Overview of 131st Maine Legislature and Legislative Updates

The 131st Maine Legislature comprises 186 legislators, including Representatives Zager and Pringle, both physicians. Key legislative committees cover areas such as taxation, health services, judiciary, and education. Find information on Maine legislation tracking, medical ethics, and policy references for decision-making. Stay informed about Maine's legislative landscape through provided resources and updates from the Maine Medical Association.

• Maine Legislature
• Legislative Updates
• Physicians in Legislation
• Legislative Committees
• Medical Ethics

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1. MMA Legislative Update: 131stMaine Legislature, First Regular & First Special Sessions January July 2023

2. Disclosure I have no financial interest in the topic of this presentation & no actual or potential conflict of interest to disclose I am an employee of the Maine Medical Association, a professional organization representing more than 4300 physicians, residents, & medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine people 9/23/2024

3. The Policymakers 186 Legislators; 131stMaine Legislature 22 D, 13 R in Senate 80 D, 68 R, 2 Independents, & 1 Vacancy in House 151 members of the House of Representatives, each representing 8,800 citizens 35 Senators, each representing 38,000 citizens All elected every 2 years for maximum of 4 consecutive terms Governor: elected every 4 years for maximum of 2 terms Impact of term limit & MCEA public campaign financing laws

4. Physicians in the 131stMaine Legislature Representative Sam Zager, M.D. (D House District 116, part of Portland) Representative Jane Pringle, M.D. (D House District 107, part of Windham) 4

5. Tracking Maine Legislation Maine legislature s web site: http://legislature.maine.gov/ Bill status: L.D. # Session laws: P.L. or Resolves Chapter Statutes: 24 M.R.S.A. sec. 2851 State agency rules online: http://www.maine.gov/sos/cec/rules/rules.html Find your Representative: https://legislature.maine.gov/house/house/MemberProfil es/ListAlpha Find your Senator: https://legislature.maine.gov/senate- home-page/find-your-state-senator

6. Medical Ethics & Policy References AMA Code of Medical Ethics: https://code-medical- ethics.ama-assn.org AMA PolicyFinder: https://policysearch.ama- assn.org/policyfinder

7. Key Legislative Committees Joint Standing Committees on: Appropriations & Financial Affairs Taxation Health & Human Services Health Coverage, Insurance & Financial Services Judiciary Labor & Housing Innovation, Development, Economic Advancement, & Business Criminal Justice & Public Safety Education & Cultural Affairs Committee lists: http://www.legislature.maine.gov/committee/#Committees 7

8. Maines Path of Legislation Idea developed Bill drafted (Legislative Request or LR) Bill introduced (Legislative Document or LD) Committee reference Committee action (public hearing/work session(s)/vote) First Reading (committee amendments) Second Reading (floor amendments) Next chamber, same process (must pass in identical form in both chambers) Governor s action (10 days to sign or veto) Law (effective 90 days after adjournment, unless emergency or specified effective date; citation is Public Law or Resolve )

9. Physician Advocacy in Maine Maine Medical Association & Maine Osteopathic Association join Legislative Committees and processes for 2024 Medical specialty societies are welcome & encouraged to join the advocacy effort Organizational meeting for Second Regular Session is Thursday, December 14, 2023; meeting will be hybrid in person at the MMA office in Manchester and by Zoom Weekly Legislative Committee Zoom meetings likely will begin the week of January 8, 2024 Key Contacts program Doctor of the Day Program

10. Highlights from the First Regular & First Special Sessions of the 131stMaine Legislature January July 2023

11. Abortion L.D. 1619, An Act to Improve Maine s Reproductive Privacy Laws (P.L. 2023, Chapter 416), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P1044&item=3&snum=131 Governor s bill MMA supported; President Erik Steele, D.O. and Legislative Committee member Connie Adler, M.D. testified in support Note continued use of term, viability which ACOG does not use, preferring abortion late in pregnancy Confirms Roe standard in Maine law no restrictions on right to choose prior to viability After viability, permitted if necessary in the professional judgment of a licensed physician who must apply the standar of care Includes a potential criminal penalty if an abortion prior to viability is performed by an individual other than a physician, PA, or APRN

12. Medical Liability L.D. 934, An Act to Amend the Laws Governing Damages Awarded for Wrongful Death (P.L. 2023, Chapter 390), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0581&item=6&snum=131 Raises cap on non-economic damages from $750,000 to $1M and adds an automatic inflation adjustment Raises cap on punitive damages from $250,000 to $500,000 Extends statute of limitations from 2 to 3 years from date of death except in the case of homicide when it is 6 years Note: advocacy of many physician and other health care organizations defeated L.D. 549, An Act Regarding a Discovery Rule for the Statute of Limitations in Cases of Medical Negligence Statute of limitations and medical malpractice pre-litigation screening panels are the two key elements of Maine s medical liability dispute resolution framework

13. Medical Liability L.D. 616, An Act to Protect Health Care Professionals Providing Reproductive Health Care Services (P.L. 2023, Chapter 345): http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0393&item=3&snum=131 Prohibits a professional liability insurer in Maine from refusing, canceling, or restricting coverage based solely on the insured s provision of reproductive health care services that may be contrary to another state s laws

14. Transgender Care for Minors L.D. 535, An Act Regarding Consent for Gender-affirming Hormone Therapy for Certain Minors (P.L. 2023, Chapter 413), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0340&item=5&snum=131 Practitioner (MD, DO, PA, APRN) may provide such care without parental consent Minor is 16 Gender dysphoria diagnosis Professional judgment is that failure to treat would harm minor Minor informs practitioner that parent(s) or guardian(s) refuse to support treatment Practitioner follows specific standards for informed consent

15. Transgender Care for Minors L.D. 1040, An Act to Require Reimbursement for Gender-affirming Care for MaineCare Members (P.L. 2023, Chapter 288), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0 676&item=3&snum=131 Requires MaineCare coverage for medically necessary care related to gender dysphoria as defined in the DSM Prohibits discrimination on the basis of gender identity or expression

16. Transgender Care L.D. 956, An Act Concerning Sexual Orientation and Gender Identity Data Collection in Health Care Facilities (P.L. 2023, Chapter 129), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0603&item=3&snum=131 Beginning 10/1/26, a health care facility, other than a pharmacy, must collect sexual orientation and gender identity data from an individual during intake unless the individual declines Does NOT apply to the office of an individual licensed practitioner

17. Maintenance of Certification (MOC) L.D. 224, An Act to Strengthen Maine s Health Care Workforce by Requiring Maintenance of Certification for Insurance Reimbursement (P.L. 2023, Chapter 40), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0 145&item=3&snum=131 Prohibits an insurer from denying or reducing reimbursement for services provided by a physician, hospital, or outpatient clinical practice because a physician does not participate in a MOC program Effective for policies issued/renewed after 1/1/24 Maine Association of Psychiatric Physicians (MAPP) bill

18. Undisputed Health Insurance Claims L.D. 1244, An Act to Define Undisputed Health Insurance Claims (P.L. 2023, Chapter 332), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0792&item=3&snum=131 Establishes a new definition of undisputed claim in the existing health insurer prompt payment standards

19. Access to Birth Control L.D. 351, An Act to Increase Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist (P.L. 2023, Chapter 115), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=S P0158&item=3&snum=131http://www.mainelegislature.org/legis/ bills/getPDF.asp?paper=SP0158&item=3&snum=131 Permits a pharmacist to prescribe, dispense, or administer a self-administered hormonal contraceptive or injectable hormonal contraceptive if: The pharmacist has completed a Board designated training The patient has provided a self-screening risk assessment The pharmacist has a valid certificate from the Board The pharmacist has referred the patient to her practitioner and provided a written record of the prescription

20. Specialist Referral from Urgent Care Facility L.D. 722, An Act to Expedite the Health Insurance Referral Process for Specialists by Allowing Referrals During Urgent Care Visits (P.L. 2023, Chapter 119), https://legislature.maine.gov/backend/App/services/getDocumen t.aspx?documentId=101106https://legislature.maine.gov/backen d/App/services/getDocument.aspx?documentId=101106 Prohibits an insurance carrier from denying coverage for behavioral health services or physical therapy services based solely on that the referral came from a provider other than the primary care provider given the referral was made during an urgent care visit and the primary care provider was notified

21. Involuntary Hospitalization Process L.D. 459, An Act to Update the Procedures for Issuance of Orders Relating to Involuntary Hospitalizations (P.L. 2023, Chapter 66), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=S P0213&item=3&snum=131 Authorizes an electronic endorsement submitted by secure electronic means to be accepted in place of a physical signature for involuntary hospitalization judicial review

22. Pharmacist Administration of Vaccines L.D. 1151, An Act Concerning the Authority for Pharmacists to Administer Vaccines (P.L. 2023, Chapter 170), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=S P0478&item=3&snum=131 Changes the age when a pharmacist may administer the flu vaccine without a prescription from 7 years to 3 years It authorizes a pharmacist to administer a FDA-approved and CDC-recommended vaccine to a minor from age 3 to age 18 with a valid prescription It authorizes a pharmacist to administer a FDA-approved and CDC-recommended vaccine to a person age 18 or older without a prescription, but for a vaccine not within the CDC guidelines, a valid prescription is required A pharmacist must provide a written record of the vaccination to the patient and must notify the PCP of the vaccination within 72 hours of the vaccination

23. Vaccine Administration by Pharmacy Technicians L.D. 899, An Act to Authorize Vaccine Administration by Pharmacy Technicians and to Reduce Vaccine Administration Training Requirements for Pharmacists (P.L. 2023, Chapter 245), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0555&item=6&snum=131 Authorizes a pharmacy technician to administer vaccines under the direct supervision of a pharmacist who is qualified to administer vaccines

24. HIV/AIDS Testing L.D. 1736, An Act to Advance the National HIV/AIDS Strategy in Maine by Broadening HIV Testing (P.L. 2023, Chapter 281), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P1115&item=3&snum=131 With patient consent, a health care provider is directed to include an HIV test in the standard set of tests for an individual who may have a STD

25. Access to Differing Opioid Overdose- reversing Medications L.D. 1728, An Act to Ensure Access to Federally-approved Opioid Overdose-reversing Medication (P.L. 2023, Chapter 161), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=S P0692&item=2&snum=131 Includes any FDA-approved opioid reversal medication for authorized use in collaborative practice agreements, prescriptions, pharmacy purchases, standing orders, and law enforcement use

26. Mandatory Reporting Process L.D. 474, An Act to Improve Collaboration Between Mandatory Reporters and Law Enforcement in the Investigation of Alleged Child Abuse and Neglect (P.L. 2023, Chapter 146), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0291&item=2&snum=131 Requires a staff or person in charge of a public or private medical institution, agency, or facility to disclose the same documentation of child abuse or neglect submitted to the Maine DHHS to law enforcement upon request

27. Health Insurance Coverage for Breast Examinations L.D. 1836, An Act Regarding Insurance Coverage for Diagnostic and Supplemental Breast Examinations (P.L. 2023, Chapter 338), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P1168&item=4&snum=131 Requires insurance coverage for diagnostic and supplemental breast examinations if a screening mammography s results are inconclusive

28. Funding for Maine Pediatric & Behavioral Health Partnership L.D. 231, An Act to Support the Maine Pediatric and Behavioral Health Partnership (P.L. 2023, Chapter 339), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0152&item=3&snum=131 Provides continued funding for this Program

29. Study of a SUD Hotline L.D. 162, Resolve, to Study the Establishment of a Substance Use Disorder Hotline (Resolves 2023, Chapter 69), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0103&item=3&snum=131 Hotline to support primary care physicians and other providers giving care to patients with substance use disorders

30. Review MaineCare Telehealth Policy L.D. 757, Resolve, to Review Telemonitoring and Certain Telehealth Services Reimbursed under MaineCare (Resolves 2023, Chapter 89), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=S P0315&item=3&snum=131 review on MaineCare Coverage of telemonitoring systems with specific regards to any access restrictions. DHHS review on MaineCare Coverage of telemonitoring systems with specific regards to any access restrictions

31. Study Regarding Foreigned-trained Physicians L.D. 937, Resolve, to Establish the Commission Regarding Foreign-trained Physicians Living in Maine (Resolves 2023, Chapter 93), http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=H P0584&item=3&snum=131http://www.mainelegislature.org/legis/ bills/getPDF.asp?paper=HP0584&item=3&snum=131 Commission to study integrating foreign-trained physicians into Maine s health care workforce MMA nominated James Jarvis, M.D. as physician member

32. Preview of the Second Regular Session Cloture deadline for bill filing for Second Regular Session: September 29, 2023; Legislative Council review process Bills carried over from the First Regular and First Special Sessions Governor can submit bills at any time 131stLegislature convenes for Second Regular Session on January 3, 2024 General effective date for bills enacted during the First Regular Session: June 29, 2023 General effective date for bills enacted during the First Special Session: October 25, 2023 MMA Legislative Summary of the First Regular and First Special Sessions: https://www.mainemed.com/sites/default/files/content/2023%20Legislative%20Summary_ 8.4.pdf

33. Key Carry Over Bills LD 663: An Act to Require Health Insurance Coverage for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Pediatric Acute onset Neuropsychiatric Syndrome LD 1533: An Act to Provide for Consistent Billing Practices by Health Care Providers LD 1577: An Act to Require Health Insurance Coverage for Biomarker Testing LD 796: An Act Concerning Prior Authorizations for Health Care Provider Services LD 1407: An Act to Amend the Maine Insurance Code Regarding Payments by Health Insurance Carriers to Providers LD 1498: An Act to Create an Advocacy and Complaint Process for Health Care Providers Within the Bureau of Insurance

34. Key Carry Over Bills LD 1955: An Act to Require Hospitals and Hospital affiliated Providers to Provide Financial Assistance for Medical Care LD 353: An Act Concerning Substance Use Disorder, Treatment, Recovery, Prevention and Education LD 906: An Act to Ensure Physicians Receive Full Diagnostic Test Data Concerning Tick borne Diseases LD 1902: An Act to Protect Personal Health Data LD 1735: An Act to Safeguard Gender affirming Health Care LD 1973: An Act to Enact the Maine Consumer Privacy Act LD 1977: An Act to Create the Data Privacy and Protection Act LD 738: An Act to Establish a Paid Family and Medical Leave System

35. Key Carry Over Bills LD 1914: An Act to Enact the Maine Psilocybin Health Access Act LD 1215: An Act to End the Sale of Flavored Tobacco Products LD 1360: An Act Requiring Training Regarding and Screening for Adverse Childhood Experiences LD 1693: An Act to Address Unsafe Staffing of Nurses and Improve Patient Care LD 225: An Act to Fund Free Health Clinics LD 223: An Act Regarding Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities LD 904: An Act Supporting the Rural Health Care Workforce in Maine LD 997: Resolve, to Reduce Workforce Barriers for Mental Health Professionals in Maine LD 1837: An Act to Increase Oral Health Services

36. Key Carry Over Bills LD 1797: An Act to Expand Maine's Health Care Workforce by Expanding Educational Opportunities LD 1558: An Act to Prohibit the Sale of Tobacco Products in Pharmacies and Retail Establishments Containing Pharmacies LD 999: An Act to Support Family Caregivers by Expanding Family Medical Leave LD 1792: Resolve, to Establish the Rural Health Services Task Force LD 1305: Resolve, to Design and Implement a community based Model of Care for Adolescent Mental Health LD 1858: An Act to Ensure Access to Newly Born Male Infant Circumcision by Requiring MaineCare Coverage LD 1304: Resolve, to Establish the Task Force to Study Barriers to Achieving Behavioral Health Integration and Parity

37. Administrative Rulemaking DHHS Rate Review process Rights of Recipients of behavioral health services stakeholder process

38. Federal Issues Medicare payment issues Health care reform: MMA s revised Statement on Reform of the U.S. Health Care System, adopted by MMA Board of Directors on June 7, 2023, https://www.mainemed.com/sites/default/files/content/statement _hcr_mma_board_adopted_6_7_23_FINAL.pdf Interim Meeting of the AMA House of Delegates, National Harbor, MD, November 11-14, 2023 AMA National Advocacy Conference, Washington, D.C., April 12-14, 2024

39. Questions? Andrew B. MacLean, J.D. CEO amaclean@mainemed.com; 207-215-7462 (Mobile) Mikenzie Dwyer Public Health & Government Affairs Manager mdwyer@mainemed.com; 207-475-3312 (Mobile)