An Act To Increase Access to Health Insurance Products
Maine Legislature, Session 122, LD 1845
Committee Amendment CA_A_H1012 (House)
Amends: 24-A MRSA §6903, 24-A MRSA §6905, 24-A MRSA §6908, 24-A MRSA §6910, 24-A MRSA §6916

COMMITTEE AMENDMENT "A" to H.P. 1285, L.D. 1845, 
Act To Increase Access to Health Insurance Products" 
Bill, "An 
Amend the bill by striking out everything after the enacting 
clause and before the summary and inserting in its place the 
following: 
'Sec. 1. 22 MRS A §3174-DD, as amended by PL 2005, c. 400, 
Pt. C, §2, is further amended to read: 
§3174-DD. 
Dirigo health coverage 
The 
department 
may 
contract 
with 
one 
or 
more 
health 
insurance carriers or the Dirigo Health Self-administered Plan 
established pursuant to Title 24-A, 
section 6981 to purchase 
Dirigo Health Program coverage for MaineCare members who seek to 
enroll through their employers pursuant to Title 24-A, section 
6910, subsection 4, paragraph B. 
A MaineCare member who enrolls 
in the Dirigo Health Program as a member of an employer group 
receives 
full 
MaineCare 
benefits 
through 
the 
Dirigo 
Health 
Program. 
The benefits are delivered through the employer-based 
health plan, subject to nominal cost sharing as permitted by 42 
United States Code, Section 13960(2003) and additional coverage 
provided under contract by the department. 
Sec. 2. 24-A MRSA §6903, sub-§l, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
1. Board. "Board" means the Board of ];)il'eetel's Trustees of 
Dirigo Health, as established in section 6904. 
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COMMITTEE AMENDMENT .. A 
.. to H.P. 1285, L.D. 1845 
See. 3. 24.A MRSA §6904, as enacted by PL 2003, c. 469, Pt. 
A, §8, is amended to read: 
§6904. 
Board of Trustees of Dirigo Health 
Dirigo Health operates under the supervision of --a-
Board of 
~~~eete~s Trustees of Dirigo Health established 
accordance with this section. 
the 
in 
1. 
Appointments. 
The 
board consists 
of --9-
~ voting 
members and -6-
~ ex officio, nonvoting members as follows. 
A. 
The -~- 2 voting members of the board must be appointed 
by the Governor, subject to review by the joint standing 
committee of the Legislature having jurisdiction over health 
insurance matters and confirmation by the Senate. 
B. 
The -6-
~ ex officio, nonvoting members of the board are: 
(1) 
The 
Commissioner 
of 
Professional 
and 
Financial 
Regulation or the commissioner's designee; 
(2) 
The director of the Governor's Office of Health 
policy and Finance or 
the director 
of 
a 
successor 
agency; aBe 
( 3 ) 
The Commissioner of Administrative and Financial 
Services or the commissioner's designeeT; and 
(4) 
The Treasurer of State or the treasurer's designee. 
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COMMITTEE AMENDMENT 
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2-A. 
Qualifications of voting members. 
Voting members of 
the board must be gualified in accordance with this subsection. 
A. 
Six of 
the voting 
members 
of the 
board must 
have 
knowledge of and experience in one or more of the following 
areas: 
(1) 
Health care purchasing: 
(2) 
Health insurance; 
(3) 
MaineCare: 
(4) 
Health policy and law; 
(5) 
State management and budget: 
(6) 
Health care financing: 
(7) 
Labor or consumer advocacy: and 
(8) 
Marketing. 
B. 
Three of the voting members of the board must have 
knowledge of and experience in one or more of the following 
areas: 
(1) Accounting; 
(2) Banking: 
(3) Securities; and 
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COMMITTEE AMENDMENT ·A .. to H.P. 1285, L.D. 1845 
(4) Insurance. 
C. 
Except as provided in this paragraph, a voting member of 
the board may not be: 
(1) A representative or employee of a health insurance 
carrier authorized to do business in this State; 
(2) 
A representative or employee of 
a 
health care 
provider operating in this State; 
(3) 
Affiliated 
with 
a 
health 
or 
health-related 
organization regulated by State Government; or 
(4) A representative or employee of Dirigo Health. 
A nonpracticing health care practitioner, retired or former 
health care administrator or retired or former employee of a 
health 
insurance 
carrier 
is 
not 
prohibited 
from 
being 
considered for board membership as long as that person is 
not currently affiliated with a health or health-related 
organization. 
3. 
Terms of office. 
Voting members serve 3 -year terms. 
Voting members 
may serve up to 
consecutive terms. 
Of the 
initial appointees, 
one member serves an initial term of one 
year, 
members serve initial terms of 2 years and 2 members 
serve initial terms of 3 years. 
The Governor shall fill any 
vacancy for an unexpired term in accordance with subsections 1 
and 2. 
Members reaching the end of their terms may serve until 
replacements are named. 
4. 
Chair. 
The Governor shall appoint one of the voting 
members as the chair of the board. 
5. 
Quorum. 
±h~ee 
Five 
voting 
members 
of 
the 
board 
constitute a quorum. 
6. 
Affirmative vote. 
An affirmative vote of -J- 2 members 
is required for any action taken by the board. 
1. 
Compensation. 
A member of the board must be compensated 
according 
to 
the 
provisions 
of 
Title 
5, 
section 
12004-G, 
subsection 14-D; a member must receive compensation whenever that 
member fulfills any board duties in accordance with board bylaws. 
8. 
Meetings. 
The board shall meet a~-~ea£~-4-~-~-a-yea~ 
a~-~e~Rla~-iB~e~vals monthly and may also meet at other times at 
the call of the chair or the executive director. 
All meetings of 
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COMMITTEE AMENDMENT .~ .. to H.P. 1285, L.D. 1845 
the board are public proceedings wi thin the meaning of Title l, 
chapter 13, subchapter 1. 
Sec. 4. 24-A MRSA §6905, as enacted by PL 2003, c. 469, Pt. 
A, §8, is repealed and the following enacted in its place: 
§6905. 
Limitation on lipbility 
1. Indemnification of Dirigo Health employees. 
An employee 
of Dirigo Health is not subject to any personal liability for 
having 
acted withjn the 
course 
and 
scope 
of 
membership 
or 
employment to carry out any power or duty under this chapter. 
Dirigo Health shall indemnify any member of the board and any 
employ~e 
of 
Dirigo 
Health 
against 
expenses 
actually 
and 
necessarily incurred by that member or employee in connection 
with the defense of any action or proceeding in which that member 
or 
employee is made 
a 
party by 
reason of past or present 
authority with Dirigo Health. 
2. Limitation on lipbility of board members. 
The personal 
liability of a member of the board is governed by Title 18-B, 
section 1010. 
Sec. 5. 24-A MRSA §6908, sub·§2, 1[E, as amended by PL 2005, c. 
400, Pt. C, §6, is further amended to read: 
E. 
Arrange the provision of Dirigo Health Program benefit 
coverage 
to 
eligible individuals 
and 
eligible 
employees 
through contracts with one or more qualified bidders in 
accordance 
with 
section 
6910 
or 
through 
the 
self-administered plan authorized pursuant to section 6981; 
Sec. 6. 24-A MRS A §6909, sub·§2, llA, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
A. 
Serve as the liaison between the board e~-ai£e€~e£s and 
Dir igo Health and serve as secretary and treasurer to the 
board; 
Sec. 7. 24-A MRSA §6910, sub·§l, as amended by PL 2005, c. 
400, Pt. C, §8, is further amended to read: 
1. 
Dirigo Health Program. 
Dirigo Health shall arrange for 
the provision of health benefits coverage through the Dirigo 
Health Program not later than October 1, 2004. 
The Dirigo Health 
Program 
must 
comply 
with all 
relevant 
requirements 
of 
this 
Title. 
Dirigo Health Program coverage may be offered by health 
insurance 
carriers 
that 
apply 
to 
the 
board 
and 
meet 
qualifications 
described in this 
section 
and 
any 
additional 
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COMMITTEE AMENDMENT .)1 .. to H.P. 1285. L.D. 1845 
qualifications set by the board or may be provided through the 
Dirigo Health Self-administered Plan pursuant to section 6981. 
Sec. 8. 24-A MRSA §6916 is enacted to read: 
§69l6. 
Market~~g_and sale of Dirigo Health Program; 
qualifications of insurance producers 
1. 
Qualifications of insurance 
producers. 
An 
insurance 
producer licensed pursuant to chapter 16 may solicit, negotiate 
and sell insurance products offered by or through the Dirigo 
Health Program if the following conditions are met prior to any 
such solicitation, negotiation or sale: 
A. 
The producer is authorized by the superintendent to 
soli~it, negotiate 
and 
sell 
insurance 
products 
for 
the 
health line of business; 
B. 
The 
producer has 
successfully completed all training 
offered and required by the Dirigo Health Program for the 
solicitation, negotiation and sale of Dirigo Health Program 
insurance 
products, 
including 
any 
continuing 
training 
offered and required by the Dirigo Health Program; 
C. 
The producer provides the carrier or carriers with which 
the Dirigo Health Program has contracted to underwrite and 
provide Dirigo Health Program coverage a current certificate 
from the Dirigo Health Program certifying the successful 
completion of all training offered and 
required by 
the 
Dirigo Health Program; and 
D. The producer successfully completes all training specific 
to the sale of Dirigo Health Program insurance products 
offered and required by the carrier or carriers contracting 
with the Dirigo Health Program to underwrite and provide 
Dirigo Health Program coverage, 
including any continuing 
training offered and required by such carrier or carriers. 
2. 
Annual certification required. 
Training pursuant to 
subsection 1 must be completed annually, 
and any certificate 
establishing successful completion of training is valid for one 
year from the date of issuance. 
If a producer fails to obtain 
certification 
following 
the 
expiration 
of 
the 
prior 
year's 
certificatiQ.n, 
the 
producer 
may 
not 
continue 
to 
solicit, 
negotiate and sell insurance products offered by or through the 
Dirigo Health Program. 
3. 
Carrier appointment not required. 
Notwithstanding any 
other provision of law, an insurance producer licensed pursuant 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ,)4" to H.P. 1285, L.D. 1845 
to 
qhapter 
who 
complies 
with 
this 
section 
may solicit, 
negotiate and sell insurance products offered by or through the 
Dirigo Health Program without being a)?pointed by the carrier or 
carriers contracting with the Dirigo Health Program to underwrite 
and provide Dirigo Health Program coverage. 
A producer may not 
soliqit, 
negotiate or sell insurance produqts offered by or 
through the Dirigo Health Program if the producer is not in 
compliance with this subsection. 
Notwithstanding section 1445, 
the 
carrier or 
carriers 
contracting with the 
Dirigo 
Health 
Program to underwrite and provide Dirigo Health Program coverage 
are not liable for the actions of an insurance )?roducer who has 
not been appointed to solicit, negotiate 
and sell insurance 
products offered by or through the Dirigo Health Program. 
Sec. 9. 24-A MRSA c. 87, sub-c. 4 is enacted to read: 
SUBCHAP'iER 4 
DIRlGO HEALTH SELF -ADMINISTERED PLAN 
§6981. 
DirigQ Health Self-administered Plan 
Notwithstanding section 6910, 
subsection 2, 
Dirigo Health 
may provide access to health benefits coverage by establishing 
the Dirigo Health Self-administered Plan, referred to in this 
section as "the self administered plan," pursuant to this section. 
1. 
Establishment. 
Dirigo 
Health 
may 
provide 
access 
to 
health 
benefits 
coverage 
through 
the 
Dirigo 
Health 
Self-administered 
Plan 
subject 
to 
the 
reguirements 
of 
this 
section. 
The board may make a determination that Dirigo Health 
will 
provide 
access 
to 
health benefits 
qQverage 
through 
a 
self administered plan after the board evaluates competitive bids 
for health benefits coverage for 
self-administered and fully 
underwritten health benefits coverage. 
If the board determines 
that Dirigo Health will provide access to health coverage through 
a self-administered plan as authgrized under this section, the 
board shall 
submit 
a 
report explaining the 
reasons 
for 
the 
decision to the 
joint standing committee of the Legislature 
having jurisdiction over health insurance matters within 30 days 
of the decision. 
Upon receipt of a report from the board, the 
chairs of the joint standing committee of the Legislature having 
juriSdiction over health insurance matters may call a meeting of 
the qommittee. 
Following receipt of such a report, the joint 
standing committee of the Legislature having jurisdiction over 
heglth insurance matters may report out legislation to the next 
regular or special session of the Legislature relating to the 
establishment of the Dirigo Health Self-administered Plan. 
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COMMITTEE AMENDMENT .]+ .. to H.P. 1285, L.D. 1845 
2. 
Cooperative agreements. 
Dirigo Health may enter into 
voluntary cooperative agreements with 
a 
public purchaser 
for 
purchasing 
purposes 
and 
administrative 
functions. 
If 
a 
cooperative 
agreement 
is 
entered 
into 
pursuant 
to 
this 
subsection, the self-administered plan and any public purchaser 
shall maintain separate and distinct risk pools and reserves and 
may 
not 
commingle 
risk 
pools 
or 
reserve 
funds 
under 
any 
circumstances. 
For 
the 
purposes 
of 
this 
subsection, 
"public 
purchaser" means an entity that purchases health coverage in 
whole or in part with public funds, including, but not limi ted 
to, the state employee health insurance program. the University 
of Maine System, the Maine Community College System, the Maine 
Education Association benefits trust, the Maine School Management 
Association benefits trust and municipal and county governments. 
For the purposes of this subsection, "public purchaser" does not 
mean the Department of Health and Human Services, 
Office of 
MaineCare Services 
except for cooperative agreements for 
the 
purchasing of pharmaceuticals pursuant to Title 5, section 2031. 
3. Additional responsibilities of board. 
In addi tion to 
the duties and responsibilities set out in sections 6908 
and 
6910, the board is authorized to: 
A. 
Operate the self-administered plan pursuant to a trust 
instrument in accordance with Title 18-8; 
B. 
Develop, maintain and modify a business plan for the 
self-administered plan as appropriate in consultation with 
the executive director; 
C. 
Establish an operating budget for the self-administered 
plan subject to legislative approval in the biennial budget 
process in accordance with section 6908, subsection 3; 
D. 
Ensure the ongoing fiscal integrity and stability of the 
self -administered plan in accordance with subsections 5 and 
and monitor statistics provided by the executive director 
relating to the number of plan enrollees, working rates r 
utilization of benefits, operating costs and reimbursement 
for losses related to excess or stop loss coverage; 
E. 
Establish administrative and accounting procedures in 
accordance with section 6908, subsection 2, paragraph A and 
develop 
financial 
statements 
that 
are 
consistent 
with 
generally accepted accounting principles; 
F. 
Obtain necessary contracts for services, including, but 
not limited to, 
actuarial services, 
accounting services, 
ayditing 
services, 
investment 
advice 
and 
counsel 
and 
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COMMITTEE AMENDMENT ·A .. to H.P. 1285, L.D. 1845 
custodial services for financial assets in accordance with 
subsection 4; 
G. 
Take any actions nece...§.sary to comply with federal and 
state Medicaid rules regarding Dirigo Health plan enrollees 
members eligible for MaineCare: 
H. 
Take 
any 
actions 
necessary 
to 
comply 
with 
federal 
Medicaid managed care organization contract requirements as 
provided in 42 Code of Federal Regulations, Part 438 (2002); 
and 
1. 
Have and exercise all powers necessary and appropriate 
to carry out the purpQses of this section. 
4. 
Services. 
If the board determines that Dirigo Health 
will 
prQvide 
access 
to 
health 
cQyerage 
through 
the 
self administered plan pursuant to subsection 2, the board shall 
contract for the following services thrQugh a competitive bidding 
proce§s unles§ the requirement for competitive bidding is waived 
pursuant to Title 5. section 1825-B, subsection 2 or a carrier 
contracted by DirigQ Health to fully underwrite health benefits 
coverage terminate§ that contract. 
A. 
The board shall secure the services of an actuary for 
~ical advice on matters regarding the operation of the 
self-administered plan in accordance with this paragraph. 
The board shall contract for actuarial services after a 
competitive bidding process at least every 3 years and may 
award a bid only to an actuary who is a 
member in good 
standing of the American Academy of Actuaries or a successor 
organization. 
The contract must require the actuary to: 
(1) Act as a technical advisor to the board on matters 
regarding the operation of the self-administered plan 
in accordance with this paragraph; 
(2) 
Certify the 
amounts 
of 
the benefits paid 
and 
payable under this section; 
(3) Analyze the year' s operations and results and the 
experience of the self-administered plan; 
(4) 
Determine 
appropriate 
actuarial 
assumptions 
for 
recommendation to the board; and 
(5) Determine the appropr late level of reserves needed 
to sustain the self-administered plan and pay benefits. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT .~ .. to H.P. 1285, L.D. 1845 
B. 
The board shall secure the services of one or more 
fiduciaries 
or 
registered 
investment 
advisors 
through 
negotiated 
contractual 
arrangements. 
The 
contract 
must 
require the fiduciary or registered investment advisor to: 
(1) 
Invest and reinvest the funds in accordance with 
appropriate financial and trust standardsj 
(2) 
Advise 
the 
board 
as 
to 
reasonable 
investment 
philosophyj and 
(3) 
Su~t regular reports of investments and changes 
to the board. 
C. 
The board shall contract with an appropriate financial 
institution for custodial services for the securities and 
other investment assets of the self-administered plan. 
The 
contract 
must 
require 
the 
custodian 
to 
meet 
financial 
safeguards and other qualifications determined by the board, 
including restrictions on the manner in which deposits and 
withdrawals of funds are completed. 
D. 
When 
the self-administered plan is established, 
the 
board shall purchase, through contracts from one or more 
3rd-party administrators or any organization necessary to 
administer and provide a health plan, a policy or policies 
or a contract to provide the benefits specified by this 
section. 
The purchase of policies by the board must be 
accomplished 
by 
use 
of 
a 
written contract 
for 
a 
term 
determined by the board. 
The 
board 
may 
contract 
for 
any 
other 
applicable 
services 
necessary to comply with federal law. 
5. 
Administration. 
The 
following 
provisions 
govern 
the 
administration of the self-administered plan. 
A. 
The assets and liabilities of the self-administered plan 
are solely the assets and liabilities of Dirigo Health. 
B. 
The actuary under contract with the board pursuant to 
subsection 4 shall determine: 
(1) The appropriate level of reserves estimated to be 
sufficient 
to 
pay 
claims 
and 
administrative 
costs 
according to subsection 10, paragraph Bj 
(2) Whether the program is operating on an actuarially 
sound basis, 
and 
any 
recommendations based on 
that 
determination; 
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COMMITTEE AMENDMENT A 
.. to H. P. 1285, L. D. 1845 
(3) A rate structure for the self-administered plan, 
including working rates actuarially sufficient to pay 
anticipated claims for the current claims year as well 
as to provide sufficient reserves for incurred but not 
reported claims; 
(4) 
Recommendations as to the purchase of excess or 
stop 
loss 
insurance 
including 
suggested 
attachment 
levels and limits; and 
(5) 
Recommendations 
as 
to the 
need for 
a 
security 
deposit or surety bond to protect against insolvency. 
The actuary shall annually present information to the board 
on the determinations made pursuant to this paragraph as 
well as the method of distribution of any accumulations 
above 
the 
reserves 
including use of excess 
reserves 
to 
moderate the working rates. 
C, 
Upon 
receipt 
of 
the 
initial 
presentation 
and 
recommendations of the actuary pursuant to paragraph Band 
annually 
thereafter, 
the 
board 
shall 
submit 
that 
presentation 
to 
the 
superintendent 
for 
review. 
The 
superintendent shall review the actuary I s presentation and 
provide comments to the board. 
6. Audits: financial statements. 
The board shall arrange 
for an annual audit of its financial statements by an independent 
certified 
public 
accounting 
firm. 
Within 
days 
of 
the 
completion 
of 
the 
audit, 
a 
copy 
of 
the 
audited 
financial 
statements must be distributed to the Legislature in the same 
manner as required by section 6908, subsection 4. A copy of the 
audited financial statements must also be made available for 
public inspection. 
7. Public entity. The Dirigo Health Self-administered Plan 
is 
a 
public entity for 
the purposes of 
Code of Federal 
Regulations, Section 438.116. 
8. 
Application 
of 
certain 
insurance 
provisions. 
The 
self-administered 
plan 
must 
meet 
or 
exceed 
the 
following 
requirements as if health benefits coverage were provided by a 
health insurance carrier: 
A. 
The 
requirements 
for 
ratings 
practices 
pursuant 
to 
section 2736-C, subsection 2 and section 2808-8, subsection 
£L 
Page ll-LR2927(2) 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ·A " to H.P. 1285, L.D. 1845 
B. 
The 
requirements 
for guaranteed issuance pursuant to 
section 2736-C, subsection 3 and section 2808-B, subsection 
II 
C. 
The 
requirements 
for 
guaranteed 
renewal 
pursuant 
to 
section 2736-C, subsection 3 and section 280S-B, subsection 
su1:1ject to the limitations of available funds maintained 
by the self-administered plan in accordance with subsection 
10; 
D. The requirements for continuity of coverage, coverage of 
late enrollees and preexisting condition exclusions pursuant 
to chapter 36; 
E. The requirements for mandated coverage of specific health 
care services and for specific diseases and for certain 
providers of health care services pursuant to Title 24 and 
this Title; and 
F. The requirements for the 1:1enefits, rights and protections 
for individuals enrolled in health plans pursuant to chapter 
56-A 
and 
Bureau 
of 
Insurance 
Rule, 
Chapter 
850. 
Notwithstanding any statute or common law to the contrary, 
an individual enrolled in the self-administered plan may 
maintain a 
cause of action against the self-administered 
plan 
su1:1ject 
to 
the 
requirements 
of section 4313. 
This 
paragraph is a waiver of the State' s defense of immunity 
under Title 14, chapter 741. 
The self-administered plan may not enter into any contract with a 
3rd-party 
administrator, 
carrier 
or 
other 
organization 
to 
administer and provide health coverage that has not demonstrated 
compliance with all applica1:1le state laws. 
9. 
DirigQ Health Self-administered Plan nQt an insurer. 
The 
Dirigo Health Self-administered Plan is not 
an 
insurer, 
reciprocal insurer or joint underwriting association under the 
laws of the State. 
The administration of the self-administered 
plan 1:1y 
the board does not constitute doing the business 
of; 
insurance. 
10. 
Reserves. 
This subsection applies to reserves of the 
self-administered plan. 
A. 
The Dirigo Health Reserve is created as 
an account 
within the Dirigo Health Enterprise Fund, 
as established 
pursuant to section 6915, for the deposit of reserves as 
required by paragraph B. 
B. 
The self-administered plan shall maintain a reserve at 
least equal to the sum of: 
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COMMITTEE AMENDMENT ·A .. to H.P. 1285, L.D. 1845 
(1) An amount estimated by a gualified acturary under 
subsection 
to 
be 
necessary 
to 
pay 
claims 
and 
administrative costs for the assumed risk for 2 1/2 
months: and 
(2) 
The 
amount 
determined 
annually 
by 
a 
gualified 
actuary under subsection 5 to be necessary to fund the 
unpaid portion of ultimate expected losses, including 
incurred but not reported claims, and related expenses 
incurred in the 
prov~s~on of benefits for eligible 
participants, 
less 
any credit, 
as 
determined 
by 
a 
qualified actuary, for excess Qr stop loss insurance. 
C. 
The 
Dirigo 
Health 
Reserve 
must 
be 
adjusted 
on 
a 
guarterly basis in order tQ maintain a 
reserve at least 
egual to the amount determined in paragraph B. 
D. 
The Dirigo Health Reserve is capitalized by money from 
the DirigQ Health Enterprise Fund, as established pursuant 
to section 6915, 
and any Qther 
fund advanced for ini tial 
operating expenses, 
mQnthly enrollee payments, 
any 
funds 
received from 
any public or private source, 
legislative 
appropriations, payments frQm state departments and agencies 
and such other means as the Legislature may apprQve. 
All 
money in the Dirigo Health Reserve is deemed to be the 
commingled assets of all covered enrQllees and may be used 
only fQr the purposes of this section. 
11. Stop loss insurance. 
The board may purchase excess or 
stop 
lQss 
insurance 
for 
the 
self-administered 
plan, 
with 
attachment 
levels 
and 
limits 
as 
recQmmended 
by 
a 
qualified 
actuary pursuant to subsection 5. 
If the board is unable to 
purchase 
excess 
or 
stop 
loss 
insurance 
at 
the 
recommended 
attachment 
levels 
and 
limits, 
the 
board 
does 
not 
have 
the 
authority tQ establish a self-administered plan as provided in 
this section. 
12. 
Marketing and distribution. 
The board may contract for 
the marketing and distribution of the self-administered plan in 
accordance with the requirements of this subsection. 
Any entity 
or 
individual that contracts with the self-administered plan 
shall successfully complete all training offered by Dirigo Health 
for the solicitation, negotiation and sale of health benefits 
coverage. 
Training 
must 
be 
completed 
annually, 
and 
any 
certificate establiShing successful completion of training is 
valid for one year from the date of issuance. 
If an entity or 
individual 
fails 
to 
obtain 
certification 
following 
the 
expiration of 
the prior year's certification, 
the entity or 
COMMITTEE AMENDMENT 
~.r;" 
COMMITTEE AMENDMENT "A" to H.P. 1285, L.D. 1845 
individual may not continue to solicit. negotiate and sell health 
Qenefits coyerage under the self-administered plan. 
13. 
Provider 
reimbursement. 
In 
any 
contract 
wi th 
a 
3rd party 
administrator. 
carrier 
or 
other 
organization 
to 
administer 
and 
provide health 
coverage 
to 
enrollees 
of 
the 
self-administered plan. the Qoard shall ensure that: 
A. Providers contracting to provide health coverage to plan 
enrollees are reimbursed at a 
rate comparable to current 
market reimbursement rates among commercial carriers in the 
State; 
B. Providers contracting to provide health coverage to plan 
enrollees are paid in a timely manner in accordance with the 
same reguirements that would Qe reguired under state law for 
health insurance carriers pursuant to Title 24-A, section 
2436; ang 
C. If the self-administereg plan fails to pay for health 
care services as set forth in the contract. providers are 
governed Qy the stangargs reguired pursuant to section 4204. 
subsection 6. 
This paragraph does not prohibit a provider 
from 
collecting or 
attempting 
to 
collect 
from 
a 
plan 
enrollee any amount for services not normally payaQle to the 
self-administered plan. including any applicable copayments 
and deductiQles. 
14. No liability for plan enrollees. This section does not 
create any liability on the part of eligible employers. eligible 
employees or eligiQle individuals enrolled in: Dirigo Health in 
the event that the self-administered plan becomes insolvent or 
f~ils to pay claims. 
Sec. 10. New appointments to Board of Trustees of Dirigo Health; 
staggered terms. 
Notwithstanding 
the 
Maine 
Revised 
Statutes. 
Title 
24-A, 
section 6904, 
subsection 3, 
the terms of the 
members added to the Board of Trustees of Dirigo Health pursuant 
to this Act must be staggered. 
The Governor shall appoint one 
member for a term of 1 year, one member for a term of 2 years and 
members for terms of 3 years. I 
SUMMARY 
This amendment replaces the bill and is the majority report 
of the committee. 
The amendment expands the Dirigo Health Board 
of Directors from 5 to 9 members and renames it the Board of 
Trustees of Dirigo Health. The amendment requires that 3 voting 
members 
of 
the board have expertise in accounting, 
banking, 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .~ .. to H.P. 1285", L.D. 1845 
securities or insurance and adds the Treasurer of State as an ex 
officio, nonvoting member. The amendment clarifies that 5 members 
of the board constitute a quorum and that an affirmative vote of 
members is needed for the board to take action. The amendment 
extends the limitation on personal liability of trustees under 
the Maine Uniform Trust Code to the trustees of Dirigo Health. 
The 
amendment 
permits 
licensed 
insurance 
producers 
with 
health authority to sell the Dirigo Health Program insurance 
products if the producer meets certain training requirements. 
Additionally, 
the bill exempts producers 
from the appointment 
requirement solely for purposes of selling the Dirigo Health 
Program 
insurance 
products 
and 
holds 
a 
carrier 
underwriting 
Dirigo Health Program coverage harmless from liability for any 
actions of such producers. 
The amendment gives authority to Dirigo Health to provide 
access to health benefits coverage through the Dirigo Health 
Self-administered 
Plan 
after 
the 
board 
evaluates 
bids 
for 
self-administered and fully insured benefits coverage. 
If the 
board 
makes 
the 
decision 
to 
provide 
coverage 
through 
a 
self-administered plan, 
the 
amendment 
requires 
the 
board 
to 
report to the joint standing committee of the Legislature having 
jurisdiction over health insurance matters within 30 days of the 
decision. The amendment also gives the committee the authority to 
report out legislation relating to the self-administered plan. 
If the Dirigo Health Self-administered Plan is established, 
the 
amendment 
authorizes 
the 
board 
to 
enter 
into 
voluntary 
cooperative agreements with a public purchaser for purchasing and 
administrative functions only, but requires that the risk pools 
and reserves of the Dirigo Health Self-administered Plan and any 
public purchaser may not be commingled. The amendment expands the 
duties 
and responsibilities of the board with regard to the 
establishment 
and ongoing management of 
the self-administered 
plan. 
The amendment requires the board to contract for services 
from 
actuaries, 
investment 
counsel, 
financial 
institutions, 
3rd-party administrators and any other organization necessary to 
administer the plan. 
The 
amendment requires an actuary under 
contract to the board to determine the appropriate level of 
reserves and administrative costs for the plan and the amount of 
stop loss insurance necessary, 
provide opinions regarding the 
actuarial soundness of the plan, develop a rate structure for the 
plan and report annually to the board. 
The amendment requires the Dirigo Health Self-administered 
Plan to maintain reserves at least equal to the sum of the amount 
necessary to pay claims and administrative costs for the assumed 
risk for 
1/2 months and the amount determined annually by a 
qualified actuary to be necessary to fund the unpaid portion of 
Page l5-LR2927(2) 
COMMITTEE AMENDMENT 
~.c;. 
COMMITTEE AMENDMENT "~" to H.P. 1285, L.D. 1845 
ultimate expected losses and related expenses incurred in the 
prov~s~on of 
benefits. 
The 
amendment 
requires 
the 
reserve 
account to be adjusted on a quarterly basis and to be capitalized 
from any initial start-up funds transferred into the account by 
Dirigo Health, monthly enrollee payments, any funds received from 
any 
public 
or 
private 
source, 
legislative 
appropriations, 
payments from any state departments or agencies and any other 
means approved by the Legislature. The amendment also authorizes 
the board to purchase excess or stop loss insurance at attachment 
limits and levels recommended by a qualified actuary and removes 
the authority to establish a self-administered plan in the event 
the board is unable to purchase that insurance. 
The amendment requires the Dirigo Health Self-administered 
Plan to meet the same requirements of the Maine Insurance Code 
that would be required by state law if health benefits coverage 
were provided by a health insurance carrier for community rating, 
guaranteed issuance, guaranteed renewal, continuity of coverage 
and mandated benefits. 
The 
amendment 
also requires that the 
self-administered plan 
extend 
the 
same 
benefits, 
rights 
and 
protections of the Maine Revised Statutes, Title 24-A, chapter 
56-A 
and Bureau of 
Insurance 
Rule 
Chapter 
850, 
including 
a 
limited right to sue the Dirigo Health Self-administered Plan. 
The amendment specifically waives the State's defense of immunity 
under the Maine Tort Claims Act. 
FISCAL NOTE REQUIRED 
(See attached) 
Page l6-LR2927(2) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Revised: 04/11106 ~ac:.. 
LD 1845 
LR 2927(02) 
An Act To Increase Access to Health Insurance Products 
Fiscal Note for Bill as Amended by Committee Amendment t~" 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Majority Report 
Fiscal Note 
Potential current biennium cost increase - General Fund 
Minor cost increase - Other Funds 
Assumes that giving the Dirigo Health Program the option to convert to a self-administered plan could result in the 
State bearing additional financial liability if reserves and stop loss insurance provisions required in the bill prove to be 
inadequate. Assumes any additional costs to the Dirigo Health Program from the other changes made in the bill can 
be absorbed by the program utilizing existing resources of the Dirigo Health Enterprise Fund. Assumes any additional 
costs to the Bureau of Insurance in the Department of Professional and Financial Regulation can be absorbed by the 
Bureau utilizing existing budgetary resources. 
LR2927(2) - Fiscal Note - Page 1 of 1