SP0537, LD 1453, item 1, An Act To Increase the Transparency of Charges and Expenses of Hospitals That Receive State Funding

An Act To Increase the Transparency of Charges and Expenses of Hospitals That Receive State Funding

Be it enacted by the People of the State of Maine as follows:

PART A

Sec. A-1. 22 MRSA §8712, sub-§5 is enacted to read:

5. Hospital financial data; transparency. The organization shall promote public transparency of hospital financial data and shall collect, synthesize, analyze and publish this data and reports by January 1, 2014 and annually thereafter in a format that is easily understood by the average consumer and in a format that allows consumers to compare hospital pricing so they can make informed choices in obtaining health care. The organization shall contract with an independent entity with no financial interest in or affiliation with any hospital in this State or any insurance carrier to analyze the financial data of hospitals reported to the organization pursuant to this chapter and to prepare the reports and analysis required by this subsection.

Sec. A-2. 24-A MRSA §2736, sub-§5 is enacted to read:

5. Additional information. For filings made on or after January 1, 2014, when determining whether a filing meets the requirements that rates not be excessive, inadequate or unfairly discriminatory, the superintendent shall consider information and reports related to hospital finances published by the Maine Health Data Organization pursuant to Title 22, section 8712, subsection 5.

PART B

Sec. B-1. Commission established. Notwithstanding Joint Rule 353, the Commission to Study Transparency, Costs and Accountability of Health Care System Financing, referred to in this Part as "the commission," is established.

1. Membership. The commission consists of 11 members appointed as follows. The membership of the commission must reflect the geographic diversity of the State. The President of the Senate shall appoint the chair from among the membership. Members serve as volunteers and without compensation or reimbursement for expenses. The membership consists of the following persons:

A. 5 members appointed by the President of the Senate as follows:

1. One person representing community hospitals chosen from a list submitted by a statewide association representing hospitals;

2. One person representing physicians chosen from lists submitted by statewide associations representing allopathic and osteopathic physicians;

3. One person who has expertise in public health issues and who is not affiliated with a hospital or a practicing physician;

4. One person representing insurers or other 3rd-party payors of health care services; and

5. One person who is a health law attorney or who has expertise in health analytics;

B. Five members appointed by the Speaker of the House as follows:

1. One person who is knowledgeable about hospital finances who is not currently associated with a hospital;

2. One person representing physicians in current clinical practice chosen from lists submitted by statewide associations representing allopathic and osteopathic physicians;

3. One person representing consumers of health care services;

4. One person representing self-insured employers; and

5. One economist familiar with econometric modeling of health care systems and the analysis and forecasting of health care costs; and

C. The Commissioner of Health and Human Services, or the commissioner's designee, ex officio.

2. Appointments; convening. All appointments must be made no later than 30 days following the effective date of this section. The appointing authorities shall notify the Executive Director of the Legislative Council once all appointments have been completed. When the appointment of all members has been completed, the chair shall call and convene the first meeting of the commission. If 30 days or more after the effective date of this section a majority of but not all appointments have been made, the chair may request authority and the Legislative Council may grant authority for the commission to meet and conduct its business.

3. Duties. The commission shall:

A. Review and evaluate the current data reported by hospitals and other health care facilities in the State pursuant to state and federal law relating to charges, costs of providing services, revenue and other financial data and make recommendations for standardizing financial reporting to enhance transparency to the public of health care costs, including the standardized accounting template used by the Maine Health Data Organization in accordance with the Maine Revised Statutes, Title 22, section 8709, subsection 1-A, and make recommendations for changes and modifications to the template so that hospitals and other health care facilities publicly report charges, negotiated rates for public and private payors, advertising fees, lobbying expenses, administrative costs and other expenses in a transparent manner;

B. Review and evaluate methods to reduce health care costs and the rate of increase in overall health care spending, including, but not limited to, the development of global budgets, accountable care organizations and other potential cost containment mechanisms, and make recommendations relating to these methods;

C. Hold at least 3 public hearings to collect information from individuals, hospitals, health care providers, insurers, 3rd-party payors, government-sponsored health care programs and interested organizations;

D. Consult with experts in the fields of health care and hospitals and public policy; and

E. Examine any other issues to further the purposes of the study.

4. Staff assistance. The Legislative Council shall provide staffing services to the commission except that the Legislative Council staff support is not authorized when the Legislature is in regular or special session. The commission may invite the Department of Health and Human Services, the Maine Health Data Organization, the Department of Professional and Financial Regulation, Bureau of Insurance and other agencies of State Government to provide additional staff support or assistance to the commission. In addition, the commission may contract for administrative, professional and clerical services if funding permits.

5. Report. The commission shall submit a report and any suggested legislation for presentation to the Joint Standing Committee on Health and Human Services and the Joint Standing Committee on Insurance and Financial Services no later than December 4, 2013.

6. Data. The commission may solicit health care cost data and information from both the public and private sectors to help inform the commission's work, including, but not limited to, the data and information of the Department of Health and Human Services, the Maine Health Data Organization, a statewide health care management association, a statewide hospital association and a statewide public health association.

7. Outside funding for commission activities. The commission may seek outside funds to provide staff support and consulting or other services to carry out the duties and requirements of the commission. Contributions to support the work of the commission may not be accepted from any party having a pecuniary or other vested interest in the outcome of the matters being studied. A person, other than a state agency, desiring to make a financial or in-kind contribution shall certify to the Legislative Council that the person has no pecuniary or other vested interest in the outcome of the commission's activities. Such a certification must be made in the manner prescribed by the Legislative Council. All contributions are subject to approval by the Legislative Council. All funds accepted must be forwarded to the Executive Director of the Legislative Council along with an accounting record that includes the amount of the funds, the date the funds were received, from whom the funds were received and the purpose of and any limitation on the use of the funds. The Executive Director of the Legislative Council shall administer any funds received by the commission.

SUMMARY

Part A of this bill requires the Maine Health Data Organization to conduct an annual study of hospital financial data, to contract with an independent organization to analyze this data and to present the data and analysis in a format that is easily understood by the average consumer beginning in 2014. Part A also requires that the Department of Professional and Financial Regulation, Bureau of Insurance consider the analysis as part of the review process for health insurance rates.

Part B of the bill establishes the Commission to Study Transparency, Costs and Accountability of Health Care System Financing. The commission is comprised of 11 members appointed by the President of the Senate and Speaker of the House to evaluate current data reported by hospitals and health care facilities relating to charges, revenue and other financial data. The commission will make recommendations about how to standardize financial reporting about health care costs and the quality of health care services to enhance transparency to the public. The commission must also make recommendations to reduce health care costs, including the development of global budgets, accountable care organizations and other cost containment mechanisms.

SP0537 LD 1453	Session - 126th Maine Legislature		LR 2045 Item 1
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