An Act To Lower Health Care Costs
Sec. 1. 5 MRSA c. 167, as enacted by PL 2019, c. 471, §1, is repealed.
Sec. 2. 5 MRSA §12004-G, sub-§14-I, as enacted by PL 2019, c. 471, §2, is repealed.
Sec. 3. 5 MRSA §12004-G, sub-§14-J is enacted to read:
|Health Care||Maine Commission on Affordable Health Care, Board of Directors||Expenses Only||24-A MRSA §7703|
Sec. 4. 22 MRSA §8712, sub-§6, as enacted by PL 2019, c. 471, §3, is amended to read:
Sec. 5. 24-A MRSA c. 97 is enacted to read:
MAINE COMMISSION ON AFFORDABLE HEALTH CARE
§ 7701. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
§ 7702. Maine Commission on Affordable Health Care
The Maine Commission on Affordable Health Care is established as an independent executive agency to oversee the health care delivery and payment system in this State for the purposes set forth in this chapter and as provided in this section. The exercise by the Maine Commission on Affordable Health Care of the powers conferred by this chapter is the performance of essential governmental functions.
§ 7703. Board of Directors of the Maine Commission on Affordable Health Care
The commission is overseen by a board of directors, as established in Title 5, section 12004-G, subsection 14-J.
(1) Three members appointed by the Governor, including one member as chair with demonstrated expertise in health care delivery, health care management at a senior level or health care finance and administration, one member with demonstrated expertise in health care finance and administration and one member who is a primary care physician;
(2) Three members appointed by the President of the Senate, including one member who represents a health care consumer advocacy organization, one member who is a health economist and one member who has demonstrated expertise in behavioral health, substance use disorder and mental health services and mental health care reimbursement systems; and
(3) Three members appointed by the Speaker of the House, including one member who represents the health care workforce, one member who is a purchaser of health care representing business management or health benefits administration and one member with demonstrated expertise in innovative medical technologies and treatments for patient care; and
(1) The Commissioner of Health and Human Services or the commissioner's designee; and
(2) The Commissioner of Administrative and Financial Services or the commissioner's designee.
A member of the board may not be employed by, a consultant to, a member of the board of directors of, affiliated with or otherwise a representative of a carrier or other insurer, an agent or broker, a health care provider or a health care facility or health clinic while serving on the board. A member of the board may not be a member, a board member or an employee of a trade association of carriers, health facilities, health clinics or health care providers while serving on the board. A member of the board may not be a health care provider unless the member receives no compensation for rendering services as a health care provider and does not have an ownership interest in a professional health care practice.
§ 7704. Powers of the Maine Commission on Affordable Health Care
§ 7705. Limitation on liability
§ 7706. Conflicts of interest
The following provisions govern any conflict of interest for a member of the board, a member of the advisory council established pursuant to section 7709 or any staff member or contractor of the board.
§ 7707. Executive director
§ 7708. Records
Except as provided in subsections 1 and 2, information obtained by the commission under this chapter is a public record within the meaning of Title 1, chapter 13, subchapter 1.
§ 7709. Advisory council
§ 7710. Establishment of health care cost growth targets and health care quality targets
The commission shall solicit testimony from a payor paying providers more than 10% above or more than 10% below the average relative price or entering into alternative payment contracts that vary by more than 10%. A payor that provides testimony shall explain the extent of price variation between the payor's participating providers and describe any efforts to reduce such price variation.
(1) Testimony concerning unanticipated events that may have affected the total health care cost expenditures, including, but not limited to, a public health crisis such as an outbreak of a disease, a public safety event or a natural disaster;
(2) Testimony concerning trends in the severity or complexity of patient conditions or use of services;
(3) Testimony concerning trends in input cost structures, including, but not limited to, the introduction of new pharmaceuticals, medical devices and other health technologies;
(4) Testimony concerning the cost of providing certain specialty services, including, but not limited to, the provision of health care to children, cancer-related health care and medical education;
(5) Testimony related to unanticipated administrative costs for carriers, including, but not limited to, costs related to information technology, administrative simplification efforts, labor costs and transparency efforts;
(6) Testimony related to costs due to the implementation of state or federal legislation or government regulation; and
(7) Any other factors that may have led to excessive health care cost growth.
(1) File a performance improvement plan with the commission; or
(2) File an application with the commission to waive or extend the requirement to file a performance improvement plan.
(1) The costs, price and utilization trends of the health care entity over time, and any demonstrated improvement to reduce total medical expenses;
(2) Any ongoing strategies or investments that the health care entity is implementing to improve long-term efficiency and reduce cost growth;
(3) Whether the factors that led to increased costs for the health care entity can reasonably be considered to be unanticipated and outside of the control of the entity. Such factors may include, but are not limited to, age and other health status adjusted factors and other cost inputs such as pharmaceutical expenses and medical device expenses;
(4) The overall financial condition of the health care entity;
(5) A significant difference between the growth rate of potential gross state product and the growth rate of actual gross state product; and
(6) Any other factors the commission considers relevant.
(1) Within 45 days of receipt of a notice under this subsection;
(2) If the health care entity has requested a waiver or extension under paragraph C, within 45 days of receipt of a notice that the waiver or extension has been denied; or
(3) If the health care entity is granted an extension, on the date given on the extension.
The performance improvement plan must be generated by the health care entity and identify the causes of the entity's cost growth and must include, but is not limited to, specific strategies, adjustments and action steps the entity proposes to implement to improve cost performance. The performance improvement plan must include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for a performance improvement plan may not exceed 18 months.
(1) Extend the implementation timetable of the performance improvement plan;
(2) Approve amendments to the performance improvement plan as proposed by the health care entity;
(3) Require the health care entity to submit a new performance improvement plan under this subsection; or
(4) Waive or extend the requirement to file any additional performance improvement plans.
(1) Willfully neglected to file a performance improvement plan with the commission within 45 days as required under paragraph C;
(2) Failed to file an acceptable performance improvement plan in good faith with the commission;
(3) Failed to implement the performance improvement plan in good faith; or
(4) Knowingly failed to provide information required by this section to the commission or knowingly falsified the same.
The commission shall seek to promote compliance with this section and may impose a civil penalty only as a last resort.
§ 7711. Health care spending and prescription drug spending targets for public payors
For the purposes of this section, "public payor" means any division of state, county or municipal government that administers a health plan for employees of that division of state, county or municipal government or an association of state, county or municipal employers that administers a health plan for its employees, except for the MaineCare program.
(1) Expenditures and utilization data for health care spending for each plan offered by a public payor including spending for prescription drugs as a subset of the overall health care spending;
(2) Administrative expenses for each health plan offered by a public payor; and
(3) Health plan premiums and enrollee cost sharing for each plan offered by a public payor; and
Health care spending data provided to the board under this subsection is confidential to the same extent it is confidential while in the custody of the entity that provided the data to the board.
§ 7712. Rules
The commission may adopt rules as necessary to implement this chapter. Rules adopted in accordance with this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 6. Transition. The following provisions apply to the establishment of the Maine Commission on Affordable Health Care pursuant to the Maine Revised Statutes, Title 24-A, chapter 97.
1. Board appointed. Within 30 days of the effective date of this Act, the Governor, the President of the Senate and the Speaker of the House of Representatives shall post nominations for the appointment of the members of the Board of Directors of the Maine Commission on Affordable Health Care. As soon as practicable after Senate confirmation of board members, the board shall appoint the executive director pursuant to Title 24-A, section 7707.
2. Initial staffing; Bureau of Insurance. Upon request from the Board of Directors of the Maine Commission on Affordable Health Care, the Department of Professional and Financial Regulation, Bureau of Insurance shall provide initial staffing assistance to the commission in the initial phases of its operations until the appointment of the executive director. The executive director of the Maine Commission on Affordable Health Care shall hire staff and contract for services to implement this Act.
Sec. 7. Staggered terms; Board of Directors of the Maine Commission on Affordable Health Care. Notwithstanding the Maine Revised Statutes, Title 24-A, section 7703, subsection 2, of the members initially appointed to the Board of Directors of the Maine Commission on Affordable Health Care, 4 members must be appointed to serve initial terms of 2 years, 3 members must be appointed to serve initial terms of 3 years and 2 members must be appointed to serve initial terms of 4 years.
Sec. 8. Appropriations and allocations. The following appropriations and allocations are made.
MAINE COMMISSION ON AFFORDABLE HEALTH CARE
Maine Commission on Affordable Health Care N340
Initiative: Establishes one Public Service Executive II position and one Comprehensive Health Planner II position starting August 1, 2020.
POSITIONS - LEGISLATIVE COUNT
|GENERAL FUND TOTAL||$0||$195,345|
This bill establishes the Maine Commission on Affordable Health Care to monitor health care spending growth in the State and also set health care quality benchmarks. The bill also requires the commission to establish health care spending targets for public payors, including separate targets for prescription drugs.