An Act To Clarify and Update the Laws and Rules Related to Real th Care Further amend the bill by inserting after the title and before the enacting clause the following: Emergency preamble. Whereas, Acts of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and Whereas, rules governing the Community Health Access Program have been drafted and are under review by the Department of Human Services; and Whereas, current law designates those rules as major substantive rules and subject to legislative review before final approval; and Whereas, the rules will not be provisionally adopted before adjournment of the Legislature; and Whereas, this Act designates the rules as routine technical rules to allow the Community Health Access Program to become operational before the Legislature reconvenes next January; and Page l-LR19l3(2) COMMITTEE AMENDMENT
Maine Legislature, Session 121, LD 1507
Committee Amendment CA_A_H515 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2809-A, 24-A MRSA §4209, 24-A MRSA §2803-A, 22 MRSA §3192

AMENDMENT "11" to H.P. llOO, L.D. 1507, Bill, "An 
and Update the Laws Related to Health Insurance" 
Amend the bill by striking out the title and substituting 
the following: 
'An Act To Clarify and Update the Laws and Rules Related to 
Real th Care' 
Further amend the bill by inserting after the title and 
before the enacting clause the following: 
'Emergency preamble. Whereas, Acts of the Legislature do not 
become effective until 90 days after adjournment unless enacted 
as emergencies; and 
Whereas, rules governing the Community Health Access Program 
have been drafted and are under review by the Department of Human 
Services; and 
Whereas, current 
law 
designates 
those 
rules 
as 
major 
substantive rules and subject to legislative review before final 
approval; and 
Whereas, the rules will not be provisionally adopted before 
adjournment of the Legislature; and 
Whereas, this Act designates the rules as routine technical 
rules to allow the Community Health Access Program to become 
operational before the Legislature reconvenes next January; and 
Page l-LR19l3(2) 
COMMITTEE AMENDMENT 
.'~ 
~. 
COMMITTEE AMENDMENT .. ff" to H.P. 1100, L.D. 1507 
Whereas, in the judgment of the Legislature, these facts 
create an emergency within the meaning of the Constitution of 
Maine 
and 
require 
the 
following 
legislation 
as 
immediately 
necessary for the preservation of the public peace, health and 
safety; now, therefore,' 
Further amend the bill by striking out all of Part Band 
inserting in its place the following: 
'PARTB 
Sec. B-1. 24 MRSA §2317-B, sub-§15-A, as enacted by PL 2003, 
c. 156, §l, is amended to read: 
1S-A. 
Title 24-A, section 2809-A. 
Neeiee--o-f--eaaeellaeieB 
aaa-eve4~~~4~~-o-f--~~~~-esveFa~e Conversion on termination 
of policy or eligibility, Title 24-A, section 2809-AT-6~9seeeisBs 
l-A-aaa-l-li; 
Sec. B-2. 24-A MRSA §2809-A, sub-§l-A, as amended by PL 2003, 
c. 156, §§2 and 3, is further amended to read: 
I-A. 
Notification of cancellation. 
An insurer mase-pFsviae 
9y--~~~-~~-mail--a~-~-~Q--QaysL-~-~-~4~4~4~-ef 
eaReella6iea-~~-~~~-p~emiam may not cancel or refuse 
to renew any policy for hospital, surgical. dental or major 
medical expense insurance until the insurer has provided by first 
class mail at least 10 days' prior notification according to this 
section. 
The notice must include the date of cancellation of 
coverage 
and, 
if applicable, 
the time period for exercising 
policy 
conversion rights. 
The 
notice also must 
include 
an 
explanation of any applicable grace period. 
Notification is not 
required when the insurer has received written notice from the 
group policyholder that replacement coverage has been obtained. 
A. 
Notice must be mailed to the group policyholder or 
subgroup sponsor. 
B-1. 
At the time of notification under paragraph A, notice 
must be mailed to the certificate holder at the last address 
provided to the insurer by the subgroup sponsor.L SF the 
group policyholder ee-~-he--~-aaless or the certificate 
holder. 
If the insurer does not have an address on file for 
the certificate holder. the notice must be mailed to the 
office of the subgroup sponsor. if any. or the group policy 
holder. 
The notice must also include information to the 
certificate holder 
about 
the availability of 
individual 
coverage as described in subsection I-B. 
COMMITTEE AMENDMENT 
\\.~ 
COMMITTEE AMENDMENT .. j:f:: to H.P. 1100, L.D. 1507 
Sec. B-3. 24-A MRSA §4209, sub-§6, as amended by PL 2003, c. 
156, §5, is further amended to read: 
6. 
Rotification of cancellation. 
A health maintenance 
organization masE-~~~~-~~~SE-£~~~~~-aE-~~--~-aays~ 
p~~9~-~~~~~~~-&~-£~~~~~~-~~-aeapaymea~-~--eR~9±±meRE 
eRa~'Jes may not cancel or refuse to renew any group contract 
until it has provided by first class mail at least 10 days' prior 
notification according to this section. 
The notice must include 
the date of cancellation of coverage and the time period for 
exercising contract conversion rights. 
The notice also must 
include 
an 
explanation 
of 
any 
applicable 
grace 
period. 
Notification is not required when the 
iRsa~e~ health maintenance 
organization has received written notice from the group contract 
holder that replacement coverage has been obtained. 
A. 
Notice must be mailed to the group contract holder or 
subgroup sponsor. 
B-1. 
At the time of notification under paragraph A, notice 
must 
be mailed to the 
individual enrollee at the last 
address provided to the health maintenance organization by 
the subgroup sponsor 
9~ • the group contract holder 
E9-~Re 
Rea±ea-~~~-~~~~~--aB*ess or the individual 
enrollee. 
If the health maintenance organization does not 
have an address on file for the individual enrollee. the 
notice must be mailed to the office of the subgroup sponsor. 
if any, or the group contract holder. 
The notice must also 
include information to the individual enrollee about the 
availability of individual coverage as described in section 
2809-A, subsection I-B. 
Further amend the bill in Part D by striking out all of 
section 1 and inserting in its place the following: 
'Sec. D-l. 24-A MRSA §2803-A, sub-§2, as amended by PL 2001, 
c. 410, Pt. B, §l, is further amended to read: 
2. 
Disclosure of basic loss information. 
Upon written 
request, every insurer shall provide loss information concerning 
a 
group 
policy or 
contract to 
its policyholder 
or 
former 
policyholder within 21 business days of the date of the request. 
This subsection does not apply to a former policyholder whose 
coverage terminated more than 18 months prior to the date of a 
request. ' 
COMMITTEE AMENDMENT 
(.ot", 
~ •. 
COMMITTEE AMENDMENT ,,~. to H.P. 1100, L.D. 1507 
Further 
amend 
the bill by 
inserting after Part H· the 
following: 
. PART I 
Sec. 1-1. 22 MRSA §3192, sub-§7, as enacted by PL 2001, c. 
439, Pt. BBB, §l and affected by §3, is amended to read: 
7. 
COPDUIli.ty health plan corporation excess insurance. 
In 
order to ensure adequate financial resources to pay for medical 
services allowed in the benefit plans developed by community 
health 
plan 
corporations, 
a 
local 
community 
health 
plan 
corporation is required to enter into agreements' wi th insurers 
licensed 
in 
this 
State 
to 
obtain 
community 
health 
plan 
corporation excess insurance and to provide coverage for those 
portions of the health care benefits package that expose the 
corporations to financial risks beyond the resources of the 
corporation. 
The department may develop rules to provide further 
options 
for 
community 
health 
plan 
corporations 
to 
maintain 
financial 
solvency. 
Participation 
in 
the 
Medicaid 
program 
satisfies 
the 
requirement 
of 
this 
subsection. 
Rules 
adopted 
pursuant 
to 
this 
subsection 
are 
Rla;eF--fHle5~aR~ive 
routine 
technical rules as defined in Title 5, chapter 375, subchapter 
I I -A aREl- -f'AU6-t-- ee--FEW-i-ewed-- ~t),l'e--f..i-sal---app£.g.v.a.!--ey - -t~ - :jeiR1: 
61:aREliR~-~it-t~-e~-~-~~~~~e--Aav.i-~--}ur~~~~~-eveF 
heal~h-iR6QFaRee-Rla1:~eF6 A=A. 
Sec. 1-2. 22 MRSA §3192, sub-§8, ,C, as enacted by PL 2001, c. 
439, Pt. BBB, §1 and affected by §3, is amended to read: 
C. 
The department may 
seek 
a 
waiver 
from 
the Federal 
Government as necessary to permit funding under the Medicaid 
program 
to 
be 
used 
for 
coverage 
of 
Medicaid-eligible 
individuals enrolled in a plan offered by a community health 
plan corporation. The department may adopt rules required to 
implement the waiver in accordance with this paragraph. 
Rules 
adopted 
pursuant 
to 
this 
paragraph 
are 
Rla;eF 
6u6~aR~ive routine technical rules as defined in Title 5, 
chapter 375, subchapter II-A 
aBEl-~--be--Fev4ewee--&e~eFe 
fiBal--appFeval--ey--~he--;eiB~--6~aREliB~--eeRlRli~1:ee--ef--~he 
be~i61a~QFe--~~--1~£45e4€~4e~--~v&F--~-t~--iB6QFaBee 
Rla~~eF6 2-A. 
Sec. 1-3. 22 MRSA §3192, sub-§14, as enacted by PL 2001, c. 
439, Pt. BBB, §l and affected by §3, is amended to read: 
14. 
minimum 
enrollee 
limiting 
Rules. 
The department shall adopt rules establishing 
standards 
for 
financial 
solvency, 
benefit 
design, 
protections, 
disclosure 
requirements, 
conditions 
for 
enrollment and procedures for dissolution of a community 
COMM/rrEE AMENDMENT 
.. 
f'~f" 
W, 
~ ... , 
COMMITTEE AMENDMENT ,~" to H.P. 1100, L.D. 1507 
health plan corporation. 
The department may also adopt any rules 
necessary to carry out the purposes of this section. 
Rules 
adopted pursuant to this subsection are majeF-6QB6~aB~ive routine 
technical rules as defined in Title 5, chapter 375, subchapter 
II-A 
aBEl-~-Be--Fe-V-i-ewed--Be-fe-£e--~.i-B-a-l--~~--:9Y'--t-he--jeiB~ 
s~aBEliB~-~.i-t~~-e~--~-~~~~~~e--aavi~--}ur~~~~~-eveF 
aeal~R-iBSQFaBee-maEEeFs 2-A. 
Emergency clause. 
In view of the emergency cited in the 
preamble, Part I of this Act takes effect when approved and Parts 
A to H take effect 90 days after approval of this Act.' 
Further amend the bill by relettering or renumbering any 
nonconsecutive 
Part 
letter 
or 
section 
number 
to 
read 
consecutively. 
SUMMARY 
This 
amendment 
makes 
the 
changes 
to 
the 
notification 
provisions in Part B of the bill consistent with Public Law 2003, 
chapter 156. 
The amendment also clarifies that the requirement 
that loss information be provided to a former group policyholder 
upon request does 
not apply to policyholders whose 
coverage 
terminated 
more 
than 
months 
prior 
to 
the 
request. 
The 
amendment also makes 
the rule-making process related to the 
community health program routine technical rules rather than 
major substantive rules. 
The amendment also adds an emergency preamble and emergency 
clause to the bill. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Revised: 05120/03 ~ae 
Office of Fiscal and Program Review 
LD 1507 
An Act To Clarify and Update the Laws and Rules Related to Health 
Care 
LR 1913(02) 
Fiscal Note for Bill as Amended by Committee Amendment" " 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional cost to the Department of Professional and Financial Regulation and the Department of Human 
Services to implement this bill can be absorbed by the departments utilizing existing resources. 
LR1913(2) - Fiscal Note - Page 1 of 1 
..