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An Act To Strengthen Maine's Hospitals and Increase Access to Health Care
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1. 22 MRSA §3174-G, sub-§1, ¶F, as amended by PL 2011, c. 380, Pt. KK, §2, is further amended to read:
 
F. A person 20 to 64 years of age who is not otherwise covered under paragraphs A to E when the person's family income is below or equal to 125% of the nonfarm income official poverty line, providedexcept that the commissioner shall adjust the maximum eligibility level in accordance with the requirements of the paragraph.
 
(2) If the commissioner reasonably anticipates the cost of the program to exceed the budget of the population described in this paragraph, the commissioner shall lower the maximum eligibility level to the extent necessary to provide coverage to as many persons as possible within the program budget.
 
(3) The commissioner shall give at least 30 days' notice of the proposed change in maximum eligibility level to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs and the joint standing committee of the Legislature having jurisdiction over health and human services matters; and
Sec. A-2. 22 MRSA §3174-G, sub-§1, ¶G, as enacted by PL 2011, c. 380, Pt. KK, §3, is amended to read:
 
G. A person who is a noncitizen legally admitted to the United States to the extent that coverage is allowable by federal law if the person is:
 
(1) A woman during her pregnancy and up to 60 days following delivery; or
 
(2) A child under 21 years of age.;
Sec. A-3.  22 MRSA §3174-G, sub-§1, ¶¶H and I  are enacted to read:
 
H.  Beginning January 1, 2016, a person 21 to 64 years of age who is not otherwise eligible for medical assistance under this section, who qualifies for medical assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and whose income is equal to or below 133% of the nonfarm income official poverty line plus 5% for the applicable family size as required by federal law. A person eligible for medical assistance under this paragraph must receive the same coverage as is provided to a person eligible under paragraph E; and
 
I.  Beginning October 1, 2019, a person 19 or 20 years of age who is not otherwise eligible for medical assistance under this section, who qualifies for medical assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and whose income is equal to or below 133% of the nonfarm income official poverty line plus 5% for the applicable family size as required by federal law. A person eligible for medical assistance under this paragraph must receive the same coverage as is provided to a person eligible under paragraph E.
Sec. A-4. Contingent repeal. The Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I are repealed if:
1. Enhanced Federal Medical Assistance Percentage. The enhanced Federal Medical Assistance Percentage with respect to amounts expended for medical assistance for newly eligible Medicaid individuals described in 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) is reduced below one of the following amounts in effect for the period specified:
A. One hundred percent for calendar quarters in 2016;
B. Ninety-five percent for calendar quarters in 2017;
C. Ninety-four percent for calendar quarters in 2018;
D. Ninety-three percent for calendar quarters in 2019; or
E. Ninety percent for calendar quarters in 2020;
2. Reduction in enhanced Federal Medical Assistance Percentage effective. The reduction in the enhanced Federal Medical Assistance Percentage described in subsection 1 has taken effect; and
3. Legislative session of at least 30 days. After the reduction of the enhanced Federal Medical Assistance Percentage as described in subsections 1 and 2, the Legislature has convened and conducted a session of at least 30 calendar days.
Sec. A-5. Repeal. The Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I are repealed December 31, 2020.
PART B
Sec. B-1. Obtaining federal approval for enhanced federal match. The Commissioner of Health and Human Services shall take all steps necessary to secure an enhanced Federal Medical Assistance Percentage for services provided to the MaineCare childless adult waiver population in the State equal to that available under the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by Public Law 111-152, for individuals newly eligible for Medicaid. The commissioner shall prepare and submit to the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services in a format required by the Secretary of the federal Department of Health and Human Services an analysis of the benefits available under the MaineCare childless adult waiver as of December 1, 2009 and all necessary information to certify that members of the childless adult population were not eligible on December 1, 2009 to receive full benefits, benchmark coverage as described in Section 1937(b)(1), subparagraph (A), (B) or (C) of the United States Social Security Act or benchmark equivalent coverage as described in 42 United States Code, Section 1396u-7(b)(2). In preparing and submitting this analysis, the commissioner shall compare the services available to the childless adult population, specifically hearing services, to those of the 3 benchmark plans specified by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services and shall indicate to the secretary whether hearing services were a covered service for the childless adult population as of December 1, 2009 and whether they are a covered service under the 3 benchmark plans. The Commissioner of Health and Human Services shall submit information certified by an actuary for the purpose of certifying the benefits available to the childless adult population on December 1, 2009 if required to do so by the secretary. If the secretary does not require information certified by an actuary for that purpose, the commissioner may not pursue the services of an actuary or submit information certified by an actuary for the purpose of certifying the benefits available to the childless adult population on December 1, 2009. If the secretary requires the submission of additional information to demonstrate that members of the childless adult population otherwise qualify as "newly eligible" individuals as described in Section 1905(y)(2) of the United States Social Security Act, in order for the State to secure an enhanced Federal Medical Assistance Percentage as set forth in Section 1905(y)(1) of the United States Social Security Act, the Department of Health and Human Services shall provide all required information to the secretary within 30 days of the secretary's sending notification that additional information is required.
Sec. B-2. Report. The Commissioner of Health and Human Services shall report no later than February 1, 2016 to the Joint Standing Committee on Appropriations and Financial Affairs and the Joint Standing Committee on Health and Human Services on efforts to secure the maximum Federal Medical Assistance Percentage under section 1, including any correspondence with the federal Department of Health and Human Services regarding these efforts.
PART C
Sec. C-1. Research organization evaluation. The Office of Fiscal and Program Review shall contract with a private, nonpartisan research organization to evaluate the impact of the MaineCare expansion authorized in Part A on programs and services that do not currently receive Federal Medical Assistance Percentage matching funds or do not qualify for enhanced Federal Medical Assistance Percentage matching funds under the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by Public Law 111-152, with the goal of identifying and maximizing General Fund savings. The Commissioner of Health and Human Services, the Commissioner of Corrections and the Executive Director of the State Board of Corrections shall provide to the research organization information and assistance requested for preparation of the evaluation. In evaluating the programs and services under this Part, the research organization shall at a minimum evaluate the impact on the following programs and services: the state-funded Mental Health Services - Community, Office of Substance Abuse and General Assistance - Reimbursement to Cities and Towns programs; the elderly low-cost drug program under the Maine Revised Statutes, Title 22, section 254-D; services provided for individuals between 21 and 64 years of age who are currently eligible for MaineCare under medically needy, spend-down criteria; services provided under the Maine Medicaid Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS; services provided for parents participating in family reunification activities under Title 22, section 4041; services provided for disabled individuals between 21 and 64 years of age with incomes below 139% of the federal poverty level; services provided to individuals awaiting a MaineCare disability determination for whom the applications are subsequently granted; services provided to individuals who would have been considered eligible on the basis of a disability but for whom the full determination process was not completed; and medical services provided to persons in the care and custody of the Department of Corrections or a county correctional facility. The research organization shall also examine the amount of payment for services that hospitals received during calendar years 2016 and 2017 as a result of the expansion of MaineCare eligibility pursuant to Part A. In addition, the research organization shall evaluate any savings and the impact on health outcomes achieved through initiatives implemented pursuant to the state innovation models initiative grant.
Sec. C-2. Report. The research organization that conducts the evaluation under section 1 shall report no later than March 1 in 2016 and 2017 and February 15 in 2018 to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, the joint standing committee of the Legislature having jurisdiction over health and human services matters and the joint standing committee of the Legislature having jurisdiction over criminal justice and public safety matters on the amount of General Fund savings resulting from the MaineCare expansion authorized in Part A and identified in section 1. The reports must include the amount of savings realized during calendar years 2016 and 2017 by service area or program, the amount deposited in the MaineCare Stabilization Fund pursuant to section 3 and the amount of savings projected to be achieved through state fiscal year 2020-21 by service area or program.
Sec. C-3. Calculation and transfer. Notwithstanding any other provision of law, the State Budget Officer shall calculate the amount of savings identified in this Part that applies against each General Fund account statewide as a result of the expansion of MaineCare eligibility authorized in Part A and shall transfer the amounts by financial order upon the approval of the Governor. These transfers are considered adjustments to appropriations in fiscal year 2015-16 and fiscal year 2016-17. The State Controller shall transfer any amounts identified under this Part greater than the amounts specified in section 6 to the MaineCare Stabilization Fund established under the Maine Revised Statutes, Title 22, section 3174-KK. The State Budget Officer shall provide a report of the transferred amounts to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs no later than June 30, 2016 for fiscal year 2015-16 and no later than June 30, 2017 for fiscal year 2016-17.
Sec. C-4. Review and responsibility. Following receipt of the reports from the research organization as required under section 2, the joint standing committee of the Legislature having jurisdiction over health and human services matters shall review the information provided in the reports and shall determine if the net cost to the General Fund of providing coverage under the MaineCare program to individuals pursuant to Part A, section 3 exceeds the savings to the General Fund, including any amount deposited in the MaineCare Stabilization Fund pursuant to section 3, due to the expansion of coverage for those individuals. Following its review of the report received on February 15, 2018, the joint standing committee may report out a bill to the 128th Legislature regarding its determinations and conclusions.
PART D
Sec. D-1. 22 MRSA §3173-C, sub-§7, as amended by PL 2009, c. 415, Pt. A, §12, is further amended to read:
 
7. Copayments.   Notwithstanding any other provision of law, the following copayments per service per day are imposed and reimbursements are reduced, or both, to the following levels:
 
A. Outpatient hospital services, $3;
 
B. Home health services, $3;
 
C. Durable medical equipment services, $3;
 
D. Private duty nursing and personal care services, $5 per month;
 
E. Ambulance services, $3;
 
F. Physical therapy services, $2;
 
G. Occupational therapy services, $2;
 
H. Speech therapy services, $2;
 
I. Podiatry services, $2;
 
J. Psychologist services, $2;
 
K. Chiropractic services, $2;
 
L. Laboratory and x-ray services, $1;
 
M. Optical services, $2;
 
N. Optometric services, $3;
 
O. Mental health clinic services, $2;
 
P. Substance abuse services, $2;
 
Q. Hospital inpatient services, $3 per patient day;
 
R. Federally qualified health center services, $3 per patient day, effective July 1, 2004; and
 
S. Rural health center services, $3 per patient day.
 
The department may adopt rules to adjust the copayments set forth in this subsection. The rules may adjust amounts to ensure that copayments are deemed nominal in amount and may include monthly limits or exclusions per service category. The need to maintain provider participation in the Medicaid program to the extent required by 42 United States Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in any reduction in reimbursement to providers or imposition of copayments.
 
For an adult when the adult’s family income is above 100% of the nonfarm income official poverty line, the department shall adopt rules to adjust the copayments established under this subsection to reflect the maximum allowable amounts authorized under 42 United States Code, Section 1396o; to increase copayments as authorized by 42 United States Code, Section 1396o(h); and in compliance with Section 1396o(b)(3) to impose a copayment for services received at a hospital emergency room of up to twice the amount established as the copayment for outpatient services if the services are not emergency services. The department shall track aggregate copayments in compliance with 42 Code of Federal Regulations, Section 447.68 and, by rule, make adjustments to copayments to ensure compliance with federal law.
Sec. D-2. Contingent effective date. If a majority of the legal votes cast pursuant to Part E of this Act are cast in favor of this Act, that section of this Act that enacts the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I takes effect 30 days after the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services confirms in writing to the Commissioner of Health and Human Services that the enhanced Federal Medical Assistance Percentage set forth in Section 1905(y)(1) of the United States Social Security Act is applicable to the individuals who received coverage as of December 1, 2009, who are described in Title 22, section 3174-G, subsection 1, paragraph F and who are defined in Section 1905(y)(2) of the United States Social Security Act. Upon receipt of confirmation from the federal Centers for Medicare and Medicaid Services, the Commissioner of Health and Human Services shall notify in writing the President of the Senate, the Speaker of the House of Representatives and the Revisor of Statutes and shall provide them with a copy of the written confirmation.
PART E
Sec. E-1. Statutory referendum procedure; submission at election; form of question; effective date. This Act must be submitted to the legal voters of the State at a statewide election held in the month of November following passage of this Act. The municipal officers of this State shall notify the inhabitants of their respective cities, towns and plantations to meet, in the manner prescribed by law for holding a statewide election, to vote on the acceptance or rejection of this Act by voting on the following question:
 
"Do you favor expanding medical coverage under the MaineCare program, which would qualify Maine to receive federal funding for the cost of coverage for members who enroll under the expansion?"
 
The legal voters of each city, town and plantation shall vote by ballot on this question and designate their choice by a cross or check mark placed within a corresponding square below the word "Yes" or "No." The ballots must be received, sorted, counted and declared in open ward, town and plantation meetings and returns made to the Secretary of State in the same manner as votes for members of the Legislature. The Governor shall review the returns. If a majority of the legal votes are cast in favor of this Act, the Governor shall proclaim the result without delay and this Act becomes effective 30 days after the date of the proclamation except that that section of this Act that enacts the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I takes effect as provided in Part D of this Act.
The Secretary of State shall prepare and furnish to each city, town and plantation all ballots, returns and copies of this Act necessary to carry out the purposes of this referendum.
 
SUMMARY
This bill, which is contingent on approval by the voters of the State at referendum, does the following.
1. It expands medical coverage under the MaineCare program to adults who qualify under federal law with incomes up to 133% of the nonfarm income official poverty line, with the 5% federal income adjustment for family size. It repeals the expansion of medical coverage under the MaineCare program December 31, 2020, and it provides for repeal of the expansion prior to 2020 under certain circumstances.
2. It requires the Commissioner of Health and Human Services to provide certain information to the Secretary of the United States Department of Health and Human Services to enable the secretary to make the determination as to the eligibility of the State to obtain an enhanced Federal Medical Assistance Percentage for services for MaineCare members eligible as childless adults. It provides that until the secretary confirms that the State will get the enhanced reimbursement rate as set forth in the federal Patient Protection and Affordable Care Act, for the childless adult population in MaineCare, including persons who were members under that eligibility grouping on December 1, 2009, the expansion of medical coverage under the MaineCare program will not take effect. It requires the commissioner, upon receiving confirmation from the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, to notify the President of the Senate, the Speaker of the House of Representatives and the Revisor of Statutes and to provide them with a copy of the written confirmation.
3. It requires the Office of Fiscal and Program Review to contract with a private, nonpartisan research organization to evaluate the impact of the MaineCare expansion. It requires a report to the Legislature on the amount of General Fund savings resulting from the MaineCare expansion.
4. It amends current law on copayments in the MaineCare program. It directs the Department of Health and Human Services to increase copayments for adults with income above 100% of the nonfarm income official poverty line to the maximum allowable under federal law and to increase nominal copayments by the annual percentage increase in the medical care component of the Consumer Price Index for All Urban Consumers. It directs the department to increase MaineCare copayments for services provided in a hospital emergency room when the services are not emergency services. It requires the department to track aggregate copayments in compliance with federal law.