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Home > Statutes > Usa Maine
USA Statutes : maine
Title : Title 22. HEALTH AND WELFARE
Chapter : Chapter 405-D. HOSPITAL COOPERATION ACT (HEADING. PL 1991, c. 814, @1 (new))
Title 22 - §1881. Short title

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1881. Short title

This chapter may be known and cited as the "Hospital Cooperation Act of 1992." [1991, c. 814, §1 (new).]
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1882. Definitions

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1882. Definitions

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [1991, c. 814, §1 (new).]

1. Cooperative agreement. "Cooperative agreement" means an agreement among 2 or more hospitals or nonprofit mental health care providers for the sharing, allocation or referral of patients, personnel, instructional programs, mental health services, support services and facilities or medical, diagnostic or laboratory facilities or procedures or other services traditionally offered by hospitals or nonprofit mental health care providers, or for the coordinated negotiation and contracting with payors or employers or for the merger of 2 or more hospitals. [1995, c. 583, §1 (amd).]


2. Hospital. "Hospital" means:



A. Any acute care institution required to be licensed as a hospital under section 1811; or [1991, c. 814, §1 (new).]




B. Any nonprofit parent of a hospital, hospital subsidiary or hospital affiliate that provides medical or medically related diagnostic and laboratory services or engages in ancillary activities supporting those services. [1991, c. 814, §1 (new).]

[1991, c. 814, §1 (new).]


2-A. Merger. "Merger" means a transaction by which ownership or control over substantially all of the stock, assets or activities of one or more licensed and operating hospitals is placed under the control of another licensed hospital or hospitals or the parent organization of that hospital or hospitals. [1995, c. 583, §2 (new).]


3. Nonprofit mental health care provider. "Nonprofit mental health care provider" means a corporation organized under the Maine Nonprofit Corporation Act or an organization recognized as exempt from federal income tax under 26 United States Code, Section 501(c)(3) that is engaged primarily in the provision of mental health services. [1995, c. 232, §2 (new).]

The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1883. Certification for cooperative agreements

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1883. Certification for cooperative agreements

1. Authority. A hospital or nonprofit mental health care provider may negotiate and enter into cooperative agreements with other hospitals or nonprofit mental health care providers in the State if the likely benefits resulting from the agreements outweigh any disadvantages attributable to a reduction in competition that may result from the agreements. [1995, c. 232, §3 (amd).]


2. Application for certificate. Parties to a cooperative agreement may apply to the department for a certificate of public advantage governing that cooperative agreement. The application must include an executed written copy of the cooperative agreement and describe the nature and scope of the cooperation in the agreement and any consideration passing to any party under the agreement. A copy of the application and copies of all additional related materials must be submitted to the Attorney General and to the department at the same time. [1991, c. 814, §1 (new).]


2-A. Letter of intent. Parties to a hospital merger agreement who intend to file an application for a certificate of public advantage for the merger transaction shall file a letter of intent describing the proposed merger with the department and the Attorney General at least 45 days prior to the filing of the application for a certificate of public advantage. [1995, c. 583, §3 (new).]


3. Procedure for department review. The following procedures apply to the review of the application by the department.



A. The department shall review and evaluate the application in accordance with the standards set forth in subsection 4. [1995, c. 583, §4 (new).]




B. The department shall furnish copies of any letter of intent, application or decision to a person who requests copies and to a person who registers annually with the department for that purpose. A person may provide the department with written comments concerning the application within 30 days after the application is filed. The department shall provide the Attorney General with copies of all comments. [1995, c. 583, §4 (new).]




C. The department may hold a public hearing in accordance with rules adopted by the department. Intervention is governed by the provisions of Title 5, section 9054. [1995, c. 583, §4 (new).]




D. The parties to a cooperative agreement may withdraw their application and thereby terminate all proceedings under this chapter as follows:

(1) Without the approval of the department, the Attorney General or the Superior Court anytime prior to the filing of an answer or responsive pleading in a court action under section 1885, subsection 2 or prior to entry of a consent decree under section 1885, subsection 7; or


(2) Without the approval of the department, anytime prior to the issuance of a final decision under paragraph E if a court action has not been filed under section 1885, subsection 2.
[1995, c. 583, §4 (new).]




E. The department shall grant or deny finally the application no less than 40 days nor more than 90 days after the filing of the application. The department shall issue a recommended decision at least 5 days prior to issuing a final decision granting or denying the application. The recommended and final decisions must be in writing and set forth the basis for the decision. [1995, c. 583, §4 (new).]

[1995, c. 583, §4 (rpr).]


4. Standards for certification. The department shall issue a certificate of public advantage for a cooperative agreement if it determines that the applicants have demonstrated by clear and convincing evidence that the likely benefits resulting from the agreement outweigh any disadvantages attributable to a reduction in competition that may result from the agreement.



A. In evaluating the potential benefits of a cooperative agreement, the department shall consider whether one or more of the following benefits may result from the cooperative agreement:

(1) Enhancement of the quality of hospital or nonprofit mental health care or related care provided to Maine citizens;


(2) Preservation of hospital or nonprofit mental health care provider and related facilities in geographical proximity to the communities traditionally served by those facilities;


(3) Gains in the cost efficiency of services provided by the hospitals or nonprofit mental health care providers involved;


(4) Improvements in the utilization of hospital or nonprofit mental health care provider resources and equipment;


(5) Avoidance of duplication of hospital or nonprofit mental health care resources; and


(6) Continuation or establishment of needed educational programs for health care professionals and providers.

In any certificate for a merger issued under this chapter, the department shall make specific findings as to the nature and extent of any likely benefit found under this paragraph. [1995, c. 583, §5 (amd).]




B. The department's evaluation of any disadvantages attributable to any reduction in competition likely to result from the agreement may include, but need not be limited to, the following factors:

(1) The extent of any likely adverse impact on the ability of health maintenance organizations, preferred provider organizations, managed health care service agents or other health care payors to negotiate optimal payment and service arrangements with hospitals, physicians, allied health care professionals or other health care providers;


(2) The extent of any reduction in competition among hospitals, physicians, allied health professionals, other health care providers or other persons furnishing goods or services to, or in competition with, hospitals or nonprofit mental health care providers that is likely to result directly or indirectly from the hospital cooperative agreement;


(3) The extent of any likely adverse impact on patients or clients in the quality, availability and price of health care services;


(4) The availability of arrangements that are less restrictive to competition and achieve the same benefits or a more favorable balance of benefits over disadvantages attributable to any reduction in competition likely to result from the agreement; and


(5) The extent of any likely adverse impact on the access of persons in in-state educational programs for health professions to existing or future clinical training programs.
[1995, c. 583, §5 (amd).]




C. In evaluating the cooperative agreement under the standards in paragraphs A and B, the department shall consider the extent to which any likely disadvantages may be ameliorated by any reasonably enforceable conditions and the extent to which the likely benefits or favorable balance of benefits over disadvantages may be enhanced by any reasonably enforceable conditions under subparagraph (2).

(1) In any certificate issued under this subsection, the department may include conditions reasonably necessary to ameliorate any likely disadvantages of the type specified in paragraph B, subparagraphs (1) to (3).


(2) In any certificate issued under this subsection, the department may include additional conditions, if proposed by the applicants, designed to achieve public benefits, which may include but are not limited to the benefits listed in paragraph A.


(3) In any certificate issued under this subsection the department shall require the applicants to report periodically the extent of their compliance with any conditions issued under this paragraph. The department shall review the applicant's submission and compliance and report the results of its review to the Attorney General. Reviews are required as follows:

(a) For transactions not involving mergers, at least once in the first 39 months after issuance of the certificate; and


(b) For transactions involving mergers, between 27 and 39 months after issuance of the certificate. In this review the department also shall analyze the extent to which benefits have been achieved by the merger.

[1995, c. 583, §6 (new).]

[1995, c. 583, §§5, 6 (amd).]


5. Review by Attorney General. The department shall consult with the Attorney General regarding its evaluation of any potential reduction in competition resulting from a cooperative agreement. [1991, c. 814, §1 (new).]


6. Certificate termination and enforcement. If the department determines that the likely benefits resulting from a certified agreement no longer outweigh any disadvantages attributable to any potential reduction in competition resulting from the agreement, the department may initiate proceedings to terminate the certificate of public advantage. The department may institute proceedings to enforce any conditions included in the certificate if it determines that the applicants are not in substantial compliance with such conditions. All proceedings under this subsection must be conducted under Title 5, chapter 375, subchapter IV. [1995, c. 583, §7 (amd).]


7. Recordkeeping. The department shall maintain on file all cooperative agreements for which certificates of public advantage remain in effect. Any party to a cooperative agreement who terminates the agreement shall file a notice of termination with the department within 30 days after termination. [1991, c. 814, §1 (new).]

The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1884. Judicial review of department action

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1884. Judicial review of department action

Any applicant or intervenor aggrieved by a decision of the department in granting or denying an application, refusing to act on an application or terminating a certificate is entitled to judicial review of the decision in accordance with the Maine Administrative Procedure Act. [1991, c. 814, §1 (new).]
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1885. Attorney General authority

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1885. Attorney General authority

1. Investigative powers. The Attorney General, at any time after an application is filed under section 1883, subsection 2, or a letter of intent is filed under section 1883, subsection 2-A, may require by subpoena the attendance and testimony of witnesses and the production of documents in Kennebec County or the county in which the applicants are located for the purpose of investigating whether the cooperative agreement satisfies the standards set forth in section 1883, subsection 4. All documents produced and testimony given to the Attorney General are confidential. The Attorney General may seek an order from the Superior Court compelling compliance with a subpoena issued under this section. [1995, c. 583, §8 (amd).]


2. Court action; time limits. The Attorney General may seek to enjoin the operation of a cooperative agreement for which an application for certificate of public advantage has been filed by filing suit against the parties to the cooperative agreement in Superior Court. The Attorney General may file an action before or after the department acts on the application for a certificate; however, the action must be brought no later than 40 days following the department's approval of an application for a certificate of public advantage. After the filing of a court action under this subsection, the department may not take any further action under this chapter and the time periods specified for departmental action under section 1883, subsection 3 are tolled until the court action is dismissed by the Attorney General or the Superior Court orders the department to take further action. [1995, c. 583, §9 (amd).]


3. Automatic stay. Upon the filing of the complaint in an action under subsection 2, the department's certification, if previously issued, must be stayed and the cooperative agreement is of no further force unless the court orders otherwise or until the action is concluded. The applicants for certificate of public advantage may apply to the Superior Court for relief from that stay; the relief may be granted only upon showing of compelling justification. The Attorney General may apply to the court for any ancillary temporary or preliminary relief necessary to stay the cooperative agreement pending final disposition of the case. [1995, c. 583, §9 (amd).]


4. Standard for adjudication. In any action brought under subsection 2, the applicants for a certificate bear the burden of establishing by clear and convincing evidence that, in accordance with section 1883, subsection 4, the likely benefits resulting from the cooperative agreement outweigh any disadvantages attributable to a reduction in competition that may result from the agreement. In assessing disadvantages attributable to a reduction in competition likely to result from the agreement, the court may draw upon the determinations of federal and Maine courts concerning unreasonable restraint of trade under 15 United States Code, Sections 1 and 2 and Title 10, sections 1101 and 1102. [1991, c. 814, §1 (new).]


5. Change of circumstances. If, at any time following the 40-day period specified in subsection 2, the Attorney General determines that as a result of changed circumstances the benefits resulting from a certified agreement no longer outweigh any disadvantages attributable to a reduction in competition resulting from the agreement, the Attorney General may file suit in the Superior Court seeking to cancel the certificate of public advantage. The standard for adjudication for an action brought under this subsection is as follows.



A. Except as provided in paragraph B, in any action brought under this subsection the Attorney General has the burden of establishing by a preponderance of the evidence that, as a result of changed circumstances, the benefits resulting from the agreement and the unavoidable costs of canceling the agreement are outweighed by disadvantages attributable to a reduction in competition resulting from the agreement. [1991, c. 814, §1 (new).]




B. In any action under this subsection, if the Attorney General first establishes by a preponderance of evidence that the department's certification was obtained as a result of material misrepresentation to the department or the Attorney General or as the result of coercion, threats or intimidation toward any party to the cooperative agreement, then the parties to the agreement bear the burden of establishing by clear and convincing evidence that the benefits resulting from the agreement and the unavoidable costs of canceling the agreement outweigh the disadvantages attributable to any reduction in competition resulting from the agreement. [1995, c. 583, §10 (amd).]

[1995, c. 583, §10 (amd).]


5-A. Enforcement of conditions. Conditions included in a certificate may be enforced according to this subsection.



A. If the parties to a cooperative agreement not involving a merger are not in substantial compliance with any conditions included in the certificate under section 1883, subsection 4, or in a consent decree entered under subsection 7, the Attorney General may seek an order from the Superior Court compelling compliance with such conditions or other appropriate equitable remedies. If the Superior Court grants such relief and that relief is not effective in securing compliance with the conditions, the Superior Court may impose additional equitable remedies, including the exercise of civil contempt powers, or may cancel the certificate of public advantage upon a determination that advantages to be gained by canceling the certificate outweigh the unavoidable costs resulting from a cancellation. [1995, c. 583, §11 (new).]




B. If the parties to a cooperative agreement involving a merger are not in substantial compliance with any conditions included in the certificate under section 1883, subsection 4, or in a consent decree entered under subsection 7, the Attorney General may seek an order from the Superior Court compelling compliance with such conditions. If the parties to the merger fail to comply with any court order compelling compliance with such conditions, the Superior Court may impose additional equitable remedies to secure compliance with its orders, including the exercise of civil contempt powers or appointment of a receiver. If these additional measures are not effective in securing compliance with the conditions, and the Superior Court determines that the advantages to be gained by divestiture outweigh the unavoidable costs of requiring divestiture, the Superior Court may cancel the certificate and order divestiture of assets. [1995, c. 583, §11 (new).]

[1995, c. 583, §11 (new).]


6. Fees and costs. If the Attorney General prevails in an action under this section, the Department of the Attorney General is entitled to an award of the reasonable costs of deposition transcripts incurred in the course of the investigation or litigation and reasonable attorney's fees, expert witness fees and court costs incurred in litigation. In addition, a nonprofit mental health care provider shall reimburse the Department of the Attorney General for the costs incurred by the department in its review of an application for a certificate of public advantage submitted by a nonprofit mental health care provider or a proposed cooperative agreement submitted to the Attorney General by a nonprofit mental health care provider prior to the filing of an application, including but not limited to the costs of retaining experts, travel and obtaining data. [1995, c. 232, §5 (amd).]


7. Resolution by consent decree. The Superior Court may resolve any action brought by the Attorney General under this chapter by entering an order with the consent of the parties. The consent decree may contain any conditions authorized by section 1883, subsection 4, paragraph C. A consent decree under this subsection may not be filed with the Superior Court until 30 days after the filing of the application under section 1883, subsection 2. Upon the entry of such an order, the parties to the cooperative agreement have the protection specified in section 1886 and the cooperative agreement has the effectiveness specified in section 1886. [1995, c. 583, §12 (amd).]

The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1886. Effect of certification; applicability

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1886. Effect of certification; applicability

1. Validity of certified cooperative agreements. Notwithstanding Title 5, chapter 10, Title 10, chapter 201 or any other provision of law, a cooperative agreement for which a certificate of public advantage has been issued is a lawful agreement. Notwithstanding Title 5, chapter 10, Title 10, chapter 201 or any other provision of law, if the parties to a cooperative agreement file an application for a certificate of public advantage governing the agreement with the department, the conduct of the parties in negotiating and entering into a cooperative agreement is lawful conduct. Nothing in this subsection immunizes any person for conduct in negotiating and entering into a cooperative agreement for which an application for a certificate of public advantage is not filed. [1995, c. 583, §13 (amd).]


2. Validity of cooperative agreements determined not in public interest. If, in any action by the Attorney General, the Superior Court determines that the applicants have not established by clear and convincing evidence that the likely benefits resulting from a cooperative agreement outweigh any disadvantages attributable to any potential reduction in competition resulting from the agreement, the agreement is invalid and has no further force or effect when the judgment becomes final after the time for appeal has expired or the judgment of the Superior Court is affirmed on appeal. [1995, c. 583, §13 (amd).]


3. Other laws specifically regulating hospitals. Nothing in this chapter exempts hospitals or other health care providers from compliance with laws governing certificates of need or hospital cost reimbursement. [1991, c. 814, §1 (new).]


4. Mergers and consolidations involving licensed hospitals. [1995, c. 583, §14 (rp).]


5. Contract disputes. Any dispute among the parties to a cooperative agreement concerning its meaning or terms is governed by normal principles of contract law. [1991, c. 814, §1 (new).]

The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1887. Assessment

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1887. Assessment

Except for state-operated mental health hospitals, all hospitals licensed by the department are subject to an annual assessment under this chapter. The department shall collect the assessment. The amount of the assessment must be based upon each hospital's gross patient service revenue. For any fiscal year, the aggregate amount raised by the assessment may not exceed $200,000. The department shall deposit funds collected under this section into a dedicated revenue account. Funds remaining in the account at the end of each fiscal year do not lapse but carry forward into subsequent years. Funds deposited into the account must be allocated to carry out the purposes of this chapter. [1999, c. 306, §1 (amd); §2 (aff).]
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1888. Review

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1888. Review

By January 1, 1999, the Attorney General and the department shall submit recommendations, along with any necessary legislation, to the joint standing committee of the Legislature having jurisdiction over human resources matters regarding whether this chapter should be amended. [1995, c. 232, §7 (amd).]
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
Title 22 - §1889. Application fee

Title 22: HEALTH AND WELFARE
Subtitle 2: HEALTH
Part 4: HOSPITALS AND MEDICAL CARE
Chapter 405-D: HOSPITAL COOPERATION ACT (HEADING: PL 1991, c. 814, @1 (new))

§1889. Application fee

Any application for a certificate of public advantage involving a merger must be accompanied by an application fee of $10,000, unless the hospitals seeking to merge each have less than 50 licensed beds, in which case the fee is $2,500. The department shall place these funds into a nonlapsing dedicated revenue account and funds may be used only by the Attorney General for the payment of the cost of experts and consultants in connection with reviews conducted under this chapter. [1995, c. 583, §15 (new).]
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007 This page created on: 2005-10-01
 
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