H.P. 1305 - L.D. 1848
An Act to Create the Consumer Health Care Division within the Bureau of Insurance
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 5 MRSA §12004-I, sub-§50-A is enacted to read:
Sec. 2. 24-A MRSA c. 56-A, as amended, is further amended by repealing the chapter headnote and enacting the following in its place:
CHAPTER 56-A
HEALTH PLAN IMPROVEMENT ACT
SUBCHAPTER I
HEALTH PLAN REQUIREMENTS
Sec. 3. 24-A MRSA c. 56-A, sub-c. II is enacted to read:
SUBCHAPTER II
CONSUMER HEALTH CARE DIVISION
§4321. Consumer Health Care Division
1. Division established. The Consumer Health Care Division, referred to in this section as the "division," is established within the Bureau of Insurance. The division shall work in coordination with other bureau sections and staff to accomplish the duties set forth in subsection 4.
2. Director. The Director of the Consumer Health Care Division, referred to in this section as the "director," is the head of the Consumer Health Care Division. The director is appointed by the superintendent in consultation with the Consumer Health Care Division Advisory Council and is subject to the approval of the Commissioner of Professional and Financial Regulation. The director is subject to the Civil Service Law.
3. Staff. The superintendent may hire or assign personnel as determined necessary to perform the duties of the division subject to the approval of the Commissioner of Professional and Financial Regulation and subject to the Civil Service Law. The personnel are supervised by the director in consultation with the superintendent. The qualifications of those personnel must reflect the needs and responsibilities relating to the division's duties under this subchapter.
4. Duties. The duties of the division include:
A. Providing access to the division through a toll-free number;
B. Providing information to consumers regarding health care plan options and obtaining health care coverage and services. The division may not make any specific recommendations regarding commercially offered products;
C. Assisting enrollees to understand their rights and responsibilities under health care plans;
D. Providing information to consumers on health care plan performance by distributing materials and utilizing existing resources relating to health care plan performance;
E. Providing assistance to enrollees with complaints relating to health care plans, when appropriate. The division may assist enrollees with quality-of-care complaints by coordinating with the appropriate state health professional licensing boards and other appropriate state and federal oversight bodies with authority over quality-of-care complaints. The division shall defer any issues of professional competence to the appropriate state health professional licensing boards;
F. Collecting and disseminating information regarding health care plans, quality assurance programs and quality improvement and coordinating information with other public entities or agencies involved in the delivery, funding or regulation of health care;
G. Acting as an information resource in the development of policies and programs that protect consumer interests and rights under health care plans by:
(1) Analyzing, evaluating and monitoring the development and implementation of federal, state and local laws, regulations, rules and other governmental policies and actions that pertain to the health, safety, welfare and rights of health care consumers; and
(2) Identifying practices and policies that may affect access to quality health care, including, but not limited to, practices relating to marketing of health care plans and accessibility of services and resources for under-served areas and vulnerable populations. The division may refer these issues to the appropriate state or federal regulatory agency with jurisdiction over these practices and policies;
H. Promoting coordination between the division and other organizations that assist consumers, including, but not limited to, legal assistance providers serving low-income health care consumers and other health care consumers, health insurance counseling assistance programs, the long-term care ombudsman program pursuant to Title 22, section 5106, subsection 11-C and assistance programs for individuals with disabilities established under federal or state law;
I. Collecting and disseminating information regarding the activities of the division;
J. Submitting an annual report by January 1st of each year to the Commissioner of Professional and Financial Regulation, the Consumer Health Care Division Advisory Council and the joint standing committee of the Legislature having jurisdiction over insurance matters describing the activities carried out by the division in the year for which the report is prepared, analyzing the data available to the division and evaluating the problems experienced by consumers; and
K. Performing other duties as the superintendent may prescribe.
§4322. Consumer Health Care Division Advisory Council
1. Establishment. The Consumer Health Care Division Advisory Council, referred to in this section as the "council," as established pursuant to Title 5, section 12004-I, subsection 50-A consists of the following members:
A. Three members of the public, appointed by the President of the Senate, representing consumers of health care services;
B. Three members of the public, appointed by the Speaker of the House, representing consumers of health care services;
C. Two members of the joint standing committee of the Legislature having jurisdiction over insurance matters, one appointed by the President of the Senate and one appointed by the Speaker of the House;
D. The Commissioner of Professional and Financial Regulation, or the commissioner's designee;
E. The Commissioner of Human Services, or the commissioner's designee; and
F. The Director of the Consumer Health Care Division, who is an ex-officio, nonvoting member of the council.
The members of the public appointed by the President of the Senate and the Speaker of the House must be appointed for staggered terms not to exceed 2 years. One member must be appointed for a one-year term, and 2 members must be appointed for 2-year terms. If a member's term expires and a successor has not been appointed, the member may continue as a member until a successor is appointed.
2. Chair. The members of the council shall elect a chair from among themselves.
3. Meetings. The council shall meet at least twice annually. Meetings must be called by the chair, and at least 2-weeks prior notice of council meetings must be given to the public.
4. Compensation. Members of the council are compensated according to the provisions of Title 5, chapter 379, except that members of the council who are Legislators are entitled to receive the legislative per diem as defined in Title 3, section 2 and reimbursement for travel and other necessary expenses for attendance at meetings of the council.
5. Functions. The functions of the council are to consult with and to advise the Director of the Consumer Health Care Division concerning the division's performance of the duties under this subchapter and to make recommendations to the superintendent on issues concerning the protection of consumer interests and rights under health care plans.
Sec. 4. Transfer of funds. The Department of Professional and Financial Regulation shall transfer sufficient funds from the Bureau of Insurance to the Legislature to pay the travel and other necessary expenses of legislative members of the Consumer Health Care Division Advisory Council.
Sec. 5. Appropriation. The following funds are appropriated from the General Fund to carry out the purposes of this Act.
1998-99
LEGISLATURE
Study Commissions - Funding
Personal Services $220
Provides funds for the per diem of legislative members of the Consumer Health Care Division Advisory Council.
Sec. 6. Allocation. The following funds are allocated from Other Special Revenue to carry out the purposes of this Act.
1998-99
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF
Bureau of Insurance
Positions - Legislative Count (3.000)
Personal Services $192,280
All Other 71,760
Capital Expenditures 9,000
Allocates funds for one Division Director position, one Staff Attorney position, one Nurse V position and operating costs necessary to establish a Consumer Health Care Division, including the expenses of the Consumer Health Care Division Advisory Council.
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION ____________
TOTAL $273,040
Sec. 7. Allocation. The following funds are allocated from Other Special Revenue to carry out the purposes of this Act.
1998-99
LEGISLATURE
Study Commissions - Funding
All Other $200
Provides funds for the travel and other necessary expenses of the legislative members of the Consumer Health Care Division Advisory Council.
Effective July 9, 1998, unless otherwise indicated.
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