to transfer the revenues of the health care benefits directly to the Maine Health Care 
Fund.
4.  Defaults, underpayments and late payments.  Default, underpayment or late 
payment of any tax or other obligation imposed by this chapter results in the remedies and 
penalties provided by law, except as provided in this section.  Eligibility for health care 
benefits under this chapter may not be impaired by any default, underpayment or late 
payment of any premium or other obligation imposed by this chapter.
§7509.  Provider payments
1.  General provisions.  All health care providers licensed to practice in this State, and 
other providers as determined by the board, may participate in the Maine Health Care Plan.  
A participating health care provider shall comply with all federal laws and regulations 
governing referral fees and fee splitting, including, but not limited to, 42 United States 
Code, Sections 1320a-7b and 1395nn, whether reimbursed by federal funds or not.  A fee 
schedule or financial incentive may not adversely affect the care a patient receives or the 
care a health care provider recommends.
2.  Payments to noninstitutional providers.  The Maine Health Care Board shall 
establish and oversee a fair and efficient payment system for noninstitutional providers in 
accordance with this subsection.
A.  The board shall pay noninstitutional providers based on rates negotiated with 
providers.  Rates must take into account the need to address provider shortages.
B.  The board shall establish payment criteria and methods of payment for care 
coordination for patients, especially those with chronic illness and complex medical 
needs.
C.  Providers who accept any payment from the Maine Health Care Plan for a covered 
health care service may not bill the patient for the covered health care service.
D.  Providers must be paid within 30 business days for claims filed following 
procedures established by the board.
3.  Payments to institutional providers.  The board shall set annual budgets for 
institutional providers.  These budgets must consist of an operating and a capital budget.  
An institution's annual budget must be set to cover its anticipated health care services for 
the next year based on past performance and projected changes in prices and health care 
service levels.  The annual budget for each individual institutional provider must be set 
separately.  The board may not set a joint budget for a group of more than one institutional 
provider nor for a parent corporation that owns or operates one or more institutional 
providers.
4.  No balance billing.  Providers who accept any payment from the Maine Health 
Care Plan for a covered health care service may not bill the patient for the covered health 
care service.
5.  Capital investment plan.  The board shall periodically develop a capital investment 
plan that will serve as a guide in determining the annual budgets of institutional providers 
and in deciding whether to approve applications for approval of capital expenditures by 
noninstitutional providers.  Providers who propose to make capital purchases in excess of 
$500,000 must obtain board approval.  The board may alter the threshold expenditure level 
that triggers the requirement to submit information on capital expenditures.  Institutional 
providers shall propose these expenditures and submit the required information as part of 
the annual budget they submit to the board.  Noninstitutional providers shall submit 
applications for approval of these expenditures to the board.  The board shall respond to 
capital expenditure applications in a timely manner.
§7510.  Maine Health Care Board
1.  Establishment.  The Maine Health Care Board is established to promote the 
delivery of high-quality, coordinated health care services that enhance health; prevent 
illness, disease and disability; slow the progression of chronic diseases; and improve 
personal health management.  The board shall administer the Maine Health Care Plan.
2.  Board composition.  The board consists of 17 members, appointed by the Governor 
subject to review by the joint standing committee of the Legislature having jurisdiction 
over health coverage matters and to confirmation by the Legislature, as follows:
A.  Five patient members and 5 employer members; and
B.  Seven providers that include 3 physicians, at least one of whom must be a primary 
care physician, one registered nurse, one mental health provider, one dentist and one 
health care facility director.
3.  Term and compensation; selection of chair.  Board members serve 4-year terms.  
Board members shall set the board's compensation at an amount not to exceed the 
compensation of Public Utilities Commission members.  The board shall select the chair 
from its membership.
4.  General duties.  The board shall:
A.  Ensure that all of the requirements of this chapter are met;
B.  Hire a chief executive officer for the Maine Health Care Plan to administer all 
aspects of the plan as directed by the board;
C.  Hire a director for the Maine Health Care Fund;
D.  Conduct necessary investigations and inquiries and require the submission of 
information, documents and records the board considers necessary to carry out the 
purposes of this chapter;
E.  Establish a process for the board to receive the concerns, opinions, ideas and 
recommendations of the public regarding all aspects of the Maine Health Care Plan and 
establish the means of addressing those concerns;
F.  Establish regional planning boards to assist the board in carrying out its duties;
G.  Establish an ombudsman position to represent the interests of consumers of health 
care and to advocate on behalf of consumers;
H.  Establish a grievance process for complaints by enrollees in the Maine Health Care 
Plan;
I.  Conduct activities the board considers necessary to carry out the purposes of this 
chapter;
J.  Collaborate with the Maine Health Data Organization and the Maine Quality Forum 
to assist the board in carrying out the purposes of this chapter;
K.  Collaborate with the agencies that license health care facilities to ensure that facility 
performance is monitored and that deficient practices are recognized and corrected in 
a timely manner;
L.  Adopt rules as necessary to carry out the duties assigned under this chapter;
M.  Establish conflict-of-interest standards prohibiting providers from any financial 
benefit from their medical decisions outside of board reimbursement;
N.  Establish conflict-of-interest standards related to pharmaceutical marketing to 
providers;
O.  Require that all electronic health records used by providers be fully interoperable 
with the open-source electronic health records system used by the United States 
Department of Veterans Affairs; 
P.  Develop and implement a displaced worker support program to provide financial 
help and assistance in retraining and job placement to the state workers who may be 
displaced because of the administrative efficiencies of the Maine Health Care Plan.  To 
alleviate staffing displacements in the medical field, the displaced worker support 
program must emphasize retraining and placement into health care-related positions if 
appropriate.  As residents of this State, all displaced workers must be covered under 
the Maine Health Care Plan; and
Q.  Develop and implement a program to negotiate prices paid by the Maine Health 
Care Plan for covered pharmaceuticals, medical supplies, including biological 
products, and medically necessary assistive equipment at the lowest possible cost on 
an annual basis.
5.  Waiver request duties.  Before submitting an application for an innovation waiver 
under Section 1332 of the federal Affordable Care Act, the board shall do the following, as 
required by federal law:
A.  Conduct or contract for any necessary actuarial analyses and actuarial certifications 
needed to support the board's estimates that the waiver will comply with the 
comprehensive coverage, affordability and scope of coverage requirements in federal 
law;
B.  Conduct or contract for any necessary economic analyses needed to support the 
board's estimates that the waiver will comply with the comprehensive coverage, 
affordability, scope of coverage and federal deficit requirements in federal law.  These 
analyses must include:
(1)  A detailed 10-year budget plan; and
(2)  A detailed analysis regarding the estimated impact of the waiver on health 
insurance coverage in the State;
C.  Establish a detailed draft implementation timeline for the waiver; and
D.  Establish quarterly, annual and cumulative targets for the comprehensive coverage, 
affordability, scope of coverage and federal deficit requirements in federal law.
6.  Financial duties.  The board shall:
A.  Establish and collect premiums and the business health tax according to this 
chapter;
B.  Approve statewide and regional budgets that include budgets for accounts in 
accordance with this chapter;
C.  Negotiate and establish payment rates for providers;
D.  Monitor compliance with all budgets and payment rates;
E.  Pay claims for medical products or services as negotiated, and may issue requests 
for proposals from state nonprofit business corporations for a contract to process 
claims;
F.  Seek federal approval to bill other states for health care coverage provided to 
residents from out of the State who come to the State for long-term care or other costly 
treatment when the resident's home state fails to provide such coverage, unless a 
reciprocal agreement with those states to provide similar coverage to residents of this 
State relocating to those states is negotiated;
G.  Administer the Maine Health Care Fund;
H.  Annually determine the appropriate level for the Maine Health Care Plan reserve 
account under section 7506, subsection 5 and implement policies needed to establish 
the appropriate reserve;
I.  Implement fraud prevention measures necessary to protect the operation of the 
Maine Health Care Plan; and
J.  Work to ensure appropriate cost control by:
(1)  Instituting aggressive public health measures, early intervention and preventive 
care, health and wellness education and promotion of personal health 
improvement;
(2)  Making changes in the delivery of health care services and administration that 
improve efficiency and care quality;
(3)  Minimizing administrative costs;
(4)  Ensuring that the delivery system does not contain excess capacity; and
(5)  Negotiating the lowest possible prices for prescription drugs, medical 
equipment and medical services.
If the board determines that there will be a revenue shortfall despite the cost control 
measures mentioned in paragraph J, the board shall implement measures to correct the 
shortfall, including an increase in premiums and other revenues.  The board shall report to 
the Legislature on the causes of the shortfall, reasons for the inadequacy of cost controls 
and measures taken to correct the shortfall.
7.  Management duties.  The board shall:
A.  Develop and implement enrollment procedures for the Maine Health Care Plan;
B.  Implement eligibility standards for the Maine Health Care Plan;
C.  Arrange for health care to be provided at convenient locations, including ensuring 
the availability of school nurses so that all students have access to health care, 
immunizations and preventive care at public schools and encouraging providers to 
open small health clinics at larger workplaces and retail centers;
D.  Establish an electronic claims and payments system for the Maine Health Care 
Plan;
E.  Monitor the operation of the Maine Health Care Plan through consumer surveys 
and regular data collection and evaluation activities, including evaluations of the 
adequacy and quality of services furnished under the plan, the need for changes in the 
benefit package, the cost of each type of service and the effectiveness of cost control 
measures under the plan;
F.  Disseminate information and establish a publicly accessible health care website to 
provide information to the public about the Maine Health Care Plan;
G.  Collaborate with public health agencies, schools and community clinics;
H.  Ensure that Maine Health Care Plan policies and providers, including public health 
providers, support all residents of this State in achieving and maintaining optimum 
physical and mental health; and
I.  Annually report to the joint standing committee of the Legislature having jurisdiction 
over health coverage matters on the performance of the Maine Health Care Plan, the 
fund's fiscal condition and need for payment adjustments, recommendations for 
statutory changes, receipt of revenue from all sources, whether current year goals and 
priorities are met, future goals and priorities, major new technology or prescription 
drugs and other circumstances that may affect the cost or quality of health care.
8.  Policy duties.  The board shall:
A.  Develop and implement cost control and quality assurance procedures;
B.  Implement policies to ensure strong public health services including education and 
community-based preventive health care and clinical services;
C.  Implement policies to ensure a continuum of coordinated high-quality primary to 
tertiary care to all residents of this State; and
D.  Implement policies to ensure that all residents of this State receive culturally and 
linguistically competent care.
9.  Self-insurance.  The board shall determine the feasibility of self-insuring providers 
for malpractice and shall establish a self-insurance system and create a special fund for 
payment of losses incurred if the board determines self-insuring providers would reduce 
costs.
10.  Audit.  The Maine Health Care Plan must be audited annually by the State Auditor.  
The board may, in its discretion, arrange for an independent audit to be conducted.  A copy 
of the audit must be provided to the State Controller, to the joint standing committee of the 
Legislature having jurisdiction over appropriations and financial affairs and to the joint 
standing committee of the Legislature having jurisdiction over health coverage matters.
§7511.  Implementation
The Maine Health Care Plan must be operational beginning January 1, 2024.  
Beginning on the date the Maine Health Care Plan becomes operational, a health care plan 
may not be sold in this State for services provided by the Maine Health Care Plan.
SUMMARY
This bill establishes the Maine Health Care Plan to provide universal health care 
coverage to all residents of this State.  The bill is modeled on proposed legislation 
considered in Minnesota.