Sec. C-1. 5 MRSA §12004-I, sub-§38, as amended by PL 1997, c. 689, Pt. A, §1 and affected by Pt. C, §2, is repealed.
Sec. C-2. 22 MRSA §328, sub-§3-A is enacted to read:
3-A. Capital investment fund. "Capital investment fund" means that fund established by the Governor pursuant to Title 2, section 101, subsection 1, paragraph D.
Sec. C-3. 22 MRSA §328, sub-§8, as enacted by PL 2001, c. 664, §2, is amended to read:
8. Health care facility. "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 physician or physicians or a dentist or dentists 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; and
D. Any other space used primarily to support the activities of the ambulatory surgical facility.
Sec. C-4. 22 MRSA §328, sub-§16, as enacted by PL 2001, c. 664, §2, is amended to read:
16. Major medical equipment. "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 $1,200,000 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), paragraphs 10 and 11. In determining whether medical equipment costs more than $1,200,000 the threshold provided in this subsection, 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 term "cost" includes the fair market value. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the commissioner to reflect the change in the Consumer Price Index, medical index.
Sec. C-5. 22 MRSA §328, sub-§17-A is enacted to read:
17-A. New health service. "New health service" means:
1. Capital expenditure. The obligation of any capital expenditures by or on behalf of a health care facility of $110,000 or more that is associated with the addition of a health service that was not offered on a regular basis by or on behalf of the health care facility within the 12-month period prior to the time the services would be offered;
2. Addition of health service. The addition of a health service that is to be offered by or on behalf of a health care facility that was not offered on a regular basis by or on behalf of the health care facility within the 12-month period prior to the time the services would be offered and that, for the 3rd fiscal year of operation, including a partial first year following addition of that service, is projected to entail incremental annual operating costs directly attributable to the addition of that health service of at least $400,000; or
3. Addition of health care practitioner. The addition in the private office of a health care practitioner, as defined in Title 24, section 2502, subsection 1-A, of new technology that costs $1,200,000 or more. The department shall consult with the Maine Quality Forum Advisory Council established pursuant to Title 24-A, section 6952, prior to determining whether a project qualifies as a new technology in the office of a private practitioner. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the commissioner to reflect the change in the Consumer Price Index medical index. With regard to the private office of a health care practitioner, "new health service" does not include the location of a new practitioner in a geographic area.
"New health service" does not include a health care facility that extends a current service within the defined primary service area of the health care facility by purchasing within a 12-month time period new equipment costing in the aggregate less than the threshold provided in section 328, subsection 16;
Sec. C-6. 22 MRSA §328, sub-§27 is enacted to read:
27. State Health Plan. "State Health Plan" means the plan developed in accordance with Title 2, chapter 5.
Sec. C-7. 22 MRSA §329, sub-§§2 to 4, as enacted by PL 2001, c. 664, §2, are amended to read:
2. Acquisitions of major medical equipment. Acquisitions of major medical equipment with a cost in the aggregate of $1,200,000 or more. The use of major medical equipment on a temporary basis in the case of a natural disaster, major accident or equipment failure and the use of replacement equipment do not require a certificate of need. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the commissioner to reflect the change in the Consumer Price Index medical index;
3. Capital expenditures. Except as provided in subsection 6, the obligation by or on behalf of a health care facility of any capital expenditure of $2,400,000 or more. Capital expenditures in the case of a natural disaster, major accident or equipment failure for replacement equipment or for parking lots and garages, information and communications systems and physician office space do not require a certificate of need. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the commissioner to reflect the change in the Consumer Price Index medical index;
4. New health service. The offering or development of any new health service. For purposes of this section, "new health service" includes only the following:
A. The obligation of any capital expenditures by or on behalf of a health care facility of $110,000 or more that is associated with the addition of a health service that was not offered on a regular basis by or on behalf of the health care facility within the 12-month period prior to the time the services would be offered; or
B. The addition of a health service that is to be offered by or on behalf of a health care facility that was not offered on a regular basis by or on behalf of the health care facility within the 12-month period prior to the time the services would be offered and that, for the 3rd fiscal year of operation, including a partial first year, following addition of that service, is projected to entail incremental annual operating costs directly attributable to the addition of a new health service of at least $400,000.
A certificate of need is not required for a health care facility that extends a current service within the defined primary service area of the health care facility by purchasing within a 12-month time period new equipment costing in the aggregate less than $1,200,000;
Sec. C-8. 22 MRSA §335, sub-§1, as enacted by PL 2001, c. 664, §2, is repealed and the following enacted in its place:
1. Basis for decision. Based solely on a review of the record maintained under subsection 6, the commissioner shall approve an application for a certificate of need if the commissioner determines that the project:
A. Meets the conditions set forth in subsection 7;
B. Is consistent with the State Health Plan;
C. Ensures high-quality outcomes and does not negatively affect the quality of care delivered by existing service providers;
D. Does not result in inappropriate increases in service utilization, according to the principles of evidence-based medicine adopted by the Maine Quality Forum, as established in Title 24-A, section 6951; and
E. Can be funded within the capital investment fund.
Sec. C-9. 22 MRSA §335, sub-§1-A is enacted to read:
1-A. Review cycle. The commissioner shall review applications periodically on a competitive basis.
Sec. C-10. 22 MRSA §335, sub-§5, as enacted by PL 2001, c. 664, §2, is amended to read:
5. Record. The record created by the department in the course of its review of an application must contain the following:
A. The application and all other materials submitted by the applicant for the purpose of being made making those documents part of the record;
B. All information generated by or for the department in the course of gathering material to assist the commissioner in determining whether the conditions for granting an application for a certificate of need have or have not been met. This information may include, without limitation, the report of consultants, including reports by panels of experts assembled by the department to advise it on the application, memoranda of meetings or conversations with any person interested in commenting on the application, letters, memoranda and documents from other interested agencies of State Government and memoranda describing officially noticed facts;
C. Stenographic or electronic recordings of any public hearing held by the commissioner or the staff of the department at the direction of the commissioner regarding the application;
D. Stenographic or electronic recording of any public informational meeting held by the department pursuant to section 337, subsection 5;
E. Any documents submitted by any person for the purpose of being made making those documents part of the record regarding any application for a certificate of need or for the purpose of influencing the outcome of any analyses or decisions regarding an application for certificate of need, except documents that have been submitted anonymously. Such source-identified documents automatically become part of the record upon receipt by the department; and
F. Preliminary and final analyses of the record prepared by the staff.; and
G. Written assessments by the Director of the Bureau of Health and the Superintendent of Insurance assessing the impact of the application on the health care system or cost of health insurance in the State.
Sec. C-11. 22 MRSA §335, sub-§7, ¶¶C and D, as enacted by PL 2001, c. 664, §2, are amended to read:
C. There is a public need for the proposed services as demonstrated by certain factors, including, but not limited to:
(1) Whether, and the extent to which, the project will substantially address specific health problems as measured by health needs in the area to be served by the project;
(2) Whether the project will have a positive impact on the health status indicators of the population to be served;
(3) Whether the services affected by the project will be accessible to all residents of the area proposed to be served; and
(4) Whether the project will provide demonstrable improvements in quality and outcome measures applicable to the services proposed in the project; and
D. The proposed services are consistent with the orderly and economic development of health facilities and health resources for the State as demonstrated by:
(1) The impact of the project on total health care expenditures after taking into account, to the extent practical, both the costs and benefits of the project and the competing demands in the local service area and statewide for available resources for health care;
(2) The availability of state funds to cover any increase in state costs associated with utilization of the project's services; and
(3) The likelihood that more effective, more accessible or less costly alternative technologies or methods of service delivery may become available.; and
Sec. C-12. 22 MRSA §335, sub-§7, ¶E is enacted to read:
E. The project meets the criteria set forth in subsection 1.
Sec. C-13. 22 MRSA §338, sub-§1, ¶¶A and B, as enacted by PL 2001, c. 664, §2, are amended to read:
A. New medical technologies and the impact of those technologies on the health care delivery system in the State; and
B. Unmet need for health care services in the State.; and
Sec. C-14. 22 MRSA §338, sub-§1, ¶C is enacted to read:
C. The quality of health care.
Sec. C-15. 22 MRSA §1718 is enacted to read:
Each hospital or ambulatory surgical center licensed under chapter 405 shall maintain a price list of the most common inpatient services and outpatient procedures provided by the licensee.
A. For inpatient services, the price list must include a per diem bed charge and an average charge for all ancillary charges for the 15 most common nonemergent services involving inpatient stays. If the per diem bed charge includes all ancillary charges for a procedure, no further information is required.
B. For outpatient nonemergent procedures for which an individual would not incur a bed charge, the price list must include average charges for the 20 most common surgical and diagnostic procedures, excluding laboratory services.
C. For emergency services, the price list must include average charges for facility and physician services according to the level of emergency services provided by the hospital and based on the time and intensity of services provided.
The hospital or ambulatory surgical center licensed under chapter 405 shall post in a conspicuous place a statement about the availability of the price list as required by this section. Posting of the price list is not required.
The hospital or ambulatory surgical center licensed under chapter 405 shall provide its price list upon request of a consumer.
The price list may include a statement that actual charges may vary depending on individual need and other factors.
Sec. C-16. 22 MRSA §2061, sub-§2, as amended by PL 1993, c. 390, §24, 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 Human Services in accordance with the provisions of the Maine Certificate of Need Act of 1978 2002, as amended, or, in the case of a project for a hospital, has been reviewed and approved by the Maine Health Care Finance Commission to the extent required by chapter 107 and is consistent with the cost containment provisions for health care and health coverage of the State Health Plan adopted pursuant to Title 2, section 101, paragraph A;
Sec. C-17. 22 MRSA §8702, sub-§4, as amended by PL 2001, c. 596, Pt. B, §21 and affected by §25, is further amended to read:
4. Health care facility. "Health care facility" means a public or private, proprietary or not-for-profit entity or institution providing health services, including, but not limited to, a radiological facility licensed under chapter 160, a health care facility licensed under chapter 405 or certified under chapter 405-D, an independent radiological service center, a federally qualified health center or, rural health clinic or rehabilitation agency certified or otherwise approved by the Division of Licensing and Certification within the Department of Human Services, a home health care provider licensed under chapter 419, a residential care facility licensed under chapter 1664, a hospice provider licensed under chapter 1681, a community rehabilitation program licensed under Title 20-A, chapter 701 a retail store drug outlet licensed under Title 32, chapter 117, a state institution as defined under Title 34-B, chapter 1 and a mental health facility licensed under Title 34-B, chapter 1.
Sec. C-18. 22 MRSA §8702, sub-§4-A is enacted to read:
4-A. Health care practitioner. "Health care practitioner" has the meaning provided in Title 24, section 2502, subsection 1-A.
Sec. C-19. 22 MRSA §8702, sub-§8, as enacted by PL 1995, c. 653, Pt. A, §2 and affected by §7, is amended to read:
8. Payor. "Payor" means a 3rd-party payor or 3rd-party administrator.
Sec. C-20. 22 MRSA §8702, sub-§9-A is enacted to read:
9-A. Quality data. "Quality data" means information on health care quality required to be submitted pursuant to section 8708-A.
Sec. C-21. 22 MRSA §8702, sub-§11, as amended by PL 2001, c. 677, §2, is further amended to read:
11. Third-party payor. "Third-party payor" means a health insurer, nonprofit hospital, medical services organization or managed care organization licensed in the State or the plan established in chapter 854. "Third-party payor" does not include carriers licensed to issue limited benefit health policies or accident, specified disease, vision, disability, long-term care, or nursing home care or Medicare supplement policies.
Sec. C-22. 22 MRSA §8703, sub-§1, as amended by PL 2001, c. 457, §4, is further amended to read:
1. Objective. The purpose purposes of the organization is are to create and maintain a useful, objective, reliable and comprehensive health information database that is used to improve the health of Maine citizens and to issue reports, as provided in section 8712. This database must be publicly accessible while protecting patient confidentiality and respecting providers of care. The organization shall collect, process and, analyze and report clinical and, financial, quality and restructuring data as defined in this chapter.
Sec. C-23. 22 MRSA §8704, sub-§1, ¶A, as amended by PL 2001, c. 457, §7, is further amended to read:
A. The board shall develop and implement data collection policies and procedures for the collection, processing, storage and analysis of clinical, financial, quality and restructuring data in accordance with this subsection for the following purposes:
(1) To use, build and improve upon and coordinate existing data sources and measurement efforts through the integration of data systems and standardization of concepts;
(2) To coordinate the development of a linked public and private sector information system;
(3) To emphasize data that is useful, relevant and is not duplicative of existing data;
(4) To minimize the burden on those providing data; and
(5) To preserve the reliability, accuracy and integrity of collected data while ensuring that the data is available in the public domain; and.
(6) To collect information from providers who were required to file data with the Maine Health Care Finance Commission. The organization may collect information from additional providers only when a linked information system for the electronic transmission, collection and storage of data is reasonably available to providers.
Sec. C-24. 22 MRSA §8704, sub-§1, ¶C, as enacted by PL 1995, c. 653, Pt. A, §2 and affected by §7, is amended to read:
C. The organization may modify the uniform reporting systems for clinical, financial, quality and restructuring data to allow for differences in the scope or type of services and in financial structure among health care facilities, providers or payors subject to this chapter.
Sec. C-25. 22 MRSA §8704, sub-§7, as amended by PL 2001, c. 457, §9, is further amended to read:
7. Annual report. The board shall prepare and submit an annual report on the operation of the organization and the Maine Health Data Processing Center as authorized in Title 10, section 681, including any activity contracted for by the organization, and on health care trends to the Governor and the joint standing committee of the Legislature having jurisdiction over health and human services matters no later than February 1st of each year. The report must include an annual accounting of all revenue received and expenditures incurred in the previous year and all revenue and expenditures planned for the next year. The report must include a list of persons or entities that requested data from the organization in the preceding year with a brief summary of the stated purpose of the request.
Sec. C-26. 22 MRSA §8704, sub-§10, as amended by PL 2001, c. 457, §10, is repealed.
Sec. C-27. 22 MRSA §8707, sub-§2, as enacted by PL 1995, c. 653, Pt. A, §2 and affected by §7, is amended to read:
2. Notice and comment period. The rules must establish criteria for determining whether information is confidential clinical data, confidential commercial financial data or privileged medical information and adopt procedures to give affected health care providers, facilities and payors notice and opportunity to comment in response to requests for information that may be considered confidential or privileged.
Sec. C-28. 22 MRSA §8708-A is enacted to read:
The board shall adopt rules regarding the collection of quality data. The board shall work with the Maine Quality Forum and the Maine Quality Forum Advisory Council established in Title 24-A, chapter 87, subchapter 2 to develop the rules. The rules must be based on the quality measures adopted by the Maine Quality Forum pursuant to Title 24-A, section 6951, subsection 2. The rules must specify the content, form, medium and frequency of quality data to be submitted to the organization. In the collection of quality data, the organization must minimize duplication of effort, minimize the burden on those required to provide data and focus on data that may be retrieved in electronic format from within a health care practitioner's office or health care facility. As specified by the rules, health care practitioners and health care facilities shall submit quality data to the organization. Rules adopted pursuant to this section are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. C-29. 22 MRSA §8712 is enacted to read:
The organization shall produce clearly labeled and easy-to-understand reports as follows. Unless otherwise specified, the organization shall distribute the reports on a publicly accessible site on the Internet or via mail or e-mail, through the creation of a list of interested parties. The organization shall publish a notice of the availability of these reports at least once per year in the 3 daily newspapers of the greatest general circulation published in the State. The organization shall make reports available to members of the public upon request.
1. Quality. At a minimum, the organization, in conjunction with the Maine Quality Forum, established in Title 24-A, section 6951, shall develop and produce annual quality reports.
2. Price. At a minimum, the organization, with advice from the Maine Health Data Processing Center as authorized in Title 10, section 681, shall develop and produce annual reports on prices charged for the 15 most common services provided by health care facilities and health care practitioners, excluding emergency services. For health care facilities, the reports must include, but are not limited to, the average price charged per service per facility and total number of services per facility.
3. Comparison report. At a minimum, the organization shall develop and produce an annual report that compares the 15 most common diagnosis-related groups and the 15 most common outpatient procedures for all hospitals in the State and the 15 most common procedures for nonhospital health care facilities in the State to similar data for medical care rendered in other states, when such data are available.
4. Physician services. The organization shall provide an annual report of the 10 services and procedures most often provided by osteopathic and allopathic physicians in the private office setting in this State. The organization shall distribute this report to all physician practices in the State. The first report must be produced by July 1, 2004.
Sec. C-30. 24 MRSA §2987 is enacted to read:
A health care practitioner shall notify patients in writing of the health care practitioner's charges for health care services commonly offered by the practitioner. Upon request of a patient, a health care practitioner shall assist the patient in determining the actual payment from a 3rd-party payor for a health care service commonly offered by the practitioner. A patient may file a complaint with the appropriate licensing board regarding a health care practitioner who fails to provide the consumer information required by this section.
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