An Act to Improve Dirigo Health
Maine Legislature, Session 122, LD 1680
Committee Amendment CA_A_S491 (Senate)
Amends: 24-A MRSA §2736, 24-A MRSA §2736-A, 24-A MRSA §2736-C, 24-A MRSA §2808-B, 24-A MRSA §690, 24-A MRSA §6913, 24-A MRSA §6914, 24-A MRSA §6915, 24-A MRSA §6951

COMMITTEE AMENDMENT .. A .. to S.P. 625, L.D. 1680, Bill, 
Act to Improve Dirigo Health" 
"A.n 
Amend the bill by striking out everything after the enacting 
clause and inserting in its place the following: 
. Sec. 1. 24·A MRS A §2736, sub-§3, 1[B, as amended by PL 2003. 
c. 469, Pt. E, §9, is further amended to read: 
B. 
The 
insurer 
must 
demonstrate 
in 
accordance 
wi t'l 
generally 
accepted 
actuarial 
principles 
and 
practice::; 
consistently applied that, as of a date no more than 210 
days prior to the filing, the ratios of ~enefits incurred to 
premiums earned for those products average no less than 80'\ 
for the previous l2-month period. 
~e~-~~~~~~-~Bi6 
ea~e~~a~ienT-~-5av~R~5-~~~~-~~--¥aiQ-~~--t9 
see~ien-e9~~-ffi~s~-Be-~~ea~ea-as-ine~~~ea-e±aiffisT 
Sec. 2. 24-A MRSA §2736, sub-§4, 1JC, as amended by PL 2003, c. 
469, Pt. E, §10, is further amended to read: 
C. 
In any hearing conducted under this subsection, 
the 
Bureau of Insurance and any party asserting that the rates 
are excessive have the burden of establishing that the rates 
are 
excessive. 
The 
burden 
of 
proving 
that 
rates 
ar~ 
adequater and not unfairly discriminatory ana--i-n--c--Gffi¥1-i-ar:€e 
Wi~B--~~--r~~~~-~--~e~~~eR--e9~~ remains with the 
insurer. 
Page l-LR238l(2} 
COMMITTEE AMENDMENT 
.. '~. 
::,.~ 
..... '. 
COMMITTEE AMENDMENT .. A .. to S.P. 625, L.D. 1680 
Sec. 3. 24-A MRSA §2736-A, first 1f, as amended by PL 2003, c . 
469, Pt. E, §11, is further amended to read: 
If at any time the superintendent has reason to believe that 
a 
filing does 
not meet 
the 
requirements that rates not 
be 
excessive, 
inadequateT 
or 
unfairly discriminatory 
e~--Be~--iB 
eeRlpJ,iaBee--w:i-t:-h-~i<.Ha--&91~ or that the filing violates any of 
the provisions of chapter 23, the superintendent shall cause a 
hearing to be held. 
Sec. 4. 24-A MRSA §2736-C, sub-§2, 1JF, as enacted by PL 2003, 
c. 469, Pt. E, §12, is repealed. 
Sec. 5. 24-A MRSA §2736-C, sub-§5, as amended by PL 2003, c. 
469, Pt. E, §13, is further amended to read: 
5. 
Loss ratios. 
For all policies and certificates issued 
on 
or 
after 
the 
effective 
date 
of 
this 
section, 
the 
superintendent shall disapprove any premium rates filed by any 
carrier, whether initial or revised, for an individual health 
policy unless it is anticipated that the aggregate benefits 
estimated to be paid under all the individual health policies 
maintained in force by the carrier for the period for which 
coverage is to be provided will return to policyholders at least 
65'\ of the aggregate premiums collected for those policies, as 
determined in accordance with accepted actuarial principles and 
practices and on the basis of incurred claims experience and 
earned premiums. 
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saviB~s-~~~--~aymeB~s-~~-~~~~~B~--~-£€£-t:~~-&9~~-~--Be 
~~ea~eQ-a6-iBe~~~eQ-elaimST 
Sec. 6. 24-A MRSA §2808-B, sub-§2-A, 1fC, as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
C. 
Rates for small group health plans must be filed in 
accordance with this section and subsections 2-B and 2-C for 
premium rates effective on or after July 1, 
2004T--e-lfC-e-p~ 
~sa~-~~-~~~~~-~-~~~-~e~-~~-~~~~-h€~~~h-~~-a~e 
Be~-~~~~-~e-~~~--~~-~~-~~~-e~~~€~-~--e~ 
aBy-~€£~~~~-~ha~-~~~--paymeB~-~~£~~~-t:-~~-6~Bsee~ieB 
6-8T-~a~a~~a~h-~~~~~~~~~-~~&-e~~e~~~-Be~e~e 
J~:l:y-:l:T-69ge. 
Sec. 7. 24-A MRSA §2808-B, sub-§2-B, 1fA, as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
A. 
The superintendent shall disapprove any premium rates 
filed by any carrier, whether initial or revised, 
for a 
small group health plan unless it is anticipated that the 
aggregate benefits estimated to be paid under all the small 
COMMITTEE AMENDMENT 
· 
.'\~ t~:t 
COMMITTEE AMENDMENT "A" to S.P. 625, L.D. 1680 
group health plans maintained in force by the carrier fOe 
the period for which coverage is to be provided will return 
to policyholders at least 75% 
of the aggregate premiums 
collected for those policies, as determined in accordance 
with accepted actuarial principles and practices and on the 
basis of incurred claims experience and earned premiums. 
Fe~ 
~ae--~~~--~---~~~&--ea~e~~atieB7--~-~~--e~~6e~ 
paymeBts-~~-paFsaaBt-~~-&&G~1&a-~~~~-~-ge-~~~~-a5 
:i:Be~FFeEi-e*a:i:Hl6 ... 
Sec. 8. 24-A MRS:A §2808-B, sub-§2-B, ,D, as enacted by PL 
2003, c. 469, Pt. E, §16, is repealed. 
Sec. 9. 24-A MRSA §2808-B, sub-§2-B, 1fF, as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
F. 
Any rate hearing conducted with respect to filings that 
meet 
the 
criteria in 
paragraph 
E 
is 
subject 
to 
this 
paragraph. 
(1) 
A person requesting a hearing shall provide the 
superintendent with a written statement detailing the 
circumstances that justify a hearing, notwithstanding 
the satisfaction of the criteria in paragraph E. 
(2) 
If the superintendent decides to hold a hearing, 
the 
superintendent shall issue 
detailing the circumstances that 
notwithstanding the satisfaction 
paragraph E. 
a 
written 
statement 
justify a 
hearin~, 
of the criteria In 
(3) 
In any hearing conducted under this paragraph, the 
bureau and 
any party asserting that the rates are 
excessive have the burden of establishing that the 
rates are excessive. 
The burden of proving that rates 
are adequateT and not unfairly discriminatory 
aBe.--i-~ 
eeHlp*:i:aBee--~~~-~~--Fe~a:i:reHleBt6--~--~~--99*J 
remains with the carrier. 
Sec. 10. 24·A MRSA §2839-B, sub-§2, as enacted by PL 2003, 
469, Pt. E, §17, is amended to read: 
2. 
Annua1 fi1inq. 
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. 
±Be 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ,t1" to S.P. 625, L.D. 1680 
~i~iB~-~--a~se-~~~~-~aa~-~~-ea~~ie~-~-iBe~Haea--~-i~6 
eH~e~ieBee--a~y--&a~~~&-~-~~-~--~e€~~y--e~--~ae6e 
saviB~s-e~~6e~-~~-~~~-~~~-s&e~~&-e9l6T 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 I, section 402, subsection 3. 
Sec. 11. 24-A MRSA §690S, sub-§2, 1fB, as enacted by PL 2003, 
c. 469, Pt. A, §8, is repealed. 
Sec. 12. 24-A MRSA §6913, as amended by PL 2005, c. 400, Pt. 
A, §§10 to 13 and Pt. C, §9, is repealed. 
Sec. 13. 24-A MRSA §6914, as amended by PL 2005, c. 400, Pt. 
A, §14, is further amended to read: 
§6914. Intragovernmenta1 transfer 
S~aF~iB~-.,J..Q.ly--l-r-6g94T Dir igo Health shall transfer funds, 
as necessary, to a special dedicated, nonlapsing revenue account 
administered by the agency of State Government that administers 
MaineCare for the purpose of providing a state match for federal 
Medicaid dollars only for those employees enrolled in the Dirigo 
Health Program through their employer who are determined eligible 
for MaineCare. 
Dirigo Health may not transfer funds for the 
purpose of providing a state match for federal Medicaid dollars 
for 
individuals 
directly enrolled 
in 
MaineCare 
due 
to 
any 
expansion in MaineCare eligibility. 
Dirigo Health shall annually 
set the amount of contribution. 
Sec. 14. 24-A MRSA §6915, as amended by PL 2005, c. 386, Pte 
D, §3, is further amended to read: 
§6915. Diriqo Bea1th Enterprise Fund 
The 
Dirigo 
Health 
Enterprise 
Fund 
is 
created 
as 
an 
enterprise fund for the deposit of any funds advanced for initial 
operating expenses, payments made by employers and individuals T 
aBY-6ay4B~6-~~~~-~~~~~-~-&&e~~~-9916 and any 
funds received from any public or private source. 
The fund may 
not lapse, but must be carried forward to carry out the purposes 
of this chapter. 
Sec. 15. 24-A MRSA §6951, first 1[, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
The Maine Quality Forum, referred to in this subchapter as 
"the forum," is established within Dirigo Health. 
The forum is 
COMMITTEE AMENDMENT 
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.-." "tJfO. 
COMMITTEE AMENDMENT "A" to S.P. 625, L.D. 1680 
governed by the board with advice from the Maine Quali ty Forum 
Advisory Council pursuant to section 6952. 
The forum must be 
fundedT-~-~ea6~--~-pa~~7--~h~~h-~~-&avi~&-~~~-¥aYffieR~6 
ffiaee-¥QrSQaB~-~e-6ee~ieB-e9±~ within the limitations of available 
~. Except 
as 
provided 
in 
section 
6907, 
subsection 
2. 
information obtained by the forum is a public record as provided 
by Title 1, chapter 13, subchapter 1. 
The forum shall perform 
the following duties. 
Sec. 
16. 
Appropriations 
and 
allocations. 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care -
Payments to Providers 0147 
The 
following 
Initiative: 
Provides the state share of Medicaid services for 
the parents or caretaker relatives of MaineCare eligible children 
when the child's family income is greater than 150% but equal to 
or below 200°-0 of the federal nonfarm income official poverty 
line. 
These costs had previously been funded by a transfer of 
revenue from the Dirigo Health Enterprise Fund. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
SUMMARY 
2005-06 
$0 
$0 
2005-06 
$0 
$0 
2006-07 
$8,313,000 
$8,313,000 
2006-07 
($8,313,000) 
($8,313,000)· 
This amendment is the minority report of the committee and 
replaces the bilL which is a concept draft pursuant to 
Join~ 
Rule 208. 
The amendment repeals the savings offset payment. 
The 
amendment requires that the subsidy program for enrollees in the 
Dirigo Health Program and the Maine Quality Forum, which were 
funded with the savings offset payment, continue with funding 
from existing resources 
of 
the 
Dirigo 
Health 
Program. 
The 
amendment also prohibits any funds collected by Dirigo Health 
from being used as the state share for individuals directly 
enrolled in MaineCare. 
The 
amendment 
$8,313,000 
for 
the 
services for parents 
adds 
a 
General 
Fund 
appropriation 
of 
costs 
of 
the 
state share 
for 
MaineCare 
as a result of the provision prohibiting 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,A" to S.P. 625, L.D. 1680 
these costs 
from 
being funded 
through transfers 
from Dirigo 
Health. 
This amendment also corrects several cross-references. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 02/03/06 ~ae 
LD 1680 
LR 2381(02) 
An Act to Improve Dirigo Health 
Fiscal Note for Bill as Amended by Committee Amendment 'A" 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Projections 
2005-06 
2006-07 
2007-08 
Net Cost (Savings) 
General Fund 
$0 
$8,313,000 
$8,978,000 
Appropriations/Allocations 
General Fund 
$0 
$8,313,000 
$8,978,000 
Other Special Revenue Funds 
$0 
($8,313,000) 
($8,978,000) 
Revenue 
Other Funds 
$0 
($43,700,000) 
($43,700,000) 
Transfers 
Other Special Revenue Funds 
$0 
($8,313,000) 
($8,978,000) 
Other Funds 
$0 
$8,313,000 
$8,978,000 
Fiscal Detail and Notes 
Projections 
2008-09 
$9,696,000 
$9,696,000 
($9,696,000) 
($43,700,000) 
($9,696,000) 
$9,696,000 
Assumes a General Fund appropriation of $8.3 million will be required to fund the state share of the costs of Medicaid 
services for the parents of MaineCare eligible children with family incomes between 150% and 200% of the nonfarm 
income official poverty line that had previously been funded by a transfer of revenue from the Dirigo Health 
Enterprise Fund. Assumes the elimination of the Savings Offset Payment (SOP) would reduce Dirigo Health 
Enterprise Fund revenue begining in July of 2006 and would result in a loss of 75% of the 2006 SOP and 25% of the 
2007 SOP for state fiscal year 2006-07. For the purposes of this fiscal estimate, the 2007 SOP is assumed to be equal 
to the 2006 SOP. The impact of any subsequent changes to the Dirigo program (e.g., changes to the subsidy program, 
benefit design, employer/employee contributions, the MQF, etc.) would depend on actions taken by the Dirigo Health 
Board and cannot be determined at this time. 
LR2381(2) - Fiscal Note - Page 1 of 1