An Act To Promote Universal Health Care, Including Dental, Vision and Hearing Care
Sec. A-1. 24-A MRSA c. 95 is enacted to read:
HEALTHY MAINE ACT
§ 7501. Short title
This chapter may be known and cited as "the Healthy Maine Act."
§ 7502. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
§ 7503. Healthy Maine; establishment; governance
Healthy Maine is created as a body corporate and politic and a public instrumentality of the State to finance health care services for all residents of the State, to administer state and federal health care funds and to institute fiscally sound payment policies that improve and maintain high standards for value, quality and healthy outcomes for all beneficiaries.
§ 7504. Board of trustees of Healthy Maine
(1) Can be easily accessed by providers and beneficiaries;
(2) Allow Healthy Maine to maintain a central database of medical records suitable for management and cross-sectional and longitudinal research purposes;
(3) Ensure the confidentiality of beneficiaries' medical records in compliance with all federal and state health care laws, regulations and rules concerning the confidentiality of patient medical records; and
(4) Is easily portable to and interoperable with all other medical records systems in use throughout the State;
§ 7505. Health care services
(1) The benefits required by federal law;
(2) Any optional MaineCare benefits authorized under state law or services covered under the Children's Health Insurance Program for which these individuals are eligible; and
(3) Any additional benefits provided in Healthy Maine's benefit package.
§ 7506. Healthy Maine secondary payor; state health plan; subrogation rights
(1) Healthy Maine has an agreement with the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services that requires it to pay for services that would have been paid under Medicare Parts B or D; or
(2) Healthy Maine offers a Medicare Advantage plan and the beneficiary voluntarily enrolls in that plan.
Healthy Maine may recover health care payments from any other collateral source, such as a health insurance plan, health benefit plan or other payor that is primary to Healthy Maine.
§ 7507. Effective date
This chapter takes effect July 1, 2020.
Sec. B-1. Transition. The Department of Health and Human Services and any other affected department or agency of the State shall assist Healthy Maine in seeking all waivers, exemptions and agreements from State Government and the Federal Government that are necessary to transfer health care funding from the Federal Government and from any state departments and agencies to Healthy Maine.
Sec. B-2. Interim meetings; implementing legislation. The Joint Standing Committee on Health and Human Services and the Joint Standing Committee on Insurance and Financial Services are authorized to jointly meet as needed, but shall meet at least 3 times, during the 2017 legislative interim to oversee planning and implementation related to the establishment of Healthy Maine. At these meetings, the Commissioner of Health and Human Services and the Superintendent of Insurance shall brief the committees on planning issues, progress, challenges and the timeline for implementation. The committees shall provide opportunities for health care consumers, providers and advocates to speak to the committee. The committees shall jointly submit legislation to the Second Regular Session of the 128th Legislature by January 15, 2018 to implement Part A of this Act. The committees shall include in the legislation provisions to:
1. Fund the operation of Healthy Maine;
2. Transfer responsibility for administering the MaineCare program and the children's health insurance program established in the Maine Revised Statutes, Title 22, section 3174-T from the Department of Health and Human Services to Healthy Maine;
3. Transfer responsibility for administering any other state or federal health care program to Healthy Maine;
4. Obtain all waivers, exemptions and agreements from State Government and the Federal Government that are necessary to transfer health care funding from the Federal Government and from any state departments and agencies to Healthy Maine;
5. Transfer to Healthy Maine all state and federal funds associated with programs for which Healthy Maine will assume responsibility;
6. Enable Healthy Maine to receive the appropriate federal fund contribution in lieu of the federal premium tax credits, cost-sharing subsidies and small business tax credits provided in the federal Patient Protection and Affordable Care Act or its successor acts;
7. Repeal or amend, as appropriate, those provisions of the Maine Workers' Compensation Act of 1992 and any other provisions of law that concern the provision of medical care for workers who suffer injuries or illnesses arising out of and in the course of their employment and for the payment of premiums for medical benefits, whether by employers or insurers covered under the laws governing workers' compensation or that otherwise conflict with Title 24-A, chapter 95;
8. Ensure that the State's expenditures for health care services, including the State's responsibility for providing matching funds for MaineCare and other federally supported health care programs, do not fall below the expenditure levels for health care services in the year preceding the effective date of Part A of this Act;
9. Determine the process for selecting or electing the members of the board of trustees of Healthy Maine established in Title 24-A, section 7504; and
10. Effectuate a smooth and efficient transfer of the programs and responsibilities and to enable affected departments and agencies to assist Healthy Maine in the assumption of its duties.
Sec. B-3. Transfer of state and federal funds; responsibility for distribution. No later than July 1, 2020, the State shall transfer to Healthy Maine all state and federal funds for MaineCare, the children's health insurance program established in the Maine Revised Statutes, Title 22, section 3174-T and any other program to be administered by Healthy Maine. The State may retain any funds necessary to meet payment obligations that exist as of the date of transfer. Upon receipt of this funding, Healthy Maine is responsible for paying for all benefits and services previously paid by State Government and the Federal Government with those funds, and Healthy Maine shall assume responsibility for the proper administration and distribution of state and federal funds pursuant to state and federal law.
Sec. B-4. Phase-in; delivery of service models. Healthy Maine shall assume payment for health care services in a manner designed to minimize disruptions to existing delivery and payment systems. Healthy Maine shall phase in payment reforms and a unified billing system and shall employ payment models that optimize quality, value, patient experience and healthy outcomes for beneficiaries.
This bill establishes a single-payer health care system in the State, effective July 1, 2020, that finances health care services for most Maine residents. The bill directs the Joint Standing Committee on Health and Human Services and the Joint Standing Committee on Insurance and Financial Services to jointly submit during the 2017 legislative interim legislation to fully implement the single-payer system.