An Act To Modify the Calculation and Implementation Date of Savings Offset Payments under the Dirigo Health Act
Maine Legislature, Session 122, LD 1577
Committee Amendment CA_A-HA_B_H687 (House)
Amends: 24-A MRSA §6913

HOUSE AMENDMENT "£3,, to COMMITTEE AMENDMENT 
L.D. 
1577, 
Bill, 
"An 
Act 
To 
Modify 
the 
Implementation Date of Savings Offset Payments 
Health Act" 
"A" to S.P. 555, 
Calculation 
and 
under the Dirigo 
Amend the amendment by striking out all of the emergency 
preamble. 
Further 
amend the 
amendment in Part A in section 5 by 
striking out all of subsection 12 and inserting in its place the 
following: 
'12. 
Report: 
jurisdiction. 
Dirigo Health shall 
report 
twice annually, once in January and once during the last month of 
the regular legislative session, to the joint standing committee 
of 
the 
Legislature 
having 
jurisdiction 
over 
insurance 
and 
financial 
service§ matters on the Dirigo Health Program 
and 
budget. 
Minutes of meetings of the Board of Directors of Dirigo 
Health must be provided to each member of the joint standing 
committees of the Legi§lature having jurisdiction over insurance 
and financial §eryices matters. health and human §ervices matters 
and appropriations and financial affairs. I 
Further amend the amendment in Part A by striking out all of 
section 10 (page 4, lines 49 to 50 and page 5, lines 2 to 10 in 
amendment) and inserting in its place the following: 
'Sec. A-10. 24-A MRSA §6913, sub-§1, as enacted by PL 2003, c. 
469, Pt. A, §8, is repealed and the following enacted in its 
place: 
1. Determination of cost savings. 
The following are the 
procedures for determining cost savings. 
Page l-LR1479(17) 
HOUSE AMENDMENT 
~i ,'~ 
~\ ~: .• I 
HOUSE AMENDMENT'S" to COMMITTEE AMENDMENT "A" to S. P . 555, L . D . 
1577 
A. 
After an opportunity for a hearing conducted pursuant to 
Title 
5, 
chapter 
375, 
subchapter 
4, 
the 
board 
shall 
determine annually not later than April 1st 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 MaineCare enrollment due to 
an expansion in MaineCare eligibility occurring after June 
30, 2004. 
B. 
Within 30 days of the board's determination pursuant to 
paragraph A, 
the board shall file with the superintendent 
its determination as well as the supporting information for 
that determination. 
The filing constitutes a public record. 
c. 
Following a public hearing held in accordance with the 
Maine Administrative Procedure Act and no later than 6 weeks 
following the receipt of the board's determination, 
the 
superintendent shall issue an 
ord~r approving, in whole or 
in part, or disapproving the filing made under paragraph B. 
The 
board is 
designated 
a 
party to 
the 
hearing. 
The 
superintendent shall approve the filing upon a determination 
that the aggregate measurable cost savings filed by the 
board 
are 
reasonably 
supported 
by 
the evidence 
in 
the 
record. ' 
Further amend the amendment in Part A in section 11 in 
SUbsection 3 by striking out all of paragraph H (page 7, lines 23 
to 28 in amendment) and inserting in its place the following: 
'H. 
Annual 
savings 
offset 
payments 
received 
must 
be 
reconciled by Dirigo 
Health. 
Any 
unused 
payments 
must 
reduce the next savings offset payment charged to health 
insurance carriers, 
3rd-party administrators 
and employee 
benefit excess insurance carriers according to a 
formula 
developed by the board.' 
Further amend the 
amendment in Part B in section 1 
by 
striking out all of subsections 2 and 3 (page 8, lines 19 to 48 
in amendment) and inserting in their place the following: 
'2. Convening of working group: schedule. The Superintendent 
of Insurance shall convene the first meeting of the working 
group. 
In order to complete its work in a timely fashion, the 
HOUSE AMENDMENT 
HOUSE AMENDMENT ':bIt to COMMITTEE AMENDMENT "A" to S.P. 555, L.D. 
1577 
working group may make 
time 
frames 
discussed 
its 
with 
recommendations in accordance wi th 
the Joint Standing 
Committee 
on 
Insurance and Financial Services. 
3. Duties. 
The working group shall make recommendations to 
advise the board on the following issues: 
A. 
The definition of "subsidy" within the Dirigo Health 
Program; 
B. The definition of "paid claims" for the purpose of using 
paid 
claims 
as 
the 
base 
for 
savings 
offset 
payment 
assessments 
on 
administrators 
health 
insurance; carriers, 
3rd-party 
and 
employee 
benefit 
excess 
insurance 
carriers; 
C. The process for implementing and invoicing savings offset 
payment assessments based on the recommended definition of 
paid claims; 
D. 
The 
board's 
proposed 
methodology 
for 
calculating 
aggregate measurable cost savings. This recommendation must 
be made no later than September 20, 2005; and 
E. 
A 
funding 
strategy 
to 
cover 
Dirigo 
Health's 
administrative expenses. This recommendation must be made no 
later than December 31, 2005.' 
Further 
amend the amendment in 
subsection 
by striking out all of 
inserting in their place the following: 
Part 
B 
in 
paragraphs 
section 
A to C 
in 
and 
'A. 
No later than the effective date of this Act, the board 
shall 
file 
with 
the 
Superintendent 
of 
Insurance 
its 
determination as to the aggregate measurable cost savings in 
this State, including any reduction or avoidance of bad debt 
and charity care cost to health care providers as a result 
of 
the 
operation 
of 
Dirigo 
Health 
and 
any 
increased 
MaineCare 
enrollment 
due 
to 
an 
expansion 
in 
MaineCare 
eligibility occurring after June 30, 
2004 as well as the 
supporting information for that determination. 
The filing 
constitutes a public record; and 
B. 
Following a public hearing held in accordance with the 
Maine Administrative Procedure Act and no later than 6 weeks 
following the effective date of this Act, the Superintendent 
of Insurance shall issue an order approving, in whole or in 
part, or disapproving the filing made under paragraph A. 
The 
board is designated 
a 
party to 
the 
hearing. 
The 
superintendent shall approve the filing upon a determination 
HOUSE AMENDMENT 
HOUSE AMENDMENT ,£" to COMMITTEE AMENDMENT "A" to S.P. 555, L.D. 
1577 
that the aggregate measurable cost 
board are 
reasonably 
supported 
by 
record. ' 
savings filed by 
the 
evidence 
in 
the 
the 
Further amend the amendment by inserting after Part C the 
following: 
'PARTD 
Sec. 
D·l. 
Appropriations 
and 
allocations. 
appropriations and allocations are made. 
The 
following 
PROFESSIONAL AND FIBANCIAL REGULATION, DEPARTMENT OF 
Bureau of Insurance 0092 
Initiative: 
Allocates 
funds 
for 
the costs of 
analyzing the Board of Directors of Dirigo Health's 
determination as to the aggregate 
the operation of Dirigo Health 
OTHER SPECIAL REVENUE FUNDS 
All Other 
and 
OTHER SPECIAL REVENUE FUNDS TOTAL 
measurable cost 
related MaineCare 
2005-06 
$50,000 
$50,000 
reviewing and 
filing of its 
savings from 
expansions. 
2006-07 
$50,000 
$50,000' 
Further amend the amendment by striking out all of the 
emergency clause. 
This 
Amendment 
changes: 
SUMMARY 
amendment incorporates the changes proposed by House 
"A" 
to 
Committee 
Amendment 
"A" 
with the 
following 
1. House Amendment "A" to Committee Amendment "A" specifies 
that, not later than the effective date of the bill, the Board of 
Directors 
of 
Dirigo 
Health 
is 
required 
to 
file 
with 
the 
Superintendent of Insurance its determination of the aggregate 
measurable cost savings. 
The superintendent is then required to 
hold 
a 
public 
hearing 
and 
issue 
an 
order 
approving 
or 
disapproving the filing. 
This amendment places that requirement 
in statute, thus making it an ongoing requirement: and 
2. 
Committee 
Amendment 
"A" 
requires 
Dirigo 
Health 
to 
determine whether unused payments may be returned to insurance 
carriers. 
This amendment requires the unused payments to be used 
to reduce the next savings offset payment charged to health 
HOUSE AMENDMENT 
HOUSE AMENDMENT 'i)" to COMMITTEE AMENDMENT "A" to S.P. 555, L.D. 
1577 
insurance carriers, 3rd-party administrators and employee benefit 
excess insurance carriers according to a formula developed by the 
board. 
FISCAL NOTE REQUIRED 
(See attached) 
SPONSORED BY, ~~~~ 
___ / 
(RepreS~RRY 
TOWN: 
Calais 
HOUSE AMENDMENT 
Approved: 06/14/05 ~aC!. 
LD 1577 
LR 1479(17) 
An Act To Modify the Calculation and Implementation Date of Savings Offset Payments under the 
Dirigo Health Act 
Fiscal Note for House Amendment "Ey to Committee Amendment "A" 
Sponsor: Rep. Perry 
Appropriations/Allocations 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
2005-06 
$50,000 
2006-07 
$50,000 
Projections 
2007-08 
$50,000 
Projections 
2008-09 
$50,000 
Assumes the Bureau oflnsurance in the Department of Professional and Financial Regulation would require an 
additional Other Special Revenue Funds allocation of $50,000 per year for the costs of reviewing and analyzing the 
Dirigo Health Board's filing of its determination as to the aggregate measurable cost savings from the operation of 
Dirigo Health and related MaineCare expansions. The allocation is needed for the costs of contracted external 
expertise the Bureau anticipates it will need. 
LRI479(17) - Fiscal Note - Page 1 of 1