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Care Coordination/Care Management in Maine

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Maine law encourages patients to play a role in making their own health-related decisions by requiring certain health care providers and facilities to provide periodic patient assessments and create a service plan and/or care plan for the individual.1  The law also allows minor patients to participate in their own care by allowing minors to consent to health treatments, subject to certain restrictions.2

The state also sets forth specific patient and consumer rights with regard to health care.  Maine has established a Consumer Health Care Division within the Bureau of Insurance in order to inform health plan consumers of their rights and responsibilities.3  Hospitals are required to provide patients with average charges for services, if requested,4 and an itemized bill upon request.5  Health insurers in the state of Maine are also obligated to provide consumers with a Bill of Rights outlining benefits, review procedures, and a description of provider profiling programs.6

In addition, the state has taken a number of steps to increase the quality of health care in Maine.  Maine has enacted the Hospital and Health Care Provider Cooperation Act, which allows hospitals and providers to cooperate to enhance the quality of care delivered.7  The state has also passed legislation authorizing the establishment of accountable care organizations, as designed by the federal Patient Protection and Affordable Care Act.8  The Maine Quality Forum is another collaborative effort between the state, providers, consumers, and health plans to put out comparative health care quality reports.9  The Quality Forum is an entity within Dirigo Health, which is an independent executive agency that arranges for comprehensive, affordable health care coverage to eligible small employers, and improves health care quality in the state.10

 

Footnotes

  • 1. 10-144-113 ME. CODE R. § 10
  • 2. ME. REV. STAT. tit. 22, § 1502
  • 3. ME. REV. STAT. tit. 24-A §4321
  • 4. ME. REV. STAT. tit. 22 §1718
  • 5. ME. REV. STAT. tit. 22 §1712; 10-144-112 ME. Code R. §3.5.7
  • 6. ME. REV. STAT. tit. 24-A, § 4303
  • 7. ME. REV. STAT. tit. 22 §1842
  • 8. ME. REV. STAT. tit. 24 –A §4320-H
  • 9. ME. REV. STAT. tit. 24-A §6951
  • 10. ME. REV. STAT. tit. 24-A §6902

 

Care Coordination/Care Management in Maine

Subtopic Statute/Regulation Description
Care Coordination/Care Management Consent - Me. Rev. Stat. tit. 22, § 1502 Except as otherwise provided by law, a minor who may consent to health care services is entitled to the same confidentiality afforded to adults....
Consumer Health Care Division - Me. Rev. Stat. tit. 24-A, § 4321 Maine has established a Consumer Health Care Division within the Bureau of Insurance.  The purpose of the Division is to provide consumers of...
Consumer information - Me. Rev. Stat. tit. 22, § 1718 Every hospital or ambulatory surgical center must, upon request by an individual, provide the average charge for any inpatient service or outpatient...
Consumer Records - 10-144-113 Me. Code R. § 10 For each individual that receives assisted living services, the program must keep a record that includes identifying information of the consumer and...
Dirigo Health established; declaration of necessity - Me. Rev. Stat. tit. 24-A, § 6902 The state of Maine established Dirigo Health as an independent executive agency that makes arrangements for comprehensive, affordable health care...
Itemized bill - 10-144-112 Me. Code R. § 3.5.7 All hospitals must give written notice to all patients that they have the opportunity to request, upon discharge, to obtain a copy of an itemized...
Itemized bills - Me. Rev. Stat. tit. 22, § 1712 Patients have the right, at the time of discharge, to receive an itemized bill upon request.  The request may be made by the patient or patient...
Legislative findings and intent - Me. Rev. Stat. tit. 22, § 1842 Maine has enacted a Hospital and Health Care Provider Cooperation Act that encourages providers and hospitals to enter into agreements to work...
Maine Quality Forum - Me. Rev. Stat. tit. 24-A, § 6951 The Maine Quality Forum is established within Dirigo Health (an independent executive agency that arranges for comprehensive, affordable health care...
Payment reform pilot projects - Me. Rev. Stat. tit. 24-A, § 4320-H Maine has passed authorizing legislation to allow for the establishment of Accountable Care Organizations, as defined by the federal Patient...
Plan requirements - Me. Rev. Stat. tit. 24-A, § 4303 Maine has enacted a Health Care Bill of Rights that provides patients with certain basic rights when obtaining health insurance.  Included in...
Record keeping - Me. Rev. Stat. tit. 22, § 1846 The Department of Human Services is required to maintain records of all entities that have applied for the certificate of public advantage to...
Reports - Me. Rev. Stat. tit. 22, § 8712 The Maine Health Data Organization must file reports on both quality and payments.  The reports must be in an easy to understand format, and be...
Click on the individual state law in the table above to see our summary of the individual law.


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