An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government and to Change Certain Provisions of the Law Necessary for the Proper Operations of State Government for the Fiscal Years Ending June 30, 2004 and June 30,2005 LR 2700(06)
Maine Legislature, Session 121, LD 1828
Committee Amendment CA_A-HA_C_H652 (House)
Amends: 22 MRSA §3174-G, 24-A MRSA §6910, 24-A MRSA §6913

HOUSE 
AMENDMENT "C" to COMMITTEE 
AMENDMENT 
"A" 
to H.P. 
1351, 
L.D. 
1828, 
Bill, 
"An 
Act 
To 
Make 
Supplemental 
Appropriations 
and Allocations for the Expenditures 
of State 
Government and To Change Certain Provisions of the Law Necessary 
for the Proper Operations of State Government for the Fiscal 
Years Ending June 30, 2004 and June 30, 2005" 
Amend the amendment by inserting after Part CC the following: 
'PART DD 
Sec. DD-l. 22 MRSA §3174-G, sub-§4 is enacted to read: 
4. 
Limitation. 
The authority of the department pursuant to 
subsection I. paragraphs B. C. D. and E to provide coverage above 
the financial eligibility limits in effect on January I. 2004. as 
enacted in Public Law 2003. chapter 469, Part A. section 5. is 
limited by the funding available to Dirigo Health to provide the 
state match for federal Medicaid dollars for the purchase of 
coverage for those persons. 
Pursuant to Title 24-A. 
section 
6914, available funding may not include money collected as 
a 
savings offset payment pursuant to Title 24-A, section 6913. 
Sec. DD-2. 24-A MRSA §6910, sub-§l, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
1. 
Dirigo Health Insurance. 
Dirigo Health shall arrange 
for the provision of health benefits coverage through Dirigo 
Health Insurance not later than October 1, 
2004, 
except that 
coverage 
for 
persons 
eligible 
under 
the 
Medicaid 
expansion 
Page l-LR2700(6) 
HOUSE AMENDMENT 
HOUSE 
AMENDMENT 
L.D. 1828 
.. c, .. to COMMITTEE 
AMENDMENT "A" to H.P. 1351, 
authorized in Public Law 2003. chapter 469. Part A. section 5 may 
not begin until February 1, 2006. 
Dirigo Health Insurance must 
-comply with all relevant requirements of this Title. 
Dirigo 
Health Insurance may be offered by health insurance carriers that 
apply to the board and meet qualifications described in this 
section and any additional qualifications set by the board. 
Sec. DD-3. 24-A MRSA §6913, sub-§§l, 3 and 7, as enacted by PL 
2003, c. 469, Pt. A, §8, are amended to read: 
1. 
Determination of cost savings. 
After an opportunity for 
a hearing conducted pursuant to Title 5, chapter 375, subchapter 
4, the board shall determine annually not later than April the 
aggregate measurable cost savings, 
including any reduction or 
avoidance of bad debt and charity care costs to health care 
providers in this State as a result of the operation of Dirigo 
Health and any 
increased enrollment due 
to 
an expansion in 
MaineCare eligibility occurring 
ai~el'-..;r~-3-0-r-6994 on February 
1. 2006. 
3. 
Maximum 
savings offset payments on health insurance 
carriers and employee benefit excess insurance carriers. 
Each 
health insurance carrier and employee benefit excess insurance 
carrier must pay a savings offset in an amount not to exceed 4.0% 
of annual health insurance premiums and employee benefit excess 
insurance premiums on policies issued pursuant to the laws of 
this State that insure residents of this State. 
The savings 
offset payment may not exceed savings resulting from decreasing 
rates of growth in the State's health care spending and bad debt 
and charity care costs. The savings offset payment applies to 
premiums paid on or after July 1, 2005. Savings offset payments 
must reflect aggregate measurable cost savings, including any 
reduction or avoidance of bad debt and charity care costs to 
health care providers in this State, as a result of the operation 
of Dirigo Health and any increased enrollment due to an expansion 
in 
MaineCare 
eligibility occurring 
ai~el'--J~Re--6gT--~9g4 on 
February 1. 
2006, 
as determined by the board consistent with 
subsection 1. 
A health insurance carrier and employee benefit 
excess insurance carrier may not be required to pay a savings 
offset 
payment 
on 
policies 
or 
contracts 
insuring 
federal 
employees. 
7. 
Demonstration of recovery of savinqs offset payments 
through reduction in rate of growth in State's health spending 
and 
bad 
debt 
and 
charity 
care. 
In 
accordance 
with 
the 
requirements of this subsection, every health insurance carrier 
and health care provider shall demonstrate that best efforts have 
been made to ensure that a carrier has recovered savings offset 
payments 
made 
pursuant 
to 
this 
section 
through 
negotiated 
reimbursement 
rates 
that 
reflect 
health 
care 
providers' 
HOUSE AMENDMENT 
~ 
4tW 
HOUSE 
AMENDMENT "V' to COMMITTEE 
AMENDMENT "A" to H.P. 1351, 
L.D. 1828 
reductions or stabilization in the cost of bad debt and charity 
care as 
a result of the operation of Dirigo Health and any 
increased enrollment due to an expansion in MaineCare eligibility 
occurring a~~e~-J~Be-~QT-aQQ4 on February 1, 2006. 
A. 
A health insurance carrier shall use best efforts to 
ensure health insurance premiums reflect any such recovery 
of savings offset payments as those savings offset payments 
are 
reflected 
through 
incurred 
claims 
experience 
in 
accordance with subsection 9. 
B. 
During any negotiation with a health insurance carrier 
relating to a health care provider's reimbursement agreement 
with that carrier, a health care provider shall provide data 
relating to any reduction or avoidance of bad debt and 
charity care costs to health care providers in this State, 
as a result of the operation of Dirigo Health and as 
a 
result of any increased enrollment due to an expansion in 
MaineCare eligibility occurring 
afte~--J~Be--~QT--6QQ4 on 
February I. 2006. 
Sec. DD-4. 24-A MRSA §6913, sub-§8, ~C, as enacted by PL 2003, 
c. 469, Pt. A, §8, is amended to read: 
C. 
Health insurance carriers and health care providers 
shall 
report 
annually, 
beginning 
March 
1, 
2005 
and 
thereafter, information regarding the experience of a prior 
12-month period on the efforts undertaken by the carrier and 
provider to recover savings offset payments, as reflected in 
reimbursement rates, through a reduction or stabilization in 
bad debt and charity care costs as a result of the operation 
of Dirigo Health and any increased enrollment due to an 
expansion in MaineCare eligibility occurring afee~-~-~QT 
aQQ4 on February 1. 2006. 
The board shall determine the 
appropriate format for the report and utilize existing data 
on file with state 
agencies 
or 
other organizations 
to 
minimize duplication. The report must be submitted to the 
board. 
Using 
the 
information 
submitted by 
carriers 
and 
providers, 
the 
board 
shall 
submit 
a 
summary 
of 
that 
information by October 1, 2005 and annually thereafter. 
Sec. DD-5. 24-A MRSA §6913, sub-§9, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
9. 
Demonstration of offset. 
As 
provided 
in 
sections 
2736-C, 
2808-B 
and 
2839-B, 
the 
claims 
experience 
used 
to 
determine any filed premiums or rating formula must reasonably 
reflect, in accordance with accepted actuarial standards, known 
changes and offsets in payments by the carrier to health care 
providers in this State, including any reduction or avoidance of 
HOUSE AMENDMENT 
Co· 
~ 
~. 
HOUSE 
AMENDMENT ,,~ to COMMITTEE 
AMENDMENT "A" to H.P. 
L.D. 1828 
1351, 
bad debt and charity care costs to health care providers in this 
State as a result of the operation of Dirigo Health and any 
increased enrollment due to an expansion in MaineCare eligibility 
occurring ai~e~-~~-~r-6QQ4 Qn February 1, 2006 as determined 
by the board consistent with subsection 1. 
Sec. DD·6. 24·A MRSA §6914, as enacted by PL 2003, c. 469, 
Pt. A, §8, is amended to read: 
§6914. Intragovernmental transfer 
Starting Ja1y-lr-.JQQ4 February L 
2006, Dirigo Health shall 
transfer funds, as necessary, to a special dedicated, nonlapsing 
revenue account administered by the agency of State Government 
that administers MaineCare for the purpose of providing a state 
match for federal Medicaid dollars. Dirigo Health shall annually 
set the amount of contribution. 
The transfer may not include 
money collected as a savings paymeB~ offset payment pursuant to 
section 6913. 
Sec. DD-7. PL 2003, c. 469, Pt. A, §9 is amended to read: 
Sec. A·9. Monthly report. 
The Department of Human Services 
shall provide a monthly report of enrollment and expenditures for 
the noncategorical adults enrolled in the MaineCare program under 
the Maine Revised Statutes, Title 22, section 3174-G, subsection 
1, 
paragraph F. 
~Be Beginning with 
the first report after 
February 1, 2006, the report must include the number of members, 
expenses and projections for expenses in the state fiscal year 
for members enrolled under the expansion of income eligibility 
under Title 22, section 3174-G, subsection L 
paragraph F from 
100% of the nonfarm income official poverty line to 125% of the 
nonfarm income official poverty line. 
Sec. DD-S. PL 2003, c. 469, Pt. A, §11 is amended to read: 
Sec. A·H. Effective date. 
That section of this Part that 
amends 
the Maine Revised Statutes, Title 22, 
section 3174-G, 
subsection 1 takes effect on 
t:Be--dat_e_-.t.!:l.a.t.--ee.~~~-.,i-s--i,i!:,6t: 
pF9ViaeQ--~-~.,i~~~-empJ9yee6--aBa--e-~~~~-~~¥~~~~~--aBae!:' 
~iFi~9-~~~-~£~~~~£~e--as-~~1~~-iB--~i~1&-~~--6eet:ieB 
e91Q February 1, 2006. 
Sec. DD·9. 
Appropriations and allocations. 
appropriations and allocations are made. 
HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 
The 
following 
HOUSE AMENDMENT 
~~ 
~ 
~' 
HOUSE 
AMENDMENT "C,/' to COMMITTEE 
AMENDMENT "A" to H.P. 1351, 
L. D. 1828 
Initiative: 
Deallocates funds as a result of the delay in the 
expansion of Medicaid eligibility under the Dirigo Health program. 
Federal Expenditures Fund 
All Other 
Federal Expenditures Fund Total 
Other Special Revenue Funds 
All Other 
Other Special Revenue Funds Total 
HUMAN SERVICES, DEPARTMENT OF 
DEPARTMENT 'l'OTALS 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL -
ALL FUNDS 
2003-04 
$0 
2003-04 
2003-04 
$0 
2004-05 
($46,516,263) 
(46,516,263) 
2004-05 
(23,952,246) 
{23,952,246} 
2004-05 
(46,516,263) 
(23,952,246) 
($70,468,509)' 
Further amend the amendment by 
any 
nonconsecutive 
Part 
letter 
or 
consecutively. 
relettering or renumbering 
section 
number 
to 
read 
SUMMARY 
This amendment changes the date that Medicaid coverage of 
certain elderly and disabled individuals, children, infants, the 
parent or caretaker of certain infants or children and pregnant 
women would take effect from the date that coverage is first 
provided to eligible employees 
and eligible individuals under 
Dirigo Health Insurance 
as established in the Maine 
Revised 
Statutes, Title 24-A, section 6910 to February 1, 2006. 
SPONSORED BY: 
(Representative 
TOWN: 
Cornville 
HOUSE 
AMENDMENT 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Approved: 01129/04 .:t?ae. 
12lst Maine Legislature 
Office of Fiscal and Program Review 
LD 1828 
An Act to Make Supplemental Appropriations and Allocations for 
the Expenditures of State Government and to Change Certain 
Provisions of the Law Necessary for the Proper Operations of State 
Government for the Fiscal Years Ending June 30, 2004 and June 
30,2005 
LR 2700(06) 
Fiscal Note for House Amendment " "to Committee Amendment "A" 
Sponsor: Rep. Mills 
Fiscal Note Required: Yes 
Fiscal Note 
2003-04 
2004-05 
$0 
$0 
$0 
($46,516,263) 
($23,952,246) 
$0 
($46,516,263) 
Delaying the effective date of the Medicaid eligibility expansions authorized under the Dirigo Health legislation 
will delay the availability of Federal matching funds available to the Dirigo Health program. State resources 
designated for use by the program -- both the one-time transfer from the General Fund and Other Special 
Revenue funds (employer, employee, and individual contributions) -- would still be available for use by the 
Dirigo Board to fund program benefits and costs (still to be determined). The delay would also temporarily 
reduce the liability of Dirigo to pay for the MaineCare costs of individuals who enroll in MaineCare as 
individuals outside of a Dirigo Health plan. 
LR2700(6) - Fiscal Note - Page 1 of 1