SP0421, LD 1353, item 1, An Act To Establish Transparency in Primary Health Care Spending

An Act To Establish Transparency in Primary Health Care Spending

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA §8702, sub-§8-D is enacted to read:

8-D. Primary care. "Primary care" means regular check-ups, wellness and general health care provided by a health care practitioner with whom the patient has initial contact for a health issue, not including an urgent care or emergency health issue, and by whom the patient may be referred to a specialist.

Sec. 2. 22 MRSA §8718 is enacted to read:

§ 8718. Primary care data

1. Report. An insurer shall report annually to the organization the insurer's total primary care expenditures on a date and in a form determined by the organization. The organization shall provide information received under this subsection to the Maine Quality Forum for the purposes of Title 24-A, section 6951, subsection 12. For purposes of this section, "insurer" has the same meaning as in Title 24-A, section 4.

2. Rules. The organization may adopt rules to carry out the purposes of this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

Sec. 3. 24-A MRSA §6903, sub-§13-B is enacted to read:

13-B. Primary care. "Primary care" means regular check-ups, wellness and general health care provided by a provider with whom the patient has initial contact for a health issue, not including an urgent care or emergency health issue, and by whom the patient may be referred to a specialist.

Sec. 4. 24-A MRSA §6951, sub-§12 is enacted to read:

12. Primary care reporting. The forum shall submit an annual report to the Department of Health and Human Services and the joint standing committee of the Legislature having jurisdiction over health and human services matters that includes:

A. Of their respective total medical expenditures, the percentage paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust and the average percentage of total medical expenditures paid for primary care across all payers; and

B. The methods used by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust to pay for primary care.

Sec. 5. Maine Quality Forum to conduct health spending reporting study. The Maine Quality Forum, established in the Maine Revised Statutes, Title 24-A, section 6951, shall consult with other state and national agencies and organizations to determine the best practices for reporting spending on primary care services by insurers. For purposes of this section, "primary care" means general health care provided by a health care provider with whom the patient has initial contact for a health issue and by whom the patient may be referred to a specialist. By January 15, 2020, the forum shall submit a report containing its findings from the study and any recommended legislation to the Department of Health and Human Services and the Joint Standing Committee on Health and Human Services. The committee may report out legislation based upon the report to the Second Regular Session of the 129th Legislature.

summary

This bill requires insurers to report primary care expenditures to the Maine Health Data Organization and for the Maine Quality Forum to use this data to report annually to the Department of Health and Human Services and the Legislature the percentage of total medical expenditures paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust respectively, the average of the percentage of total medical expenses paid for primary care across all organizations and the methods used by these organizations to pay for primary care. This bill also requires the Maine Quality Forum to conduct a study on best practices in health care spending reporting and submit its findings to the Department of Health and Human Services and the Joint Standing Committee on Health and Human Services.

SP0421 LD 1353	Session - 129th Maine Legislature		LR 1705 Item 1
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