Legislative Document No. 1591 H.P. 1150 House of Representatives, April 18, 2019
An Act To Provide Access to Health Care for Maine Citizens
Reference to the Committee on Health Coverage, Insurance and Financial Services suggested and ordered printed.
ROBERT B. HUNT Clerk
Presented by Representative BRENNAN of Portland.
Printed on recycled paper 1 Be it enacted by the People of the State of Maine as follows:
2 Sec. 1. 22 MRSA §1722, sub-§1, ¶¶A and B, as reallocated by RR 2007, c. 2, 3 §9, are amended to read: 4 A. Each hospital may voluntarily hold its consolidated operating margin to no more 5 than 3%. For purposes of this paragraph, a hospital's consolidated operating margin 6 is calculated by dividing its consolidated operating income by its total consolidated 7 operating revenue. Annually, for each hospital, the department shall establish a 8 recommended percentage that the hospital should hold its consolidated operating 9 margin to and notify a hospital of the department's recommendation for that hospital. 10 B. Each hospital may voluntarily restrain its increase in its expense per 11 casemix-adjusted inpatient and volume-adjusted outpatient discharge to no more than 12 110% of the forecasted increase in the hospital market basket index for the coming 13 federal fiscal year, as published in the Federal Register, when the federal Centers for 14 Medicare and Medicaid Services publishes the Medicare program's hospital inpatient 15 prospective payment system rates for the coming federal fiscal year. For purposes of 16 this paragraph, the measure of a hospital's expense per casemix-adjusted inpatient and 17 volume-adjusted outpatient discharge is calculated by: 18 (1) Calculating the hospital's total hospital-only expenses; 19 (2) Subtracting from the hospital's total hospital-only expenses the amount of the 20 hospital's bad debt; 21 (3) Subtracting from the amount reached in subparagraph (2) the hospital taxes 22 paid to the State during the hospital's fiscal year; and 23 (4) Dividing the amount reached in subparagraph (3) by the product of: 24 (a) The number of inpatient discharges, adjusted by the all payer case mix 25 index for the hospital; and 26 (b) The ratio of total gross patient service revenue to gross inpatient service 27 revenue. 28 For the purposes of this paragraph, a hospital's total hospital-only expenses include 29 any item that is listed on the hospital's Medicare cost report as a subprovider, such as 30 a psychiatric unit or rehabilitation unit, and does not include nonhospital cost centers 31 shown on the hospital's Medicare cost report, such as home health agencies, nursing 32 facilities, swing beds, skilled nursing facilities and hospital-owned physician 33 practices. For purposes of this paragraph, a hospital's bad debt is as defined and 34 reported in the hospital's Medicare cost report and as submitted to the Maine Health 35 Data Organization pursuant to Title 22, chapter 1683. Annually, for each hospital, the 36 department shall establish a recommended limit on an increase in the hospital's 37 expenses under this paragraph and notify the hospital of the department's 38 recommendation for that hospital. 39 Sec. 2. 36 MRSA §2892, as amended by PL 2017, c. 284, Pt. IIII, §1, is further 40 amended by adding at the end a new paragraph to read:
Page 1 - 129LR1546(01)-1 1 For state fiscal years beginning on or after July 1, 2020, the hospital's taxable year is 2 the hospital's fiscal year that ended during calendar year 2018.
3 Sec. 3. Medicare Buy-in Program and Affordable Care Act subsidies; 4 plan for increased funding. The Department of Health and Human Services shall 5 develop a plan to provide increased funding for the Medicare Buy-in Program and for 6 subsidies to individuals under the federal Patient Protection and Affordable Care Act 7 using revenue resulting from changing, from 2014 to 2018, the base year on which the 8 hospital tax is imposed under the Maine Revised Statutes, Title 36, section 2892. By 9 December 4, 2019, the department shall submit a report on the plan to the Joint Standing 10 Committee on Health Coverage, Insurance and Financial Services and the committee may 11 report out a bill relating to the report to the Second Regular Session of the 129th 12 Legislature.
13 Sec. 4. Wholesale prescription drug importation program; design. The 14 Department of Health and Human Services, in consultation with relevant other state 15 agencies, federal agencies and interested parties, shall design a wholesale prescription 16 drug importation program that complies with 21 United States Code, Section 384, 17 including requirements regarding safety and cost savings. By December 4, 2019, the 18 department shall submit the design for a wholesale prescription drug importation program 19 to the Joint Standing Committee on Health Coverage, Insurance and Financial Services 20 and the committee may report out a bill to the Second Regular Session of the 129th 21 Legislature. In designing the wholesale prescription drug importation program, the 22 department must ensure that the program:
23 1. Designates a state agency to oversee the program and become a licensed 24 wholesaler for the purpose of seeking federal certification and approval to import safe 25 prescription drugs that will provide savings to consumers in the State;
26 2. Uses Canadian suppliers of prescription drugs regulated under the appropriate 27 Canadian or provincial laws;
28 3. Includes a process to sample the purity, chemical composition and potency of 29 imported prescription drugs;
30 4. Ensures that only those prescription drugs expected to generate substantial savings 31 for consumers in the State are imported into the State;
32 5. Ensures that imported prescription drugs will not be distributed, dispensed or sold 33 outside of the State;
34 6. Ensures that consumers and health plans are charged only the actual acquisition 35 cost of the imported, dispensed prescription drugs;
36 7. Ensures that the health plan payment of the prescription drug component of 37 pharmacy and health care provider billing reimburses no more than the actual acquisition 38 cost of the dispensed, imported prescription drug;
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