An Act to Increase the Availability and Affordability of Health Care
Maine Legislature, Session 132, LD 0743
Committee: Health Coverage, Insurance and Financial Services
Sponsors: LIBBY, HAGGAN
Amends: 22 MRSA §1708, 22 MRSA §1714-A, 22 MRSA §1715, 22 MRSA §1831, 22 MRSA §2061, 24-A MRSA §4203, 24-A MRSA §4204, 24-A MRSA §4225, 24-A MRSA §4303-F, 24-A MRSA §6203, 24-A MRSA §6226, 24-A MRSA §6951, 35-A MRSA §10122, 38 MRSA §1310-X

Legislative Document
No. 743
H.P. 485
House of Representatives, February 25, 2025
An Act to Increase the Availability and Affordability of Health Care 
by Eliminating Certificate of Need Requirements
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative LIBBY of Auburn.
Cosponsored by Senator HAGGAN of Penobscot and
Representatives: BOYER of Poland, FOLEY of Wells, NUTTING of Oakland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA c. 103-A, as amended, is repealed.
Sec. 2.  22 MRSA §1708, sub-§3, ¶D, as amended by PL 2013, c. 594, §1, is further 
amended to read:
D.  Ensure that any calculation of an occupancy percentage or other basis for adjusting 
the rate of reimbursement for nursing facility services to reduce the amount paid in 
response to a decrease in the number of residents in the facility or the percentage of the 
facility's occupied beds excludes all beds that the facility has removed from service for 
all or part of the relevant fiscal period in accordance with section 333. If the excluded 
beds are converted to residential care beds or another program for which the department 
provides reimbursement, nothing in this paragraph precludes the department from 
including those beds for purposes of any occupancy standard applicable to the 
residential care or other program pursuant to duly adopted rules of the department;
Sec. 3.  22 MRSA §1714-A, sub-§4, ¶C, as amended by PL 2011, c. 687, §8, is 
further amended to read:
C.  The department shall provide in a letter written notice of the requirements of this 
section to the transferee in a letter acknowledging receipt of a request for a certificate 
of need or waiver of the certificate of need for the case of a nursing home or hospital 
transfer or in response to a request for an application for a license to operate a boarding 
home or to provide other health care services.
Sec. 4.  22 MRSA §1715, sub-§1, ¶A, as amended by PL 2017, c. 475, Pt. A, §29, 
is further amended to read:
A.  Is either a direct provider of major ambulatory service, as defined in former section 
382, subsection 8‑A, or is or has been required to obtain a certificate of need under 
section 329 or former section 304 or 304-A;
Sec. 5.  22 MRSA §1831, sub-§1, as amended by PL 2013, c. 214, §1, is further 
amended to read:
1.  Provision of information.  In order to provide for informed patient or resident 
decisions, a hospital or nursing facility shall provide a standardized list of licensed 
providers of care and services and available physicians for all patients or residents prior to 
discharge for whom home health care, hospice care, acute rehabilitation care, a hospital 
swing bed as defined in section 328, subsection 15 or nursing care is needed. The list must 
include a clear and conspicuous notice of the rights of the patient or resident regarding 
choice of providers.
A.  For all patients or residents requiring home health care or hospice care, the list must 
include all licensed home health care and hospice providers that request to be listed 
and any branch offices, including addresses and phone numbers, that serve the area in 
which the patient or resident resides.
B.  For all patients or residents requiring nursing facility care or a hospital swing bed, 
the list must include all appropriate facilities that request to be listed that serve the area 
in which the patient or resident resides or wishes to reside and the physicians available 
within those facilities that request to be listed.
C.  The hospital or nursing facility shall disclose to the patient or resident any direct or 
indirect financial interest the hospital or nursing facility has in the nursing facility or 
home health care provider.
Sec. 6.  22 MRSA §2061, sub-§2, as amended by PL 2011, c. 90, Pt. J, §19, is 
further amended to read:
2.  Review.  Each project for a health care facility has been reviewed and approved to 
the extent required by the agency of the State that serves as the designated planning agency 
of the State or by the Department of Health and Human Services in accordance with the 
provisions of the Maine Certificate of Need Act of 2002, as amended;
Sec. 7.  24-A MRSA §4203, sub-§1, as amended by PL 2003, c. 510, Pt. A, §19, is 
further amended to read:
1.   Subject to the Maine Certificate of Need Act of 2002, a A person may apply to the 
superintendent for and obtain a certificate of authority to establish, maintain, own, merge 
with, organize or operate a health maintenance organization in compliance with this 
chapter. A person may not establish, maintain, own, merge with, organize or operate a 
health maintenance organization in this State either directly as a division or a line of 
business or indirectly through a subsidiary or affiliate, nor sell or offer to sell, or solicit 
offers to purchase or receive advance or periodic consideration in conjunction with, a health 
maintenance organization without obtaining a certificate of authority under this chapter.
Sec. 8.  24-A MRSA §4204, sub-§1, as corrected by RR 2021, c. 1, Pt. B, §342, is 
repealed.
Sec. 9.  24-A MRSA §4204, sub-§2-A, as amended by PL 2013, c. 588, Pt. A, §29, 
is further amended to read:
2-A.   The superintendent shall issue or deny a certificate of authority to any person 
filing an application pursuant to section 4203 within 50 business days of receipt of the 
notice from the Department of Health and Human Services that the applicant has been 
granted a certificate of need or, if a certificate of need is not required, within 50 business 
days of receipt of notice from the Department of Health and Human Services that the 
applicant is in compliance with the requirements of paragraph B. Issuance of a certificate 
of authority shall must be granted upon payment of the application fee prescribed in section 
4220 if the superintendent is satisfied that the following conditions are met.:
A.  The Commissioner of Health and Human Services certifies that the health 
maintenance organization has received a certificate of need or that a certificate of need 
is not required pursuant to Title 22, chapter 103‑A.
B.  If the The Commissioner of Health and Human Services has determined that a 
certificate of need is not required, the commissioner makes a determination and 
provides a certification to the superintendent that the following requirements have been 
met.:
(4)  The health maintenance organization must establish and maintain procedures 
to ensure that the health care services provided to enrollees are rendered under 
reasonable standards of quality of care consistent with prevailing professionally 
recognized standards of medical practice. These procedures must include 
mechanisms to ensure availability, accessibility and continuity of care.;
(5)  The health maintenance organization must have an ongoing internal quality 
assurance program to monitor and evaluate its health care services including 
primary and specialist physician services, ancillary and preventive health care 
services across all institutional and noninstitutional settings. The program must 
include, at a minimum, the following:
(a)  A written statement of goals and objectives that emphasizes improved 
health outcomes in evaluating the quality of care rendered to enrollees;
(b)  A written quality assurance plan that describes the following:
(i)  The health maintenance organization's scope and purpose in quality 
assurance;
(ii)  The organizational structure responsible for quality assurance 
activities;
(iii)  Contractual arrangements, in appropriate instances, for delegation of 
quality assurance activities;
(iv)  Confidentiality policies and procedures;
(v)  A system of ongoing evaluation activities;
(vi)  A system of focused evaluation activities;
(vii)  A system for reviewing and evaluating provider credentials for 
acceptance and performing peer review activities; and
(viii)  Duties and responsibilities of the designated physician supervising 
the quality assurance activities;
(c)  A written statement describing the system of ongoing quality assurance 
activities including:
(i)  Problem assessment, identification, selection and study;
(ii)  Corrective action, monitoring evaluation and reassessment; and
(iii)  Interpretation and analysis of patterns of care rendered to individual 
patients by individual providers;
(d)  A written statement describing the system of focused quality assurance 
activities based on representative samples of the enrolled population that 
identifies the method of topic selection, study, data collection, analysis, 
interpretation and report format; and
(e)  Written plans for taking appropriate corrective action whenever, as 
determined by the quality assurance program, inappropriate or substandard 
services have been provided or services that should have been furnished have 
not been provided.;
(6)  The health maintenance organization shall must record proceedings of formal 
quality assurance program activities and maintain documentation in a confidential 
manner.  Quality assurance program minutes must be available to the 
Commissioner of Health and Human Services.;
(7)  The health maintenance organization shall must ensure the use and 
maintenance of an adequate patient record system that facilitates documentation 
and retrieval of clinical information to permit evaluation by the health maintenance 
organization of the continuity and coordination of patient care and the assessment 
of the quality of health and medical care provided to enrollees.;
(8)  Enrollee clinical records must be available to the Commissioner of Health and 
Human Services or an authorized designee for examination and review to ascertain 
compliance with this section, or as considered necessary by the Commissioner of 
Health and Human Services.; and
(9)  The health maintenance organization must establish a mechanism for periodic 
reporting of quality assurance program activities to the governing body, providers 
and appropriate health maintenance organization staff.
The Commissioner of Health and Human Services shall make the certification required 
by this paragraph within 60 days of the date of the written decision that a certificate of 
need was not required. If the commissioner Commissioner of Health and Human 
Services certifies that the health maintenance organization does not meet all of the 
requirements of this paragraph, the commissioner shall specify in what respects the 
health maintenance organization is deficient.;
C.  The health maintenance organization conforms to the definition under section 
4202‑A, subsection 10.;
D.  The health maintenance organization is financially responsible, complies with the 
minimum surplus requirements of section 4204‑A and, among other factors, can 
reasonably be expected to meet its obligations to enrollees and prospective enrollees.
(1)  In a determination of minimum surplus requirements, the following terms have 
the following meanings.
(a)  "Admitted assets" means assets recognized by the superintendent pursuant 
to section 901‑A.  For purposes of this chapter, the asset value is that contained 
in the annual statement of the corporation as of December 31st of the year 
preceding the making of the investment or contained in any audited financial 
report, as defined in section 221‑A, of more current origin.
(b)  "Reserves" means those reserves held by corporations subject to this 
chapter for the protection of subscribers.  For purposes of this chapter, the 
reserve value is that contained in the annual statement of the corporation as of 
December 31st of the preceding year or any audited financial report, as defined 
in section 221‑A, of more current origin.
(2)  In making the determination whether the health maintenance organization is 
financially responsible, the superintendent may also consider:
(a)  The financial soundness of the health maintenance organization's 
arrangements for health care services and the schedule of charges used;
(b)  The adequacy of working capital;
(c)  Any agreement with an insurer, a nonprofit hospital or medical service 
corporation, a government or any other organization for insuring or providing 
the payment of the cost of health care services or the provision for automatic 
applicability of an alternative coverage in the event of discontinuance of the 
plan;
(d)  Any agreement with providers for the provision of health care services that 
contains a covenant consistent with subsection 6; and
(e)  Any arrangements for insurance coverage or an adequate plan for self-
insurance to respond to claims for injuries arising out of the furnishing of 
health care services.;
E.  The enrollees are afforded an opportunity to participate in matters of policy and 
operation pursuant to section 4206.;
F.  Nothing in the proposed method of operation, as shown by the information 
submitted pursuant to section 4203 or by independent investigation, is contrary to the 
public interest.;
G.  Any director, officer, employee or partner of a health maintenance organization 
who receives, collects, disburses or invests funds in connection with the activities of 
that organization shall be is responsible for those funds in a fiduciary relationship to 
the organization.;
H.  The health maintenance organization shall maintain maintains in force a fidelity 
bond or fidelity insurance on those employees and officers of the health maintenance 
organization who have duties as described in paragraph G, in an amount not less than 
$250,000 for each health maintenance organization or a maximum of $5,000,000 in 
aggregate maintained on behalf of health maintenance organizations owned by a 
common parent corporation, or such sum as may be prescribed by the superintendent.;
I.  If any agreement, as set forth in paragraph D, subparagraph (2), division (c), is made 
by the health maintenance organization, the entity executing the agreement with the 
health 
maintenance 
organization 
must 
demonstrate 
demonstrates 
to 
the 
superintendent's satisfaction that the entity has sufficient unencumbered surplus funds 
to cover the assured payments under the agreement, otherwise the superintendent shall 
disallow may not allow the agreement.  In considering approval of such an agreement, 
the superintendent shall consider the entity's record of earnings for the most recent 3 
years, the risk characteristics of its investments and whether its investments and other 
assets are reasonably liquid and available to make payments for health care services.;
K.  The health maintenance organization provides a spectrum of providers and services 
that meet patient demand.;
L.  The health maintenance organization meets the requirements of section 4303, 
subsection 1.;
M.  The health maintenance organization demonstrates a plan for providing services 
for rural and underserved populations and for developing relationships with essential 
community providers within the area of the proposed certificate.  The health 
maintenance organization must make an annual report to the superintendent regarding 
the plan.; and
O.  Each The health maintenance organization shall provide provides basic health care 
services.
The applicant shall furnish, upon request of the superintendent, any information necessary 
to make any determination required pursuant to this subsection.
Sec. 10.  24-A MRSA §4225, as corrected by RR 2021, c. 2, Pt. A, §79, is amended 
to read:
§4225.  Commissioner of Health and Human Services' authority to contract
The Commissioner of Health and Human Services, in carrying out the commissioner's 
obligations under section 4204, subsection 1, paragraph B; section 4215; and section 4216, 
subsection 1, may contract with qualified persons to make recommendations concerning 
the determinations required to be made by the commissioner. Such recommendations may 
be accepted in full or in part by the commissioner.
Sec. 11.  24-A MRSA §4303-F, sub-§1, ¶E, as amended by PL 2023, c. 591, §3, 
is further amended to read:
E.  A carrier may not require a ground ambulance service provider to obtain prior 
authorization before transporting an enrollee to a hospital, between hospitals or from a 
hospital to a nursing home, hospice care facility or other health care facility, as defined 
in Title 22, section 328, subsection 8.  A carrier may not require an air ambulance 
service provider to obtain prior authorization before transporting an enrollee to a 
hospital or between hospitals for urgent care. For the purposes of this paragraph, the 
following terms have the following meanings.
(1)  "Ambulatory surgical facility" means a facility, not part of a hospital, that 
provides surgical treatment to patients not requiring hospitalization. "Ambulatory 
surgical facility" does not include the offices of private physicians or dentists, 
whether in individual or group practice.
(2)  "Health care facility" means a hospital, psychiatric hospital, nursing facility, 
kidney disease treatment center including a freestanding hemodialysis facility, 
rehabilitation facility, ambulatory surgical facility, independent radiological 
service center, independent cardiac catheterization center or cancer treatment 
center. "Health care facility" does not include the office of a private health care 
practitioner, as defined in Title 24, section 2502, subsection 1‑A, whether in 
individual or group practice. In an ambulatory surgical facility that functions also 
as the office of a health care practitioner, the following portions of the ambulatory 
surgical facility are considered to be a health care facility:
(a)  Operating rooms;
(b)  Recovery rooms;
(c)  Waiting areas for ambulatory surgical facility patients;
(d)  Any space with major medical equipment; and
(e)  Any other space used primarily to support the activities of the ambulatory 
surgical facility.
(3)  "Health services" means clinically related services that are diagnostic, 
treatment, rehabilitative services or nursing services provided by a nursing facility.  
"Health services" includes alcohol or drug dependence, substance use disorder and 
mental health services.
(4)  "Hospital" means an institution that primarily provides to inpatients, by or 
under the supervision of physicians, diagnostic services and therapeutic services 
for medical diagnosis, treatment and care of persons who are injured, disabled or 
sick or rehabilitation services for the rehabilitation of persons who are injured, 
disabled or sick. "Hospital" also includes psychiatric and tuberculosis hospitals.
(5)  "Major medical equipment" means a single unit of medical equipment or a 
single system of components with related functions used to provide medical and 
other health services that costs $3,200,000 or more. "Major medical equipment" 
does not include medical equipment acquired by or on behalf of a clinical 
laboratory to provide clinical laboratory services if the clinical laboratory is 
independent of a physician's office and a hospital and has been determined to meet 
the requirements of the United States Social Security Act, Title XVIII, Section 
1861(s)(10 and 11). In determining whether medical equipment costs more than 
the threshold provided in this subparagraph, the cost of studies, surveys, designs, 
plans, working drawings, specifications and other activities essential to acquiring 
the equipment must be included. If the equipment is acquired for less than fair 
market value, the cost includes the fair market value. The threshold amount for 
review must be updated by the commissioner to reflect the change in the Consumer 
Price Index for medical care services as reported by the United States Department 
of Labor, Bureau of Labor Statistics, with an effective date of January 1st each 
year.
(6)  "Nursing facility" means any facility defined under section 1812‑A.
(7)  "Rehabilitation facility" means an inpatient facility that is operated for the 
primary purpose of assisting in the rehabilitation of persons who are disabled 
through an integrated program of medical services and other services that are 
provided under competent professional supervision.
Sec. 12.  24-A MRSA §6203, sub-§1, ¶A, as amended by PL 2003, c. 510, Pt. A, 
§22, is further amended to read:
A.  The provider has submitted to the department an application for a certificate of 
need, if required under Title 22, section 329, and the department has submitted a 
preliminary report of a recommendation for approval of a certificate of need and the 
provider has applied for any other licenses or permits required prior to operation.
Sec. 13.  24-A MRSA §6203, sub-§1, ¶G, as enacted by PL 1995, c. 452, §11, is 
amended to read:
G.  The department has approved the adequacy of all services proposed under the 
continuing care agreement not otherwise reviewed under the certificate of need 
process.
Sec. 14.  24-A MRSA §6203, sub-§2, as amended by PL 1995, c. 452, §§12 to 16, 
is further amended to read:
2.  Final certificate of authority.  The superintendent shall issue a final certificate of 
authority, subject to annual renewal, when:
A.  The provider has obtained any required certificate of need or other permits or 
licenses required prior to construction of the facility;
C.  The superintendent is satisfied that the provider has demonstrated that it is 
financially responsible and shall may reasonably be expected to meet its obligations to 
subscribers or prospective subscribers;
D.  The superintendent has determined that the provider's continuing care agreement 
meets the requirements of section 6206, subsection 3, and the rules promulgated in 
adopted under this chapter; and
G.  The provider certifies to the superintendent either:
(1)  That preliminary continuing care agreements have been entered and deposits 
of not less than 10% of the entrance fee have been received either:
(a)  From subscribers with respect to 70% of the residential units, including 
names and addresses of the subscribers, for which entrance fees will be 
charged; or
(b)  From subscribers with respect to 70% of the total entrance fees due or 
expected at full occupancy of the community; or
(2)  That preliminary continuing care agreements have been entered and deposits 
of not less than 25% of the entrance fee received from either:
(a)  Subscribers with respect to 60% of the residential units, including names 
and addresses of the subscribers, for which entrance fees will be charged; or
(b)  Subscribers with respect to 60% of the total entrance fees due or expected 
at full occupancy of the community.
Within 120 days after determining that the application to the superintendent and the 
department is complete, the superintendent shall issue or deny a final certificate of authority 
to the provider, unless a certificate of need is required, in which case the final certificate of 
authority shall be issued or denied in accordance with the certificate of need schedule.
Sec. 15.  24-A MRSA §6203, sub-§6, as amended by PL 2003, c. 155, §1, is further 
amended to read:
6.  Provision of services to nonresidents.  The final certificate of authority must state 
whether any skilled nursing facility that is part of a life-care community or a continuing 
care retirement community may provide services to persons who have not been bona fide 
residents of the community prior to admission to the skilled nursing facility.  If the life-
care community or the continuing care retirement community admits to its skilled nursing 
facility only persons who have been bona fide residents of the community prior to 
admission to the skilled nursing facility, then the community is exempt from the provisions 
of Title 22, chapter 103‑A, but is subject to the licensing provisions of Title 22, chapter 
405, and is entitled to only one skilled nursing facility bed for every 4 residential units in 
the community.  Any community exempted under Title 22, chapter 103‑A rules adopted by 
the department may admit nonresidents of the community to its skilled nursing facility only 
during the first 3 years of operation.  For purposes of this subsection, a "bona fide resident" 
means a person who has been a resident of the community for a period of not less than 180 
consecutive days immediately preceding admission to the nursing facility or has been a 
resident of the community for less than 180 consecutive days but who has been medically 
admitted to the nursing facility resulting from an illness or accident that occurred 
subsequent to residence in the community.  Any community exempted under Title 22, 
chapter 103‑A rules adopted by the department is not entitled to and may not seek any 
reimbursement or financial assistance under the MaineCare program from any state or 
federal agency and, as a consequence, that community must continue to provide nursing 
facility services to any person who has been admitted to the facility.
Notwithstanding this subsection, a life-care community that holds a final certificate of 
authority from the superintendent and that was operational on November 18, 2002 and that 
is barred from seeking reimbursement or financial assistance under the MaineCare program 
from a state or federal agency may continue to admit nonresidents of the community to its 
skilled nursing facility after its first 3 years of operation with the approval of the 
superintendent.  A life-care community that admits nonresidents to its skilled nursing 
facility as permitted under this subsection may continue to admit nonresidents after its first 
years of operation only for such period as approved by the superintendent after the 
superintendent's consideration of the financial impact on the life-care community and the 
impact on the contractual rights of subscribers of the community.
Sec. 16.  24-A MRSA §6226, as amended by PL 2003, c. 510, Pt. A, §23 is repealed.
Sec. 17.  24-A MRSA §6951, sub-§6, as enacted by PL 2003, c. 469, Pt. A, §8, is 
amended to read:
6.  Technology assessment.  The forum shall conduct technology assessment reviews 
to guide the use and distribution of new technologies in this State. The forum shall make 
recommendations to the certificate of need program under Title 22, chapter 103‑A.
Sec. 18.  35-A MRSA §10122, as enacted by PL 2011, c. 424, Pt. A, §6 and affected 
by Pt. E, §1, is amended to read:
§10122.  Health care facility program
The trust shall develop and implement a process to review projects undertaken by 
health care facilities that are directed solely at reducing energy costs through energy 
efficiency, renewable energy technology or smart grid technology and to certify those 
projects that are likely to be cost-effective.  If a project is certified as likely to be cost-
effective by the trust, the review process serves as an alternative to the certificate of need 
process established pursuant to Title 22, section 329, subsection 3.
Sec. 19.  38 MRSA §1310-X, sub-§4, ¶A, as amended by PL 2003, c. 551, §17, is 
further amended to read:
A.  A commercial biomedical waste disposal or treatment facility, if at least 51% of the 
facility is owned by a licensed hospital or hospitals as defined in Title 22, section 328, 
subsection 14 or a group of hospitals that are licensed under Title 22 acting through a 
statewide association of Maine hospitals or a wholly owned affiliate of the association; 
and
SUMMARY
Under current law, before introducing additional health care services and procedures 
in a market area, a person must apply for and receive a certificate of need from the 
Department of Health and Human Services. This bill eliminates that requirement by 
repealing the Maine Revised Statutes, Title 22, chapter 103-A, which includes sections 326 
to 350-C, and making statutory changes to other provisions of law for consistency with the 
repeal of chapter 103-A.