An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government and to Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2004 and June 30, 2005 LR 2833(14)
Maine Legislature, Session 121, LD 1919
Committee Amendment CA_A-HA_M_H927 (House)
Amends: 24-A MRSA §6913

HOUSE 
AMENDMENT "M " to COMMITTEE 
AMENDMENT 
"A" to H. P . 
1420, 
L.D. 
1919, 
Bill, 
"An 
Act 
To 
Make 
Supplemental 
Appropriations 
and Allocations for the Expenditures of State 
Government and To Change Certain Provisions of the Law Necessary 
to 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 
EEEE 
the 
following: 
'PARTFFFF 
Sec. FFFF·l. 24·A MRS A §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 
aRQ--aRy--~~~-~~~~-~-~~-~£--eHpaa64ea--iR 
MaiRe~a~e-e*i~i9i*ity-eeeQ~~ia~-a~~e~~JQRe-.OT-a004. 
3. 
Maximum 
saviuqs offset payments on hea1th insurance 
carriers and emp10yee 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 
HOUSE AMENDMENT 
~~" 
HOUSE 
AMENDMENT "M" to COMMITTEE AMENDMENT "A" to H.P. 1420, 
L.D. 1919 
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 I, 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 aaQ-aBy-4~~~~~~~~~-~~-a&-eH~aa&~ea 
~a--Ma~ae~ape--el~~~9~l~ey--eeeQP~is~--a~te~--JQae--~9 r--6994, 
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 savings 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' 
reductions or stabilization in the cost of bad debt and charity 
care as 
a 
result of the operation of Dirigo Health aSQ--asy 
iae~ea&eQ-eB£eJJmeR~-£~~~~~~~-~&~aiaeGaFe-el~~i9ility 
eeeQ~piR~-aEee~-JQSe-69r-69Q4. 
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 aREl--as--a 
pe&Qle-~--aay-4~~~&F&~~&&-£~~~~-aB-~~-iB 
MaiaeGa~e-eli~i9~1~ey-eeeQ~~~B~-a~te~-JQBe-69r-6994. 
Sec. FFFF'-2. 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 
l2-month period on the efforts undertaken by the carrier and 
provider to recover savings offset payments, as reflected in 
HOUSE AMENDMENT 
.,. 
~ 
3,6 
HOUSE AMENDMENT "M" to COMMITTEE 
AMENDMENT 
"A" to H.P. 1420, 
L.D. 1919 
reimbursement rates, through a reduction or stabilization in 
bad debt and charity care costs as a result of the operation 
of Dirigo Health 
aae-~-~~~-eaEe**mea~-~-~~-aB 
eHpaasiea-~~~~~-&1~i&i1i~y-eeeQEEiR~-~~-~-~QT 
aQQ4. 
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. FFFF·3. 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 
bad debt and charity care costs to health care providers in this 
State as a result of the operation of Dirigo Health aae--a:ay 
iaeEeasee-eaEeJJmea~-Q~e-~~~~~-i&-Mai:aeGaF&-e*i~i9ili~y 
eeeQFFi:a~--a'~eF--JQae--3QT--6QQ4 as 
determined 
by 
the 
board 
consistent with subsection 1. 
Sec. FFFF·4. 24·A MRSA §691S, as enacted by PL 2003, c. 469, 
Pt. A, §8, is amended to read: 
§6915. Dirigo Health Fund 
The Dirigo Health Fund is created as a dedicated fund for 
the deposit of any funds advanced for initial operating expenses, 
payments made by employers and individuals, any savings offset 
payments made pursuant to section 6913 and any funds received 
from any public or private source except as provided in this 
section. 
Beginning July 1. 2004, with the exception of funding 
~propriated in Public Law 2003, chapter 469, General Fund money 
may not be used directly or indirectly through the fund to 
provide coyer age for a Dirigo Health Insurance enrollee or a 
dependent of the enrollee. 
The fund may not lapse, but must be 
carried forward to carry out the purposes of this chapter. 
Sec. FFFF·S. PL 2003, c. 469, Pt. A, §S is repealed. 
Sec. FFFF·6. PL 2003, c. 469, Pt. A, §9 is amended to read: 
Sec. A·9. Monthly report. 
shall 
provide 
a 
monthly 
The Department 
report 
of 
of Human Services 
enrollment 
and 
HOUSE AMENDMENT 
~.~ 
HOUSE 
AMENDMENT 
" M,. to COMMITTEE 
AMENDMENT 
,. A" to H. P • 
L.D. 1919 
1420, 
expenditures 
for 
the 
noncategorical 
adults 
enrolled 
in 
the 
MaineCare program under the Maine Revised Statutes, Title 22, 
section 3l74-G, 
subsection 1, 
paragraph F. 
The 
report must 
include the 
number 
of members, 
expenses 
and projections for 
expenses in the state fiscal year for members enrolled under the 
eHpaR6ieR-~--~-eli§iailiey-~~~-~-9~-~~~r~-iRe9me 
e"ieial-~Ft~-~~~-te--~~~~-~--the-~~~-4~-e~~ieial 
pe'Y&l'-e.y-.J.4Re Title 22 ( section 3174-G, subsection L 
paragraph 
r. 
If enrollment has been discontinued under that section, the 
report must include enrollment projections for the next calendar 
quarter. • 
Sec. FFFF-7. PL 2003, c. 469, Pt. A, §11 is repealed. 
Further amend 
any 
nonconsecutive 
consecutively. 
the amendment by 
Part 
letter 
or 
SUMMARY 
relettering or renumbering 
section 
number 
to 
read 
This 
amendment 
repeals 
increases in MaineCare 
financial 
eligibility enacted in Public Law 2003, chapter 469. 
Beginning 
July 1, 2004, with the exception of funding appropriated in the 
Dirigo Health law in 2003, the amendment prohibits the use of 
General Fund money, directly or indirectly, to pay for coverage 
for a 
Dirigo Health Insurance enrollee or a dependent of the 
enrollee. 
FISCAL NOTE REQUIRED 
... J~ee attached) 
'\ ,~lltM' 
SPONSORED BY: 
.J \ Ykkt v r" /t.e 
(Representat;,i~e P. MitiS) 
.. / 
TOWN: 
Cornville 
HOUSE AMENDMENT 
Viscal Detail and Notes 
Approved: 04/14/04 :;t;,ae. 
Office of Fiscal and Program Review 
LD 1919 
An Act to Make Supplemental Appropriations and Allocations for the 
Expenditures of State Government and to Change Certain Provisions of 
the Law Necessary to the Proper Operations of State Government for the 
Fiscal Years Ending June 30, 2004 and June 30, 2005 
LR 2833(14) 
Fiscal Note for House Amendment" It to Committee Amendment It A It 
Sponsor: Rep. Mills 
Fiscal Note Required: Yes 
Fiscal Note 
This amendment will have no net effect on General Fund appropriations and revenue and a balanced budget is 
maintained for the 2004-2005 biennium. 
LR2833(14) - Fiscal Note - Page 1 of 1