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 Amendment CA_A_H993 (House)
Amends: 5 MRSA §12004, 22 MRSA §411, 22 MRSA §414

COMMITTEE AMENDMENT ,IJ,, to H.P. 1258, L.D. 1693, "An Act To Advance 
Health Equity, Improve the Well-being of All Maine People and Create a Health Trust" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Advance Health Equity and Improve the Well-being of All Maine People' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 5 MRSA §12004-1, sub-§48-A is enacted to read: 
48-A. 
Human 
Services 
Obesity Advisory Council 
Expenses/Legislative 
Per Diem for 
Nonsalaried 
Employee Members 
Sec. 2. 22 MRSA §411, sub-§6-A is enacted to read: 
22MRSA 
§1696-J 
6-A. 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. 
Sec. 3. 22 MRSA §411, sub-§10-A is enacted to read: 
10-A. 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. 
Sec. 4. 22 MRSA §411, sub-§10-B is enacted to read: 
10-B. Social group. "Social group" means a group of people in this State that share 
similar social, economic, demographic, geographic or other characteristics, including, but 
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COMMITTEE AMENDMENT/(,, to H.P. 1258, L.D. 1693 
not limited to, race, ethnicity, gender, gender identity, sexual orientation, class, zip code, 
age or disability. 
Sec. 5. 22 MRSA §411, sub-§11-A is enacted to read: 
11-A. 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. 
Sec. 6. 22 MRSA §414 is enacted to read: 
§414. Office of Population Health Equity 
1. Office established. The Office of Population Health Equity is established within 
the department. The office is staffed by at least one full-time employee. 
2. Purpose. The Office of Population Health Equity shall: 
A. Upon request, advise the commissioner, the 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 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 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, that 
includes information regarding health programs and services, outcomes and social 
determinants of health. 
Sec. 7. 22 MRSA c. 271, sub-c. 5 is enacted to read: 
SUBCHAPTER 5 
OBESITY ADVISORY COUNCIL 
§1696-J. Obesity Advisory Council 
1. Obesity Advisory Council established. The Obesity Advisory Council, referred to 
in this subchapter as "the advisory council," is established under Title 5, section 12004-I, 
subsection 48-A to review programs relating to the reduction of unhealthy weight and 
obesity. The advisory council shall provide advice to the department in carrying out its 
duties under this section and ensure coordination of the program with relevant nonprofit 
and community agencies and the Department of Education and other relevant state 
agencies. 
2. Membership. The advisory council consists of 9 members appointed as follows: 
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COMMITTEE AJvlENDMENT "~:P. 1258, L.D. 1693 
A. Two public health officials, appointed by the Governor; 
B. Two representatives of nonprofit organizations involved in seeking to reduce 
unhealthy weight and obesity, with one representative appointed by the President of 
the Senate and one representative appointed by the Speaker of the House of 
Representatives; 
C. A person who designs and implements issue-oriented public health media 
campaigns, appointed by the Governor; 
D. Two persons involved in designing and implementing community-based education 
programs for the prevention of unhealthy weight and obesity, one to focus on adults, 
appointed by the President of the Senate, and one to focus on youth, appointed by the 
Speaker of the House of Representatives; and 
E. Two members of the public, appointed jointly by the President of the Senate and the 
Speaker of the House of Representatives in consultation with the minority leaders of 
the Senate and the House. 
3. Appointments. Members serve for 3-year terms and may be reappointed. The 
appointing authority shall fill a vacancy on the advisory council for the remainder of the 
vacant term. 
4. Chair. The advisory council shall choose a chair from among its members and 
establish its procedure for reaching decisions. 
5. Quorum. A quorum is 5 members of the advisory council. 
6. Staff assistance. The department shall provide staff assistance to the advisory 
council. 
7. 
Compensation. Each member of the advisory council who is not a salaried 
employee is entitled to compensation as provided in Title 5, section 12004-I, subsection 
48-A following approval of expenses by the commissioner. 
Sec. 8. Obesity Advisory Council initial membership. Initial appointments to 
the Obesity Advisory Council established under the Maine Revised Statutes, Title 5, 
section 12004-I, subsection 48-A must be made by October 1, 2022. Notwithstanding Title 
22, section 1696-J, subsection 3, of the initial appointments, 5 members must be appointed 
for 2-year terms and 4 members for 3-year terms. When the appointment of all members 
is complete, the Governor or the Governor's designee shall convene the first meeting of the 
advisory council no later than November 1, 2022. 
Sec. 9. Obesity prevention standards in early care and education. The 
Department of Education and the Department of Health and Human Services shall adopt 
rules to revise their 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 
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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. 10. 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 its 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"; 
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 their public school free of 
charge. A student in a public school online learning program must be made 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. 
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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 the 
Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A. 
Sec. 11. 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 Coordinator in the Maine Center for Disease Control and Prevention. 
GENERAL FUND 
2021-22 
2022-23 
POSITIONS - LEGISLATIVE COUNT 
0.000 
1.000 
Personal Services 
$0 
$97,692 
All Other 
$0 
$6,537 
GENERAL FUND TOTAL 
$0 
$104,229 
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 
All Other 
GENERAL FUND TOTAL 
Maine Center for Disease Control and Prevention 0143 
2021-22 
$0 
$0 
Initiative: Appropriates funds for district public health improvement plans. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Office of Population Health Equity N365 
2021-22 
$0 
$0 
2022-23 
$151,000 
$151,000 
2022-23 
$900,000 
$900,000 
Initiative: Appropriates funds for one Public Service Manager II position to act as the 
Health Equity Coordinator in the Office of Population Health Equity. 
GENERAL FUND 
2021-22 
POSITIONS - LEGISLATIVE COUNT 
0.000 
Personal Services 
$0 
All Other 
$0 
GENERAL FUND TOTAL 
$0 
Office of Population Health Equity N365 
2022-23 
1.000 
$125,981 
$6,537 
$132,518 
Initiative: Appropriates funds to implement data collection and reporting in the Office of 
Population Health Equity. 
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GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2021-22 
$0 
$0 
2021-22 
$0 
$0 
2022-23 
$151,000 
$151,000 
2022-23 
$1,438,747 
$1,438,747 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment: 
1. Removes from the bill the provision establishing the Trust for a Healthy Maine and 
the Trust for a Healthy Maine Board; 
2. Changes the name of the proposed Office of Health Equity to the Office of 
Population Health Equity; 
3. Retains the definitions of "health equity," "social determinants of health," "social 
group" and "structural inequity" but applies them to the laws governing public health 
infrastructure, including the Office of Population Health Equity; 
4. Creates the Obesity Advisory Council within the Department of Health and Human 
Services; 
5. Removes from the bill the provision banning the sale of flavored tobacco products; 
6. Removes from the bill the provision that increases the cigarette tax; and 
7. Retains the standards regarding obesity prevention in early child care and education 
settings and in public schools. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 04/09/22 ~ae. 
LD 1693 
LR 1927(02) 
An Act To Advance Health Equity, Improve the Well-being of All Maine People and Create a Health 
Trust 
Fiscal Note for Bill as Amended by Committee Amendment# {/I- qq3) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
·Appropriations/Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY2021-22 
FY2022-23 
$0 
$1,438,747 
$0 
$1,438,747 
Projections 
FY2023-24 
$1,447,565 
$1,447,565 
Projections 
FY 2024-25 
$1,455,366 
$1,455,366 
The bill includes General Fund appropriations to the Department of Health and Human Services of $1,438,747 
_ beginning in fiscal year 2022-23 for one position to act as the Obesity Coordinator in the Maine Center for Disease 
. Control and Prevention, evidence-based programming relating to the reduction of unhealthy weight and obesity, 
district public health improvement plans, one position to act as the Health Equity Coordinator in the Office of Health 
Equity and to implement data collection and reporting in the Office of Health Equity. 
This bill requires the Department of Education to adopt rules to revise its school nutrition and physical activity 
standards to increase obesity prevention in public schools. Of the proposed new standards, one requires the 
department to make all students, regardless of household income, eligible to receive a breakfast and lunch at the 
public school free of charge, including a student that is in a public school online learning program, contingent upon 
state funding being available. The total cost of this provision is estimated to be $36.9 million per year. Public Law 
2021, chapter 368, Part 0000 set aside $10,000,000 at the end of fiscal year 2020-21 for the cost of this provision to 
be used only if a waiver from the United States Department of Agriculture that allows for the provision of free meals 
to students during the 2022-2023 school year is not received. LD 1995, the Governor's proposed supplement budget, 
includes- a General Fund appropriation of $26.9 million in fiscal year 2022-23 to fully support the cost of the program. 
If approved by the Legislature, sufficient funds will be available to implement this program. Local school 
administrative UDits will need to develop a process for students in a public school online learning program to receive 
the free meals. 
According to the Department of Education, there is currently no funding available to provide ldtchen equipment grants 
for upgrades, repairs and maintenance or for developing and providing technical assistance and incentives for public 
schools to meet nutrition standards that are more stringent than required under current law or rule.