An Act To Increase Access to Health Insurance Products Amend the amendment by inserting before section the following: Further amend the amendment by inserting after section 10 the following: PARTB Sec. B·l. 24·A MRSA §2736·C, sub·§2, F, as enacted by PL 2003, c. 469, Pt. E, §12, is amended to read: F. A carrier that adjusts its rate shall account for the savings offset payment or any recovery in that offset payment in its experience consistent with this section and section 69l3. For any rate filing made by a carrier on or after August 1, 2006, the carrier shall certify in the filing that the carrier has not included profit from any savings realized by the carrier that were the result of the operation of Dirigo Health and any increased MaineCare enrollment due to an expansion in MaineCare eligibility occurring after June 30, 2004 and that the carrier has used Page l-LR2927(14) SENATE AMENDMENT
Maine Legislature, Session 122, LD 1845
Committee Amendment CA_A-SA_D_S697 (Senate)
Amends: 24-A MRSA §2808-B

SENATE AMENDMENT ,1)" to COMMITTEE 
AMENDMENT 
"A" to H. P . 
1285, 
L.D. 
1845, Bill, 
"An Act To 
Increase Access to Health 
Insurance Products" 
Amend 
the 
amendment 
by inserting before 
section 
the 
following: 
Further amend the amendment by inserting after section 10 
the following: 
'PARTB 
Sec. B·l. 24·A MRSA §2736·C, sub·§2, F, as enacted by PL 
2003, c. 469, Pt. E, §12, is amended to read: 
F. 
A carrier that adjusts its rate shall account for the 
savings offset 
payment 
or 
any 
recovery in 
that offset 
payment in its experience consistent with this section and 
section 69l3. 
For any rate filing made by a carrier on or 
after August 1, 
2006, 
the carrier shall certify in the 
filing that the carrier has not included profit from any 
savings realized by the carrier that were the result of the 
operation of Dirigo Health 
and 
any 
increased MaineCare 
enrollment 
due 
to an expansion in MaineCare eligibility 
occurring after June 30, 2004 and that the carrier has used 
Page l-LR2927(14) 
SENATE AMENDMENT 
SENATE AMENDMENT 1)" to COMMITTEE AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
its best efforts to limit the impact of the savings offset 
payment 
on 
rates 
in 
accordance 
with 
sound 
actuarial 
principles. 
Sec. B-2. 24-A MRSA §2808-B, sub-§2-B, 1J]), as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
D. 
A carrier that adjusts its rate shall account for the 
savings offset payment 
or any recovery of that savings 
offset 
payment 
in its 
experience 
consistent with 
this 
section and section 6913. 
For any rate filing made by a 
carrier on or after August 
1, 
2006, 
the carrier shall 
certify in the filing that the carrier has not included 
profit from any savings realized by the carrier that were 
the 
result of 
the 
operation of Dirigo 
Health 
and 
any. 
increased 
MaineCare 
enrollment 
due 
to 
an 
expansion 
in 
MaineCare eligibility occurring after June 30, 2004 and that 
the carrier has used its best efforts to limit the impact of 
the savings offset payment on rates in accordance with sound 
actuarial principles. 
Sec. B-3. 24·A MRSA §2839-B, sub-§2, as enacted by PL 2003, c. 
469, Pt. E, §17, is amended to read: 
2. 
Annual filing. 
Every carrier offering group health 
insurance specified in subsection 1 shall annually file with the 
superintendent on or before April 30th a certification signed by 
a member in good standing of the American Academy of Actuaries or 
a successor organization that the carrier's rating methods and 
practices are in accordance with generally accepted actuarial 
principles 
and 
with 
the 
applicable 
actuarial 
standards 
of 
practice as promulgated by an actuarial standards board. 
The 
filing must also certify that the carrier has included 'in its 
experience 
any savings offset payments or 
recovery of those 
savings offset payments consistent with section 6913. 
For any 
filing under this subsection made by a carrier on or after August 
1, 2006, the carrier shall certify in the filing that the carrier 
has not inCluded profit from any savings realized by the carrier 
that were· the result of the operation of Dirigo Health and any 
increased MaineCare . enrollment due to an expansion in MaineCare 
eligibility occurring after June 30, 2004 and that the carrier 
has used its best efforts to limit the impact of the savings 
offset payment 
on 
rates 
in 
accordance 
with 
sound actuarial 
principles. 
The 
filing 
also 
must 
state 
the 
number 
of 
policyholders, 
certificate holders 
and dependents, 
as of the 
close of the preceding calendar year, enrolled in large group 
health insurance plans offered by the carrier. 
A filing 
and 
supporting information are public records except as provided by 
Title 1, section 402, subsection 3. 
SENATE AMENDMENT 
.,. 
SENATE AMENDMENT 'CD" to COMMITTEE 
AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
Sec. B-4. Fixed savings offset payment for plan years beginning 
January 1, 2006 to December 31, 2006. Notwithstanding the Maine 
Revised Statutes,. Title 24-A, section 6913, subsections 1 to 3, 
the savings offset payment for plan years beginning January 1, 
2006 to December 31, 2006 must equal a total of $23,000,000 for 
all 
health 
insurance 
carriers, 
3rd-party ·administrators 
and 
employee benefit excess 
insurance 
carriers. 
For 
plan years 
beginning January 1, 
2006 to December 31, 
2006 
the Board of 
Directors of Dirigo Health shall disregard the savings offset 
amount 
calculation 
set 
forth 
in 
Title 
24-A, 
section, 6913, 
subsection 2. 
The savings offset payment established pursuant to 
this 
section must 
be 
paid in 
accordance 
with 
the 
schedule 
established in Title 24-A, section 6913, subsection 3, paragraph 
F. 
No later than 90 days after the effective date of this Act, 
all health insurance carriers shall file amended rate filings 
with the Superintendent of Insurance demonstrating the effect of 
the reduced savings offset payment pursuant to this section on 
premium rates and attesting that the carrier has used its best 
efforts to ensure that rates reflect the reduced savings offset 
payment. The savings offset payment set forth in this section 
applies retroactively to any savings offset payment that has been 
assessed and paid pursuant to Title 24-A, 
secti~n 6913 for plan 
years beginning January 1, 2006. 
No later than 30 days following 
the effective date of this Act, Dirigo Health shall issue refunds 
of, 
or credits for, 
any amounts 
collected in excess of the 
limitations established in this section. 
This section applies 
only to the 
savings offset payment 
for plan years beginning 
January 1, 2006 to December 31, 2006. 
This section may not be 
construed as repealing, 
amending or modifying in any way the 
provisions of Title 24-A, section 6913 for plan years beginning 
on or after January 1, 2007. 
This section may not be construed 
by a court of law as affirming or not affirming any actions of 
the Board of Directors of Dirigo Health or the Superintendent of 
Insurance. 
Sec. B-S. Final settlement of experience modification payment. 
Dirigo Health shall renegotiate with the carrier contracted to 
underwrite and provide Dirigo Health Program coverage for the 
purpose of reducing the 2006 experience modification payment by 
$11,000,000. 
Sec. B-6. Reduced administrative costs. 
Dirigo 
Health shall 
achieve savings of $1,900,000 for fiscal year 2006-07 through 
reductions in administrative expenses. 
PARTe 
Sec. 
C-l. 
Commission 
established. 
The 
Blue 
Ribbon 
SENATE AMENDMENT 
.... "0. 
SENATE AMENDMENT ~" to COMMITTEE AMENDMENT 
"A" to H.P. 1285, 
L.D. 1845 
Commission on the Long-term Funding of the Dirigo Health Program, 
referred to in this Part as "the commission," is established. 
Sec. C-2. Membership. The commission consists of 15 members 
appointed as follows: 
1. Two members of the Senate appointed by the President of 
the 
Senate 
and 
members 
of 
the 
House 
of 
Representatives 
appointed by the Speaker of the House. At least one legislative 
member appointed must be a member of the Joint Standing Committee 
on Insurance and Financial Services and at least one legislative 
member appointed must be a member of the Joint Standing Committee 
on Appropriations and Financial Affairs. Legislative appointments 
under this subsection must be representative of the bipartisan 
interests of the Legislature; 
2. Three members appointed by the President of the Senate, 
one member representing the interests of employers recommended by 
a statewide organization of business and employer members, one 
member representing hospitals recommended by a statewide hospital 
association and one member representing insurance producers; 
3. Three members appointed by the Speaker 'of the House of 
Representatives, 
one 
member 
representing 
health 
insurance 
carriers recommended by a statewide association of health plans, 
one member 
representing physicians recommended by a 
statewide 
medical association and 
one 
member 
representing the Medicaid 
Advisory Committee; and 
4. 
Five 
members 
appointed 
by 
the 
Governor, 
one 
member 
representing the Governor' s Office of Health Policy and Finance, 
one member representing the Board of Directors of Dirigo Health, 
one member representing organized labor, one member representing 
a 
statewide health care advocacy organization and one member 
representing a statewide consumer advocacy organization. 
Sec. C-3. Chairs. 
The first-named Senator is the Senate chair 
of the commission and the first-named member of the House is the 
House chair of the commission.' 
Sec. C-4. Appointments. All appointments must be made no later 
than 30 
days 
following the effective date 
of this Act. 
The 
appointing authorities shall notify the Executive Director of the 
Legislative Council 
upon making their appointments. 
When 
the 
appointment of all members is complete, the chairs shall call and 
convene the first meeting of the commission no later than August 
1st. 
Sec. C-S. Duties. 
The 
commission shall 
Heal th Program and make recommendations for a 
study 
the 
Dirigo 
long-term funding 
SENATE AMENDMENT 
~4" 
SENATE AMENDMENT ''J)'' to COMMITTEE AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
mechanism in an effort to ensure its sustainabi1ity over time. In 
conducting the study, the commission shall: 
1. 
Review and make recommendations for alternatives for 
funding the Dirigo Health Program and subsidies under the program 
in 
a 
fair, 
equitable 
and 
broadly 
distributed 
manner. 
The 
recommendations must include a number of funding sources and may 
include the savings offset payment in some manner; 
2. 
Evaluate the MaineCare expansion in the Dirigo Health 
reform law, 
including its funding source, 
enrollment of the 
uninsured 
and 
the 
potential 
impact 
on 
private 
payors 
and 
providers; 
3. 
Review and make recommendations for reforms that may, 
improve the affordabili ty of health insurance in the individual 
market; 
4. 
Review and make 
recommendations 
on cost containment 
methods proven effective in reducing and controlling health care 
costs and health care spending or creating savings in Maine's 
health care market; and 
5. 
Review alternatives for funding sources within existing 
resources to maximize federal Medicaid matching funds for the 
purpose of reimbursing medical providers for unpaid claims or to 
adjust rates. 
Sec. C-6. Meetings. The commission is authorized to meet at 
least 4 times in 2006 and with approval of the presiding officers 
of the Legislature may hold additional meetings and may meet at 
various locations throughout the State. Meetings must be open to 
the 
public. 
The 
commission 
shall 
consult 
stakeholders 
for 
information and assistance in gathering information related to 
the duties described in section 5. 
Sec. C-7. Staff assistance. Upon approval of the Legislative 
Council, the Office of Policy and Legal Analysis and the Office 
of Fiscal and Program Review shall provide staffing assistance to 
the commission. 
Sec. e-8. Compensation. Legislative members are entitled to 
receive the legislative per diem and reimbursement of necessary 
expenses 
for their attendance at authorized meetings of the 
commission. 
Public members not otherwise compensated by their 
employers or other entities that they represent are entitled to 
receive reimbursement of necessary expenses and a per diem equal 
to the legislative per diem for their attendance at authorized 
meetings 
of 
the 
commission. 
The 
Executive 
Director 
of 
the 
Legislative Council shall administer the commission's budget. 
SENATE AMENDMENT 
t..t'. 
SENATE AMENDMENT :CD" to COMMITTEE AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
Sec. C-9. Budget. 
The 
chairs 
of 
the 
commission, 
with 
assistance 
from 
the 
commission 
staff, 
shall 
administer 
the 
commission's budget. 
Wi thin 10 days after its first meeting, 
the commission shall present a work plan and proposed budget to 
the Legislative Council for its approval. The commission may not 
incur expenses that would result in the commission exceeding its 
approved budget. Upon request from the commission, the Executive 
Director of the Legislative Council shall promptly. provide the 
commission 
chairs 
and 
staff 
with 
a 
status 
report 
on 
the 
commission's budget, expenditures incurred and paid and available 
funds. 
Sec. C-IO. Receipt of outside funds authorized. The commission may 
seek outside funds to fund costs of the commission other than 
authorized per diem and expenses of the members authorized by 
section 8. Contributions to support the work of the commission 
may not be accepted from any party having a pecuniary or other 
vested interest in the outcome of the matters being studied. Any 
person, other than a state agency, desiring to make a financial 
or in-kind contribution must certify to the Legislative Council 
that it has no pecuniary or other vested interest in the outcome 
of the study. 
The certification must be 
made' in the manner 
prescribed by the Legislative Council. 
All 
contributions 
are 
subject 
to 
approval 
by 
the 
Legislative 
Council. 
All 
funds 
accepted must be 
forwarded to the Executive Director of the 
Legislative Council along with an accounting record that includes 
the amount of the funds, the date the funds were received, from 
whom the funds were received and the purpose of or any limitation 
on 
the 
use 
of 
the 
funds. 
The 
Executive 
Director 
of 
the 
Legislative Council shall administer any funds received by the 
commission. 
Sec. C-ll. Reports. 
No 
later than November 15, 
2006, 
the 
commission 
shall 
submit 
a 
report 
with 
findings 
and 
recommendations, 
including 
any 
suggested 
legislation, 
for 
presentation to the joint standing committee of the Legislature 
having jurisdiction over insurance and financial services matters 
and the' joint standing 
committee 
of 
the 
Legislature 
having 
jurisdiction over appropriations and financial. affairs. The joint 
standing committee of the Legislature having jurisdiction over 
insurance and financial services matters and the joint standing 
committee 
of 
the 
Legislature 
having 
jurisdiction 
over 
appropriations 
and 
financial 
affairs 
may 
each 
report 
out 
legislation to the l23rd Legislature based on. the commission's 
report. 
If the commission fails to recommend legislation, the 
joint standing committee of the Legislature having jurisdiction 
over insurance and financial services matters shall report out 
legislation to the l23rd Legislature to address the impact of the 
savings offset payment on health insurance premium rates. 
SENATE AMENDMENT 
t\.cJ'· 
SENATE AMENDMENT ::1>" to COMMITTEE AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
Sec. C-12. Appropriations and 
allocations. 
appropriations and allocations are made. 
DIRIGO REALm 
Dirigo Health Fund 0988 
The 
following 
Initiative: 
Deallocates funds to be achieved by a $1.9 million 
reduction in Dirigo Health administrative expenses and an $11 
million reduction in contracted Dirigo Health Program experience 
modification payments. 
DIRIGO REALm ENTERPRISE FUND 
Unallocated 
DIRIGO HEALTH ENTERPRISE FUND TOTAL 
DIRIGO REALm 
DEPARTMENT 'l'OTALS 
DIRIGO REALm ENTERPRISE FUND 
DEPARTMENT "lUTAL -
ALL FUNDS 
LEGISLATURE 
Study Commissions -
Funding 
0444 
2005-06 
2006-01 
$0 
($12,900,000). 
$0 
($12,900,000) 
2005-06 
2006-01 
$0 
($12,900,000) 
, 
$0 
($12,900,000) 
Initiative: 
Provides funds for the per diem and expenses of the 
Blue Ribbon Commission on the Long-term Funding of the Dirigo 
Health Program. 
GENERAL FUND 
Personal Services 
All Other 
GENERAL FUND TOTAL 
Study Commissions -
Funding 
0444 
2005-06 
$0 
$0 
$0 
2006-01 
$880 
$5,250 
$6,130 
Initiative: 
Provides a base allocation of $500 in fiscal year 
2006-07 in the event that outside funding is received to support 
the work of the Blue Ribbon Commission on the Long-term Funding 
of the Dirigo Health Program. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2005-06 
$0 
$0 
2006-01 
$500 
$500 
SENATE AMENDMENT 
,-,," 
SENATE AMENDMENT CD" to COMMITTEE AMENDMENT 
L.D. 1845 
"A" to H.P. 1285, 
LEGISLATURE 
DEPARTMENT "lUI'ALS 
GENERAL FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT "lUI'AL -
ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
OTHER SPECIAL REVENUE FUNDS 
DIRIGO HEALTH ENTERPRISE FUND 
SECTION TOTAL -
ALL FUNDS 
Further amend the amendment by 
any 
nonconsecutive 
Part 
letter 
or 
consecutively. 
SUMMARY 
This amendment does the following. 
2005-06 
2006-07 
$0 
$6,130 
$0 
$500 
$0 
$6,630 
2005-06 
2006-07 
$0 
$6,130 
$0 
$500 
$0 
($12,900,000) 
$0 ($12,893,370) , 
relettering or renumbering 
section 
number 
to 
read 
1. 
It requires carriers to certify that the carrier has not 
included profit from any savings realized by the carrier that 
were 
the result of 
the operation of Dirigo 
Health 
and 
any 
increased MaineCare enrollment due to an expansion in MaineCare 
eligibility and to use their best efforts to limit the impact of 
the savings offset payment on rates. 
2. 
It provides that the savings offset payment for plan 
years beginning January 1, 2006 to December 31, 2006 must equal a 
total of $23,000,000 for all health insurance carriers, 3rd-party 
administrators 
and employee benefit excess insurance carriers. 
It specifies that the provision may not be construed by a court 
of law as affirming or not affirming any actions of the Board of 
Directors of Dirigo Health or the Superintendent of Insurance. 
3. 
It 
requires 
Dirigo 
Health to 
renegotiate with 
the 
carrier contracted to underwrite the Dirigo Health Program for 
the purpose of reducing the 2006 experience modification payment 
by $11,000,000. 
4. 
It requires Dirigo Health to achieve savings of $1. 9 
million in administrative costs. 
SENATE AMENDMENT 
SENATE AMENDMENT 
L.D. 1845 
"]),, to COMMI TTEE AMENDMENT " A" to H. P . 1285, 
5. 
It creates the Blue Ribbon Commission on the Long-term 
Funding of the Dirigo Health Program to study the Dirigo Health 
Program and make recommendations on a long-term funding mechanism 
in an effort to ensure its sustainability. It is the intent of 
the Legislature that the commission recommend a long-term funding 
mechanism to replace 
the savings offset payment as the sole 
source of funding subsidies for the Dirigo Health Program. 
The 
commission is required to submit a report by November 15, 2006 to 
the 
joint 
standing 
committee 
of 
the 
Legislature 
having 
jurisdiction over insurance and financial services matters and 
the 
joint 
standing 
committee 
of 
the 
Legislature 
having 
jurisdiction over appropriations and financial affairs. The joint 
standing committee of the Legislature having jurisdiction over 
insurance 
and 
financial 
services 
matters 
shall 
report 
out 
legislation to address the impact of the savings offset payment. 
on health insurance premium rates. 
SPONSORED BY: ~u. ~ 
(Senator B. BRYANT) 
COUNTY: 
Oxford 
FISCAL '\OTE REQCIRED 
(See attached) 
SENATE AMENDMENT 
Approved: OS/23/06 ;:tvac:.. 
LD 1845 
LR 2927(14) 
An Act To Increase Access to Health Insurance Products 
Fiscal Note for Senate Amendment~' to Committee Amendment 'A' 
Sponsor: Sen. Bryant 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Other Special Revenue Funds 
Other Funds 
Revenue 
Other Funds 
Legislative Study 
Fiscal Note Required: Yes 
Fiscal Note 
Current Costs - Legislative Study 
2005·06 
2006·07 
$0 
$6,130 
$0 
$6,130 
$0 
$500 
$0 
($12,900,000) 
$0 
($20,700,000) 
Projections 
2007·08 
$0 
$0 
$0 
$0 
$0 
Projections 
2008·09 
$0 
$0 
$0 
$0 
$0 
The projected expenses of the Blue Ribbon Commission on the Long-term Funding of the Dirigo Health Program are 
$6,130 in fiscal year 2006-07. Since the Legislature'S budget includes $20,000 in fiscal year 2006-07 for legislative 
studies and the Council has already committed this amount, a General Fund appropriation to the Legislature of $6,130 
in fiscal year 2006-07 for this study has been included in this amendment. There is also a base allocation of $500 in 
fiscal year 2006-07 in the event that outside funding is received to support the work of the commission. 
Fiscal Detail and Notes 
Assumes the amendment's decrease in the 2006 savings offset payment (SOP) would reduce Dirigo Health Program 
revenue by $20,700,000 in fiscal year 2006-07. Includes a FY 2006-07 deallocation of $12.9 million to be achieved 
by savings of $1.9 million in Dirigo Health Agency administrative costs and an $11.0 million reduction in contracted 
Dirigo Health Program experience modification payments. While these deallocations do not fully offset the reduction 
in revenue, the Dirigo Health Program does have existing authority to keep program spending within available 
resources. Any additional costs to the Bureau of Insurance in the Department of Professional and Financial 
Regulation resulting from the amendment can be absorbed by the Bureau utilizing existing budgetary resources. 
LR2927(14) - Fiscal Note - Page 1 of 1