An Act To Repeal the Maine Certificate of Need Act of 2002
Sec. 1. 22 MRSA c. 103-A, as amended, is repealed.
Sec. 2. 22 MRSA §1708, sub-§3, ¶C, as amended by PL 2001, c. 666, Pt. A, §1 and affected by Pt. E, §1, is further amended to read:
Sec. 3. 22 MRSA §1708, sub-§3, ¶D, as corrected by RR 2001, c. 2, Pt. A, §33, is repealed.
Sec. 4. 22 MRSA §1714-A, sub-§4, ¶C, as amended by PL 2011, c. 687, §8, is further amended to read:
Sec. 5. 22 MRSA §1715, sub-§1, ¶A, as corrected by RR 2001, c. 2, Pt. A, §34, is amended to read:
Sec. 6. 22 MRSA §2061, sub-§2, as amended by PL 2011, c. 90, Pt. J, §19, is further amended to read:
Sec. 7. 24-A MRSA §4203, sub-§1, as amended by PL 2003, c. 510, Pt. A, §19, is further amended to read:
Sec. 8. 24-A MRSA §4204, sub-§1, as amended by PL 2003, c. 510, Pt. A, §20 and c. 689, Pt. B, §6, is repealed.
Sec. 9. 24-A MRSA §4204, sub-§2-A, as amended by PL 2011, c. 90, Pt. F, §6, is further amended to read:
(4) The health maintenance organization must establish and maintain procedures to ensure that the health care services provided to enrollees are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. These procedures must include mechanisms to ensure availability, accessibility and continuity of care.
(5) The health maintenance organization must have an ongoing internal quality assurance program to monitor and evaluate its health care services including primary and specialist physician services, ancillary and preventive health care services across all institutional and noninstitutional settings. The program must include, at a minimum, the following:
(a) A written statement of goals and objectives that emphasizes improved health outcomes in evaluating the quality of care rendered to enrollees;
(b) A written quality assurance plan that describes the following:
(i) The health maintenance organization's scope and purpose in quality assurance;
(ii) The organizational structure responsible for quality assurance activities;
(iii) Contractual arrangements, in appropriate instances, for delegation of quality assurance activities;
(iv) Confidentiality policies and procedures;
(v) A system of ongoing evaluation activities;
(vi) A system of focused evaluation activities;
(vii) A system for reviewing and evaluating provider credentials for acceptance and performing peer review activities; and
(viii) Duties and responsibilities of the designated physician supervising the quality assurance activities;
(c) A written statement describing the system of ongoing quality assurance activities including:
(i) Problem assessment, identification, selection and study;
(ii) Corrective action, monitoring evaluation and reassessment; and
(iii) Interpretation and analysis of patterns of care rendered to individual patients by individual providers;
(d) A written statement describing the system of focused quality assurance activities based on representative samples of the enrolled population that identifies the method of topic selection, study, data collection, analysis, interpretation and report format; and
(e) Written plans for taking appropriate corrective action whenever, as determined by the quality assurance program, inappropriate or substandard services have been provided or services that should have been furnished have not been provided.
(6) The health maintenance organization shall record proceedings of formal quality assurance program activities and maintain documentation in a confidential manner. Quality assurance program minutes must be available to the Commissioner of Health and Human Services.
(7) The health maintenance organization shall ensure the use and maintenance of an adequate patient record system that facilitates documentation and retrieval of clinical information to permit evaluation by the health maintenance organization of the continuity and coordination of patient care and the assessment the quality of health and medical care provided to enrollees.
(8) Enrollee clinical records must be available to the Commissioner of Health and Human Services or an authorized designee for examination and review to ascertain compliance with this section, or as considered necessary by the Commissioner of Health and Human Services.
(9) The organization must establish a mechanism for periodic reporting of quality assurance program activities to the governing body, providers and appropriate organization staff.
The Commissioner of Health and Human Services shall make the certification required by this paragraph within 60 days of the date of the written decision that a certificate of need was not required. If the commissioner Commissioner of Health and Human Services certifies that the health maintenance organization does not meet all of the requirements of this paragraph, the commissioner shall specify in what respects the health maintenance organization is deficient.
(1) In a determination of minimum surplus requirements, the following terms have the following meanings.
(a) "Admitted assets" means assets recognized by the superintendent pursuant to section 901-A. For purposes of this chapter, the asset value is that contained in the annual statement of the corporation as of December 31st of the year preceding the making of the investment or contained in any audited financial report, as defined in section 221-A, of more current origin.
(b) "Reserves" means those reserves held by corporations subject to this chapter for the protection of subscribers. For purposes of this chapter, the reserve value is that contained in the annual statement of the corporation as of December 31st of the preceding year or any audited financial report, as defined in section 221-A, of more current origin.
(2) In making the determination whether the health maintenance organization is financially responsible, the superintendent may also consider:
(a) The financial soundness of the health maintenance organization's arrangements for health care services and the schedule of charges used;
(b) The adequacy of working capital;
(c) Any agreement with an insurer, a nonprofit hospital or medical service corporation, a government or any other organization for insuring or providing the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the plan;
(d) Any agreement with providers for the provision of health care services that contains a covenant consistent with subsection 6; and
(e) Any arrangements for insurance coverage or an adequate plan for self-insurance to respond to claims for injuries arising out of the furnishing of health care services.
The applicant shall furnish, upon request of the superintendent, any information necessary to make any determination required pursuant to this subsection.
Sec. 10. 24-A MRSA §4225, as amended by PL 1975, c. 293, §4 and enacted by c. 503 and amended by PL 2003, c. 689, Pt. B, §7, is further amended to read:
§ 4225. Commissioner of Health and Human Services' authority to contract
The Commissioner of Health and Human Services, in carrying out his the commissioner's obligations under sections 4204, subsection 1, paragraph B, 4215 and 4216, subsection 1, may contract with qualified persons to make recommendations concerning the determinations required to be made by him the commissioner. Such recommendations may be accepted in full or in part by the Commissioner of Health and Human Services.
Sec. 11. 24-A MRSA §6203, sub-§1, ¶A, as amended by PL 2003, c. 510, Pt. A, §22, is further amended to read:
Sec. 12. 24-A MRSA §6203, sub-§1, ¶G, as enacted by PL 1995, c. 452, §11, is amended to read:
Sec. 13. 24-A MRSA §6203, sub-§2, as amended by PL 1995, c. 452, §§12 to 16, is further amended to read:
(1) That preliminary continuing care agreements have been entered and deposits of not less than 10% of the entrance fee have been received either:
(a) From subscribers with respect to 70% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or
(b) From subscribers with respect to 70% of the total entrance fees due or expected at full occupancy of the community; or
(2) That preliminary continuing care agreements have been entered and deposits of not less than 25% of the entrance fee received from either:
(a) Subscribers with respect to 60% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or
(b) Subscribers with respect to 60% of the total entrance fees due or expected at full occupancy of the community.
Within 120 days after determining that the application to the superintendent and the department is complete, the superintendent shall issue or deny a final certificate of authority to the provider , unless a certificate of need is required, in which case the final certificate of authority shall be issued or denied in accordance with the certificate of need schedule.
Sec. 14. 24-A MRSA §6203, sub-§6, as amended by PL 2003, c. 155, §1, is further amended to read:
Notwithstanding this subsection, a life-care community that holds a final certificate of authority from the superintendent and that was operational on November 18, 2002 and that is barred from seeking reimbursement or financial assistance under the MaineCare program from a state or federal agency may continue to admit nonresidents of the community to its skilled nursing facility after its first 3 years of operation with the approval of the superintendent. A life-care community that admits nonresidents to its skilled nursing facility as permitted under this subsection may continue to admit nonresidents after its first 3 years of operation only for such period as approved by the superintendent after the superintendent's consideration of the financial impact on the life-care community and the impact on the contractual rights of subscribers of the community.
Sec. 15. 24-A MRSA §6226, as amended by PL 2003, c. 510, Pt. A, §23, is repealed.
Sec. 16. 24-A MRSA §6951, sub-§6, as enacted by PL 2003, c. 469, Pt. A, §8, is amended to read:
Sec. 17. 35-A MRSA §10122, as enacted by PL 2011, c. 424, Pt. A, §6 and affected by Pt. E, §1, is amended to read:
§ 10122. Health care facility program
The trust shall develop and implement a process to review projects undertaken by health care facilities that are directed solely at reducing energy costs through energy efficiency, renewable energy technology or smart grid technology and to certify those projects that are likely to be cost-effective. If a project is certified as likely to be cost-effective by the trust, the review process serves as an alternative to the certificate of need process established pursuant to Title 22, section 329, subsection 3.
Sec. 18. 38 MRSA §1310-X, sub-§4, ¶A, as amended by PL 2003, c. 551, §17, is further amended to read:
summary
Under current law, before introducing additional health care services and procedures in a market area, a person must apply for and receive a certificate of need from the Department of Health and Human Services. This bill eliminates that requirement.