Health chief blasted for skirting Legislature

The director of Maine’s health policy office took fierce bipartisan heat Tuesday from members of the state’s Joint Standing Committee on Health and Human Services.

Trish Riley riled the lawmakers by using emergency rulemaking and bypassing the legislative process to place a controversial statewide cap on health care investment. The emergency rules, which establish limits on how much hospitals and doctors’ groups can spend annually on buildings and equipment, were issued early this week.

Normally, such action would require public hearings and the approval of the appropriate legislative committee. But Riley said it was necessary to cap spending as soon as possible.

The investment cap is part of a statewide health plan unveiled Tuesday, a key element of Gov. John Baldacci’s Dirigo Health Reform Act of 2003. The ambitious health reform act calls for multiple strategies to control the rising costs of health care while making it easier for Mainers to get the services they need.

The state health plan supports the creation of a regional network of hospitals and clinics, guides the rationing and coordination of services, and determines appropriate community-based programs that keep people healthy.

Presenting the plan to the committee, Riley said an estimated $214 million in hospital and medical equipment proposals flooded the state’s certificate of need office in May of this year after a 12-month moratorium was lifted. While long-term certificate of need guidelines are still being developed, she said, the absence of a spending cap constituted a threat to public well-being and left the door open for millions of dollars in unchallenged health care expansion – a potent driver of the medical costs she is charged with bringing under control.

Even though the committee will have an opportunity to revisit the rules in the coming legislative session, members blasted Riley for acting prematurely.

Sen. Carol Weston, R-Montville, was scathing. “I want to be sure I understand,” she said. “You believe our current [certificate of need] system is an immediate threat to public health and safety and that your new formula will save us. Is that right?”

“To me this feels like political policy, not public policy,” charged Rep. Darlene Curley, R-Scarborough. “Public policy involves the Legislature.”

The committee’s co-chairman, Rep. Thomas Kane, D-Saco, who will be term-limited in December, said he was disappointed not to have had an opportunity to look at the entire health plan before its adoption, “especially the extent to which it impacts on the certificate of need office.”

Kane suggested that the Legislature should revise portions of the Dirigo legislation to allow for greater legislative oversight.

Riley defended her decision, citing testimony from concerned consumer and business groups at an administrative hearing in June. “There was a clear message of urgency to move faster,” she said.

Riley also pledged to keep lawmakers better informed in the future. “I take your criticism seriously,” she said.

Maine’s state health plan, which will be revised next year and then every two years, is available online at www.healthpolicy.maine.gov.