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An Act To Provide Immunity to Medical Professionals Who Provide Free Health Care Services to Uninsured and Underserved Populations of the State
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24 MRSA §2908  is enacted to read:
§ 2908. Health care providers; creation of agency relationship with governmental contractors
 
1.  Definitions.     As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
 
A.  "Contract" means an agreement executed in compliance with this section between a health care practitioner and a governmental contractor for volunteer, uncompensated services that allows the health care practitioner to deliver health care services to low-income individuals as an agent of the governmental contractor.
 
B.  "Department" means the Department of Health and Human Services.
 
C.  "Free clinic" means an incorporated nonprofit health facility that provides health care at no charge.
 
D.  "Governmental contractor" means the department, a county health department or a hospital owned and operated by a governmental entity.
 
E.  "Low-income individual" means:
 
(1) An individual who is MaineCare-eligible under the laws of this State;
 
(2) An individual who is without health insurance and whose family income does not exceed 200% of the federal poverty level as defined in Title 36, section 6271, subsection 1, paragraph B; or
 
(3) Any client of the department who voluntarily chooses to participate in a program offered or approved by the department and meets the program eligibility guidelines of the department.
 
2.  Contract requirements.     A health care practitioner that executes a contract with a governmental contractor to deliver health care services on or after January 1, 2018 as an agent of the governmental contractor is a state employee for purposes of Title 14, chapter 741 while acting within the scope of duties under the contract if the contract complies with the requirements of this section and regardless of whether the patient treated is later found to be ineligible. A health care practitioner continues to be a state employee for purposes of Title 14, chapter 741 for 30 days after a determination of ineligibility to allow for treatment until the patient transitions to treatment by another health care practitioner. A health care practitioner under contract with the State may not be named as a defendant in any action arising out of medical care or treatment provided on or after January 1, 2018 under contracts entered into under this section. The contract must provide that:
 
A.  The right of dismissal or termination of a health care practitioner delivering services under the contract is retained by the governmental contractor;
 
B.  The governmental contractor has access to the patient records of a health care practitioner delivering services under the contract;
 
C.  Adverse incidents and information on treatment outcomes must be reported by a health care practitioner to the governmental contractor if the incidents and information pertain to a patient treated under the contract. The health care practitioner shall submit the reports required by Title 22, chapter 1684. If an incident involves a professional licensed under Title 32 or a facility licensed by the department, the governmental contractor shall submit the incident reports to the appropriate licensing board or the department, which shall review each incident and determine whether the incident involves conduct by the licensee that is subject to disciplinary action. All patient medical records and any identifying information contained in adverse incident reports and information on treatment outcomes that are obtained by governmental entities under this paragraph are confidential;
 
D.  Patient selection and initial referral must be made by the governmental contractor or the health care practitioner. Patients may not be transferred to the health care practitioner based on a violation of the antidumping provisions of the federal Omnibus Budget Reconciliation Act of 1989 or the federal Omnibus Budget Reconciliation Act of 1990;
 
E.  If emergency care is required, the patient need not be referred before receiving treatment but must be referred within 48 hours after treatment is commenced or within 48 hours after the patient has the mental capacity to consent to treatment, whichever occurs later; and
 
F.  A health care practitioner is subject to supervision and regular inspection by a governmental contractor.
 
A governmental contractor that is also a health care provider is not required to enter into a contract under this section with respect to the health care services delivered by its employees.
 
3.  Volunteer, uncompensated service.     For services to qualify as volunteer, uncompensated services under this section, a health care practitioner, or an employee or agent of the health care practitioner, may not receive compensation from a governmental contractor for any services provided under the contract and may not bill or accept compensation from the recipient or a public or private 3rd-party payor for the specific services provided to the low-income individuals covered by the contract.
 
4.  Notice of agency relationship.     A governmental contractor must provide written notice to each patient, or the patient's legal representative, receipt of which must be acknowledged in writing, that a health care practitioner under contract with the governmental contractor is an agent of the governmental contractor and that the exclusive remedy for injury or damage suffered as the result of any act or omission of the health care practitioner or of any employee or agent thereof acting within the scope of duties pursuant to the contract is by commencement of an action pursuant to the provisions of Title 14, chapter 741. With respect to any federally funded community health center, the notice requirements may be met by posting in a place conspicuous to all persons a notice that the federally funded community health center is an agent of the governmental contractor and that the exclusive remedy for injury or damage suffered as the result of any act or omission of the provider or of any employee or agent thereof acting within the scope of duties pursuant to the contract is by commencement of an action pursuant to the provisions of Title 14, chapter 741.
 
5.  Quality assurance program required.     A governmental contractor shall establish a quality assurance program to monitor services delivered under a contract between the contractor and a health care practitioner pursuant to this section.
 
6.  Risk management report.     The division of risk management within the Department of Administrative and Financial Services shall annually compile a report of all claims statistics for all entities participating in risk management programs administered by the division, which must include the number and total of all claims pending and paid, and defense and handling costs associated with all claims brought against contract providers under this section. This report must be forwarded to the department and included in the annual report submitted to the Legislature pursuant to this section.
 
7.  Reporting.     The following reports are required.
 
A.  Beginning January 1, 2019, the department shall annually report to the Legislature summarizing the efficacy of access to treatment outcomes with respect to providing health care services for low-income individuals pursuant to this section.
 
B.  The department shall provide an online listing of all health care practitioners under this section and the number of volunteer service hours and patient visits each provided. A health care practitioner may request in writing to the department to be excluded from the online listing.
 
8.  Malpractice litigation costs.     Governmental contractors other than the department are responsible for their own costs and attorney's fees for malpractice litigation arising out of health care services delivered pursuant to this section.
 
9.  Continuing education credit.     A health care practitioner may fulfill one hour of continuing education credit pursuant to Title 32, chapter 36 or chapter 48 by performing one hour of volunteer services to low-income individuals as provided in this section, up to a maximum of 8 continuing education hours per licensure renewal period.
 
10.  Free clinic.     A free clinic may receive a legislative appropriation, a grant through a legislative appropriation or a grant from a governmental entity or nonprofit corporation to support the delivery of contracted services by volunteer health care practitioners, including the employment of health care practitioners to supplement, coordinate or support the delivery of those services. The appropriation or grant for the free clinic does not constitute compensation from the governmental contractor for services provided under the contract, nor does receipt or use of the appropriation or grant constitute the acceptance of compensation for the specific services provided to the low-income individuals covered by the contract.
 
11.  Rules.     The department shall adopt rules to administer this section. Notwithstanding the requirements of subsection 2, paragraph D, the department shall adopt rules that specify required methods for determination and approval of patient eligibility and referral by governmental contractors and health care practitioners. The rules adopted by the department under this subsection must give health care practitioners the greatest flexibility possible in order to serve eligible patients. Rules adopted under this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
 
12.  Application.     This section applies to adverse incidents arising out of the treatment of individuals by health care practitioners acting under contract on or after January 1, 2018. This section does not reduce or limit the rights of the State or any of its agencies or subdivisions to any benefit currently provided by Title 14, chapter 741.
 
SUMMARY
This bill improves access to medical care for low-income individuals by providing governmental protection to health care practitioners who offer free medical services to underserved populations of the State. Health care professionals who contract to provide such services as agents of the State are provided immunity under the Maine Tort Claims Act.
For those health care practitioners with continuing education requirements, each hour of volunteer service provides credit for one hour of continuing education, up to a total of 8 continuing education credit hours per calendar year.
This bill applies to adverse incidents occurring on or after January 1, 2018.
This bill is modeled on Florida law.