An Act To Increase Access to Health Insurance Products
Maine Legislature, Session 122, LD 1845
Committee Amendment CA_A-HA_B_H1074 (House)
Amends: 3 MRSA §522-C, 3 MRSA §959, 22 MRSA §3174-D, 24-A MRSA §2736, 24-A MRSA §2736-C, 24-A MRSA §2808-B, 24-A MRSA §6904, 24-A MRSA §6908, 24-A MRSA §6910, 24-A MRSA §6912, 24-A MRSA §6913, 24-A MRSA §6915

HOUSE 
AMENDMENT ,.j3;" 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 striking out all of sections 1 to 10 
and inserting in their place the following: 
'Sec. I. 3 MRSA §522-C is enacted to read: 
§S22-C. Dirigo Bealthbudget review 
The 
joint standing 
committee 
of 
the 
Legislature having 
jurisdiction over health 
insurance matters 
shall 
review the 
budget of Dirigo Health biennially and submit its recommendations 
in a written report to the joint standing committee of the 
Legislature having jurisdiction over appropriations and financial 
affairs. 
, Sec. 2. 3 MRSA §959, sub-§l, 1[B, as amended by PL 2003, c. 
600, §1, is further amended to read: 
B. 
The joint standing committee of the Legislature having 
jurisdiction over insurance and financial services matters 
shall use the following list as a guideline for scheduling 
reviews: 
(1) 
State Employee Health Commission in 2009; aRe 
HOUSE AMENDMENT 
~ 
('~. 
\'~ 'fS 
\" 
HOUSE 
AMENDMENT ·b" to COMMITTEE 
AMENDMENT 
"A" to H.P. 
L.D. 1845 
1285, 
(2) 
Department 
of 
Professional 
and 
Financial 
Regulation, 
in 
conjunction with 
the 
joint standing 
committee of the Legislature having jurisdiction over 
business and economic development matters, in 2007T; and 
(3) 
Dirigo Health in 2007. 
Sec. 3. 22 MRSA §3174-DD, as amended by PL 2005, c. 400, Pte 
C, §2, is further amended to read: 
§3l74-DD. 
Dirigo health coverage 
The 
department 
may 
contract 
wi th 
one 
or 
more 
health 
insurance carriers 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 
United 
States· Code, 
Section 
1396o( 2003) 
and additional coverage provided under contract by 
the department. 
The department may not consider the amQunt of a 
subsidy received by a MaineCare member enrolled in the Dirigo 
Health 
Program 
as 
income 
when 
determining 
eligibility 
for 
MaineCare. 
Sec. 4. 24-A MRSA §2736, sub-§3, ,8, as amended by PL 2003, c. 
469, Pt. E, §9, is further amended to read: 
B. 
The 
insurer 
must 
demonstrate 
in 
accordance 
with 
generally 
accepted 
actuarial 
principles 
and 
practices 
consistently applied that, as of a date no more than 210 
days prior to the filing, the ratios of benefits incurred to 
premiums earned for those products average no less than 80% 
for the previous 12-month period. 
~e~-~~~-~~~~-tRis 
eale1:ilati:9:ar-~-6av4.fl~6--G-:&.E-&e-t;,.-~-6--pai:El-i?"\H'-suant.--t:;9 
seeti:eR-99*~-m1:ist-Be-t~eateQ-as-i::ae1:i~~eQ-elai:msT 
Sec. 5. 24-A MRSA §2736, sub-§4, ,C, 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 
are 
adequater Q!:. not unfairly discriminatory a:as-4-n--eelRplia:aee 
HOUSE AMENDMENT 
~";'" 
,. «1. 
" 
\t.' 
HOUSE 
AMENDMENT .J!;" to COMMITTEE 
AMENDMENT 
"A" to H.P. 
L.D. 1845 
1285, 
w~~a--~~--r~~r~-~--~e€~4e~--e9~6 remains with the 
insurer. 
Sec. 6. 24·A MRSA §2736·A, first" 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 9F--B9S--iB 
99fRp*:iaBee-.wi-t.-h--e&G-t;-.iG&-e91~ or that the filing violates any of 
the provisions of chapter 23, the superintendent shall cause a 
hearing to be held. 
Sec. 7. 24·A MRSA §2736-C, sub-§2, 1JF, as enacted by PL 2003, 
c. 469, Pt. E, §12, is repealed. 
Sec. S. 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 
650.0 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. 
~9F--~a&-~~-~---t.~~-€a~€~~a~4e~7--aBY 
eaviB~s-~~~--payme~~6-~~-PQ~6~a~~--~-~~~-&91~-~--be 
tFeatee-as-:iBeuFFee-e*a~meT 
Sec. 9. 24·A MRSA §2S0S-B, sub-§2-A, ,C, 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-~lH3-9-p1;; 
sRat-~-~~~~~-e~-~~~-~9F-~~-~~~~-£ea~~£-~~-aFe 
B9t-~~~~-~-~~--~~-a~Y-~~-9ff6e~-~-eF 
aBY-~~~~~-~Aa~-~~~--paym&~~-PQ~6~a~~-~~-eubsee1;;ieR 
6-8r-paEa~Eapa-~-~~~~~~-~-~~&-&~~&e~iv&-ae~eFe 
Ju*Y-;\'r-6 QQa. 
Sec. 10. 24·A MRS A §2S0S-B, sub-§2.B, ,A, as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
HOUSE AMENDMENT 
,~ l'~}. 
";'t ~ .. 
HOUSE 
AMENDMENT ~" to COMMITTEE 
AMENDMENT 
"A" to H. P . 
L.D. 1845 
1285, 
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 
group health plans maintained in force by the carrier for 
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. 
~e~ 
the--~~-~--ta~&--€aJ€~Ja~4eB7--~-~~~~--e~~6et 
paymeRe6-~~-p~~&~a»~-~~-~~~»-~~~~-~-Be-~~~~-a6 
~ReQ~~eQ-ela~msT 
Sec. 11. 24-A MRS A §2808-B, sub-§2-B, 1fD, as enacted by PL 
2003, c. 469, Pt. E, §16, is repealed. 
Sec. 12. 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 
hearing, 
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 
QX not unfairly discriminatory aas--ia 
eempl~aaee--~~~-~~--Fe~Q~~emeRts--~--~~--a9±3 
remains with the carrier. 
Sec. 13. 24-A MRS A §2839-B, sub-§2, as enacted by PL 2003, c. 
469, Pt. E, §17, is amended to read: 
HOUSE AMENDMENT 
t..' ~J' 
~ 
<;~ 
\'!< 
HOUSE 
AMENDMENT 
"~,, to COMMITTEE 
AMENDMENT "A" to H.P. 
1285, 
L.D. 1845 
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. 
';I;be 
fi.iR~-~-a.se-~~~~-~ba~-~~-earrier-~-iRe.Qaea-~~-i~s 
eHFerieRee--aa~--&&~~aq&-~~-~~-~--~e€~e£y--ef--~be6e 
saviR~s-eff6e~-~~~i~~-~it~-&ee&iea-991~T 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. 
Sec. 14. 24-A MRSA §6904, sub-§§I, 2 and 4, as enacted by PL 
2003, c. 469, Pt. A, §8, are amended to read: 
1. 
Appointments. 
The board consists of 5 voting members 
and ~-eH-effieieT ~ nonvoting members as follows. 
A. 
';I;be Of the 5 voting members of the board, 3 members 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, and 2 members must be elected by written ballot of 
plan enrollees in the Dirigo Health Program. 
B. 
';I;be There are 3 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; and 
(3) 
The Commissioner of Administrative and Financial 
Services or the commissioner's designee. 
C. 
Two nonvoting members of the board must be appointed by 
the 
Governor 
to 
represent 
labor 
and 
consumer 
advocacy 
inter~sts, respectively. 
2. 
Qualifications of voting members. 
Voting members of the 
board appointed by the Goyernor: 
HOUSE AMENDMENT 
HOUSE 
AMENDMENT r.!;.. to COMMITTEE 
AMENDMENT 
It A" to H. P . 
L.n. 1845 
1285, 
A. 
Must have knowledge of and experience in one or more of 
the following areas: 
(1) 
Health care purchasing; 
(2) 
Health insurance; 
(H--MaiReba!'ef 
(4) 
Health policy and law; or 
(6) 
Health care financing: and 
B. 
Except as provided in this paragraph, may not be: 
(1) 
A representative or 
employee 
of 
an 
insurance 
carrier authorized to do business in this State; 
(2) 
A representative or employee of a 
health care 
provider operating in this State: or 
(3) 
Affiliated 
with 
a 
health 
or 
health-related 
organization regulated by State Government. 
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. 
4. 
Chair. 
The 
~eve!'Re!' ~ 
shall a}!l}!leiRts elect one of 
the voting members as the chair of the board. 
Sec. 15. 24-A MRSA §6908, sub-§2, 1IB, as enacted by PL 2003, 
c. 469, Pt. A, §8, is repealed. 
Sec. 16. 24-A MRSA §6908, sub-§2, 1I1IC and E, as amended by PL 
2005, c. 400, Pt. C, §6, are further amended to read: 
C • 
De te rmine tae -~-ehens-i-ve- ~F-""'.i,.e.e.s--aRe.-.£>e.ne..f.J-t-s- -t;.e. -be 
iRe*Qe.ee.--iR--the--~i!'i~e--Qea~ta--P!'e~!'~--aRQ--e.eve~e}!I--tae 
s}!leeif~eat4eR6-~~--t~~~-~~~~&-P!'e~!'am a prototype for 
a health benefits package in accordance with the provisions 
in section 6910. Within 30 days of its determination of the 
geRefit-pa~~~-t~~~~~~-ta!'eQ~a prototype for a health 
benefits package for the Dirigo Health Program, the board 
H,OUSE AMENDMENT 
HOUSE 
AMENDMENT ·b· to COMMITTEE 
AMENDMENT "A" to H.P. 1285, 
L.D. 1845 
shall report on the benefit package, including the estimated 
premium and applicable coinsurance, deductibles, copayments 
and out-of-pocket maximums, to 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 
health 
and 
human 
services matters; 
E. 
Arrange the provision of Dirigo Health Program benefit 
coverage 
to eligible individuals 
and eligible employees 
~a~e~~a-~&~~-~~~-eRe--e~-~~-~~~~~~--b~aaeFs in 
accordance with sections 6910 and 6912-A; 
Sec. 17. 24.AMRSA§6908,sub·§12, as enacted by PL 2005, c. 
394, §3 and c. 400, Pte A, 
§5, is repealed and the following 
enacted in its place: 
12. 
Re,port; jurisdiction. 
The joint standing committee of 
the Legislature haying jurisdiction over insurance and financial 
services matters is the committee of jurisdiction over Dirigo 
Health. 
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 services matters 
on the Dirigo Health PrQgram and budget. 
Minutes of meetings of 
the Board of Dire~tors of Dirigo Health must be provided to each 
member of the joint standing committees of the Legislature having 
jurisdiction over 
insurance 
and 
financial 
services 
matters, 
health 
and 
human 
services 
matters 
and 
appropriations 
and 
financial affairs. 
Sec. 18. 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 
prov~s~on 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 all 
health insurance carriers licensed to transact health insurance 
in this State that 
app*y--t.~-t;ae--bo-cH:-d--a:aa meet qualifications 
described in this section and any additional qualifications set 
by the board and are approved by the superintendent in accordance 
with section 6912-A. 
HOUSE AMENDMENT 
.:.{\.'~' ~;. 
HOUSE 
AMENDMENT ~" to COMMITTEE 
AMENDMENT "A" to H . P . 
L.D. 1845 
1285, 
Sec. 19. 24-A MRSA §6910, sub-§2, as amended by PL 2005, c. 
400, Pt. C, §8, is repealed. 
Sec. 20. 24-A MRSA §6910, sub-§§3 and 4, as amended by PL 2005, 
c. 400, Pt. C, §8, are further amended to read: 
3. 
Carrier participation requirements. 
carrier of Dirigo Health Program coverage, 
carrier must: 
To 
qualify as 
a 
a health insurance 
A. 
Provide tae-€emp~eae~~~¥e-~~~~~~-aaG-Be~e~its Q 
health plan 
comparable 
to 
the 
prototype 
for 
a 
health 
benefits package under section 6908, subsection 2, paragraph 
.c as determined by the 
boardT-..iof}€..l-\i.QiiH3--a--s;.t;.aaGaIi'G-Bene~it: 
pae1£a~e that meets the requirements for mandated coverage 
for specific health servicesT and specific diseases and for 
certain providers of health services under Title 24 and this 
Title and any supplemental benefits the board wishes to make 
available; anEl 
B. 
Ensure that: 
(1) 
Providers contracting with a carrier contracted to 
provide coverage to plan enrollees do not charge plan 
enrollees 
or 
3rd parties 
for 
covered 
health 
care 
services in excess of the amount allowed by the carrier 
the provider has contracted with, except for applicable 
copayments, deductibles or coinsurance or as provided 
in section 4204, subsection 6; 
(2) 
Providers contracting with a carrier contracted to 
provide coverage to plan enrollees do not refuse to 
provide services to a plan enrollee on the basis of 
health status, 
medical condition, 
previous insurance 
status, 
race, 
color, 
creed, 
age, 
national 
origin, 
ci tizenship 
status, 
gender, 
sexual 
orientation, 
disability or marital status. 
This subparagraph may 
not be construed to require 
a 
provider to furnish 
medical services that are not within the scope of that 
provider's license; and 
(3) 
Providers contracting with a carrier contracted to 
provide coverage to plan enrollees are reimbursed at 
the negotiated reimbursement rates between the carrier 
and its provider networkT~ 
C. 
Unless otherwise provided in this chapter, comply with 
all appliceQle provisions of this Title, including, but not 
limited to, sections 2736-C end 2808-B and chapters 36 and 
56-A. 
HOUSE AMENDMENT 
II, "t;· 
..,:~~, 
" 
\! " 
HOUSE 
AMENDMENT 
L.D. 1845 
J;" to COMMITTEE 
AMENDMENT 
"A" to H.P. 1285, 
Health insurance carriers that seek to qualify to provide Dirigo 
Health Program coverage must also qualify as health plans in 
Medicaid. 
4. 
Contracting authority. 
Dirigo Health has contracting 
authority and powers to administer Dirigo Health Insurance as set 
out in this subsection. 
A. 
Dirigo Health may-eeR~Eaes-wi~h shall permit all health 
insurance carriers licensed to sell health insurance in this 
State eE-~~-~~~-e~-~~~-~~ir~~~-aQmiRis~~a~eEs 
to provide Dirigo Health Program coverage. 
In addition: 
~~*--~~~~-Heal&h-~~~--~-~e~~e5~5-~~--Fr9F9sa~s 
~Eem-hea~~h-iRs~~aRee-ea~~ieESt 
(2) 
Dirigo Health may-iRe±~ae shall require a carrier 
to 
include quality 
improvement, 
disease prevention, 
disease management and cost-containment provisions in 
~he--~~~~--w~&h--pa~~4€4pa~4R~--~~~--iRs~~aRee 
ea~rie~s--e~-~~-~r~~-~~--~~-~0¥~~4~--e~--s~eR 
se~viee&-~~~-e&»&Fa&~-wi~h-~~--eR~i~ies Dirigo 
Health Program coverage; 
~6*--~~~~-Rea±~R-~~~-re~~ire-~~~i~~~-Rea±~R 
iRs~FaRee-ea~~ie~6-~~-~~~-~~~~-~laa-1eeB~1eal-~e 
~he-~~~~-Heal~-P~e~~am7-~~--wh1ea-~~~~~~-Rea~~R 
s~Bsiaies-~~-~~~~--iR--&he-~~~-~mad~--~re~F 
maFke~T 
~4*--~i~i~e-Rea~~h-~~-~~~a&&-&e-Far~ieiFa~iH~ 
aea~~a-iR5~~aR€e-~~~~~~~-~~~r~-Heal~a-Pre~ram 
eeR~~ae~-~~-~rev1e&-~~~~~~-P~e~~am-~-it~-~e 
F*aH-eRre**ees-Re~-eB~e**ea-iR-MaiRe~a~et 
(5) 
Dirigo 
administration 
Health Program: 
Health 
may 
set 
and underwriting 
allowable 
gains for 
rates 
for 
the Dirigo 
(6) 
Dirigo Health may administer continuation benefits 
for eligible individuals from employers with 20 or more 
employees who have purchased health insurance coverage 
through 
Dirigo 
Health 
for 
the 
duration 
of 
their 
eligibility periods for continuation benefits pursuant 
to 
the 
federal 
Consolidated 
Omnibus 
Budget 
Reconciliation Act, Public Law 99-272, Title X, Private 
Health Insurance Coverage, Sections 10001 to 10003; and 
HOUSE AMENDMENT 
" . 
~;. 
'~':o:' , 
\~' 
HOUSE 
AMENDMENT ~.. to COMMITTEE 
AMENDMENT 
.. A." to H. P . 
L.D. 1845 
1285, 
(7) 
Dirigo 
Health 
may 
administer 
or 
contract 
to 
administer the United States Internal Revenue Code of 
1986, Section 125 plans for employers and employees 
participating 
in 
Dirigo 
Health, 
including 
medical 
expense 
reimbursement 
accounts 
and 
dependent 
care 
reimbursement accounts. 
B. 
Dirigo Health shall contract with eligible businesses 
seeking assistance 
from 
Dirigo 
Health 
in arranging 
for 
health benefits coverage by the Dirigo Health Program for 
their employees and dependents as set out in this paragraph. 
(1) 
Dirigo Health may establish contract 
reporting 
forms 
and 
procedures 
necessary 
efficient administration of contracts. 
and other 
for 
the 
(2) 
Dirigo 
Health 
shall 
collect 
payments 
from 
participating employers and plan enrollees to cover the 
cost of: 
(a) 
The 
Dirigo 
Health 
employees and dependents 
determined by the board; 
Program 
for 
enrolled 
in contribution amounts 
(b) 
Dirigo Health's quality assurance, 
management 
disease 
and 
preve~tion, 
disease 
cost-containment programs: 
(c) 
Dirigo Health's administrative services: and 
(d) 
Other health promotion costs. 
(3) 
Dirigo Health shall establish the m1n1mum required 
contribution levels, not to exceed 60'!-0, to be paid by 
employers toward the aggregate payment in subparagraph 
(2) and establish an equivalent minimum amount to be 
paid 
by 
employers 
or 
plan 
enrollees 
and 
their 
dependents who are enrolled in MaineCare. 
The minimum 
required contribution level to be paid by employers 
must be prorated for employees that work less than the 
number of hours of a full-time equivalent employee as 
determined 
by 
the 
employer. 
Dirigo 
Health 
may 
establish a separate minimum contribution level to be 
paid by employers toward coverage for dependents of the 
employers' enrolled employees. 
(4) 
Dirigo 
employers 
to 
HOUSE 
Health 
certify 
shall 
require 
that 
at least 
participating 
75q.o 
of 
their 
AMENDMENT 
.\ ~.~ .. 
\~., 
.... / 
HOUSE 
AMENDMENT ::6.. to COMMITTEE 
AMENDMENT 
.. A" to H. P . 
L.D. 1845 
1285, 
employees that work 30 hours or more per week and who 
do not have other creditable coverage are enrolled in 
the Dirigo Health Program and that the employer group 
otherwise meets the m~n~mum participation requirements 
specified by section 280B-B, subsection 4, paragraph A. 
(5) 
Dirigo Health shall reduce the payment amounts for 
plan enrollees eligible for a 
subsidy under section 
6912 
accordingly. 
Dirigo 
Health 
shall 
return 
any 
payments 
made 
by 
plan 
enrollees 
also 
enrolled 
in 
MaineCare to those enrollees. 
(6) 
Dirigo 
Health 
shall 
require 
participating 
employers to pass on any subsidy in section 6912 to the 
plan enrollee qualifying for the subsidy, 
up to the 
amount of payments made by the plan enrollee. 
(7) 
Dirigo Health may establish other criteria for 
participation. 
(8) 
Dirigo 
Health 
may 
limit 
the 
number 
of 
participating employers. 
(g) 
Dirigo 
Health 
shall 
limit 
participation 
to 
employers that have certified that the employer did not 
provide access to an employer-sponsored benefits plan 
to its employees in the 
6-month period immediately 
preceding the employer's application. 
(10) 
Notwithstanding section 2849-B, 
a carrier that 
provides Dirigo Health Program coverage may impose a 
preexisting condition exclusion not to exceed 6 months 
for 
a 
plan 
enrollee, 
except 
that 
a 
preexisting 
condition exclusion may 
not be 
imposed 
on 
a 
plan 
enrollee who is a federally eligible individual. 
C. 
Dirigo 
Health 
may 
permit 
eligible 
individuals 
to 
purchase Dirigo Health Program coverage for themselves and 
their dependents as set out in this paragraph. 
(1) 
Dirigo Health may establish contract 
reporting 
forms 
and 
procedures 
necessary 
efficient administration of contracts. 
and other 
for 
the 
(2) 
Dirigo Health may collect payments from eligible 
individuals participating in the Dirigo Health Program 
to cover the cost of: 
HOUSE AMENDMENT 
HOUSE 
AMENDMENT rb.. to COMMITTEE 
AMENDMENT 
"A" to H. P. 
L.D. 1845 
1285, 
400, 
(a) 
Enrollment in the Dirigo Health Program for 
eligible individuals and dependents; 
(b) 
Dirigo Health's quality assurance, 
disease 
prevention, 
disease 
management 
and 
cost-containment programs; 
(c) 
Dirigo Health's administrative services; and 
(d) 
Other health promotion costs. 
(3) 
Dirigo Health shall reduce the payment amounts for 
individuals eligible for a subsidy under section 6912 
accordingly. 
(4) 
Dirigo 
Health 
may 
require 
that 
eligible 
individuals 
certify that 
all their 
dependents 
are 
enrolled in the Dirigo Health Program or are covered by 
another creditable plan. 
~et--~~~~-H&a*~a-may--~~~~-aa-~~~~~-iaaiviaaal 
whe-.,i-6--<HH'~-ent:-l-y--emp-1G-ye4-BY-"'*l--e-l-i"9"i-b-l-e--emp-1e-ye-Ji'--t=hat= 
aees-~-~~~~--aea*~a--~~-~e-~Ji'-~~~y-~~--t=he 
eQ~~eat=--~~---Q.,iQ---~~--~~~~--aeee&&--~~--aR 
effipleyeF-speRseFee-Beaef.,i~6-~~~;r~~-*6~~~a-peFiee 
iffiffieQiately---~~eQ.,i£~---~~--~*~~&1&---iRaivieaal~6 
8pplieatiea..-
(6) 
Dirigo 
Health 
may 
limit 
the 
number 
of 
plan 
enrollees. 
(7) 
Dirigo Health may establish other criteria for 
participation. 
(8) Dirigo Health shall require an eligible individual 
tQ certify that the individual was uninsured for the 
6-month 
period 
immediately 
preceding 
the 
eligible 
individual's application. 
(9) 
Notwithstanding section 
2849 Bf 
a 
carrier that 
prQyides Dirigo Health Program coverage may impose a 
preexisting condition exclusiQn not to exceed 6 months 
fQr an eligible individual except that a preexisting 
condition exclusion may nQt be impQsed Qn an eligible 
individual who is a federally eligible individual. 
Sec. 21. 24·A MRSA §6912, first 1(, as amended by PL 2005, c. 
Pt. A, §7, is further amended to read: 
HOUSE AMENDMENT 
<~ 'e'" 
',-"' .. 
\~ . 
HOUSE 
AMENDMENT t.6. to COMMITTEE 
AMENDMENT 
"A" to H. P . 
L.D. 1845 
1285, 
Dirigo Health may establish sliding-scale subsidies for the 
purchase of Dirigo Health Program coverage paid by eligible 
individuals or employees 
wRese--~~--~-~--~~~-e£--ERe 
feae~a*--~-t-y---leve;!, 
in 
accordance 
with 
the 
eligibility 
requirements in subsection 2. 
Dirigo Health may also establish 
sliding-scale subsidies for the purchase of employer-sponsored 
health coverage paid by employees of businesses with more than 50 
employeesT-~-~~-~s-~~-~-ef-~~-~~~--~eve~EY 
;!,evel 
in 
accordance 
with 
the 
eligibility 
requirements 
in 
subsection 2. 
Sec. 22. 24-A MRSA §6912, sub-§2, 1J1JA and B, as amended by PL 
2005, c. 400, Pt. A, §8, are further amended to read: 
A. 
Be enrolled in the Dirigo Health Program and covered by 
a health plan certified pursuant to section 6912-A, have an 
income under 300% of the federal poverty level and assets 
that do not exceed 4 
times 
the limits established for 
MaineCare eligibility and be a resident of the State; or 
B. 
Be enrolled in a health plan of an employer with more 
than 50 employees aaaL 
have an income under 
300'1-0 of the 
federal poverty level and have assets that do not exceed 4 
times the limits established for MaineCare eligibility. 
The 
health plan must be certified pursuant to section 6912-A and 
meet 
any 
criteria 
established 
by 
Dirigo 
Health. 
The 
individual must meet other eligibility criteria established 
by Dirigo Health. 
Sec. 23. 24-A MRSA §6912, sub-§4, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
4. 
Limitation on amount subsidized. 
Dirigo Health may 
limit the amount subsidized of the payment made by individual 
plan enrollees under section 6910, subsection 4, paragraph C to 
40~ of the payment to more closely parallel the subsidy received 
by employees. 
In no case may the subsidy granted to eligible 
individuals in accordance with subsection 2, paragraph A exceed 
the 
maximum 
subsidy 
level 
available 
to 
other 
eligible 
individuals. 
Diriqo 
Health shall limit 
the 
subsidy 
to 
the 
premium cost for Dirigo Health Program coverage and may not apply 
a 
subsidy 
or 
discount 
to 
deductibles, 
copayments 
or 
other 
financial contributions required for eligible individuals 
and 
employees. 
Sec. 24. 24·A MRSA §6912-A is enacted to read: 
HOUSE AMENDMENT 
'!,. ;-i" 
~, .,:\ 
.. 
''''}.' 
HOUSE 
AMENDMENT b" to COMMITTEE 
AMENDMENT 
"A" to H. P . 
L.D. 1845 
1285, 
§6912-A. Approval of health insurance plans eligible for subsidies 
Upon application of 
a 
carrier, 
the superintendent shall 
certify to Dirigo Health that an individual or small group health 
plan offered by the carrier qualifies for a 
subsidy for the 
purchase of 
thQse health plans because the plan provides 
a 
cQmparable health benefits package developed by Dirigo Health in 
accQrdance with sectiQn 6908, subsectiQn 2, paragraph C and meets 
the requirements Qf section 6910. 
The superintendent may adopt 
rules as necessary fQr the administratiQn of this section. Rules 
adopted pursuant to this sectiQn are routine technical rules as 
defined in Title 5. chapter 375, subchapter 2-A. 
Sec. 25. 24-A MRSA §6913, as amended by PL 2005, c. 400, Pt. 
A, §§10 to 13 and Pt. C, §9, is repealed. 
Sec. 26. 24·A MRSA §6914, as amended by PL 2005, c. 400, Pt. 
A, §14, is further amended to read: 
§6914. Intraqovernmental transfer 
Starting July 1, 2004, Dirigo 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 Qnly for thQse employees enrolled in the Dirigo 
Health PrQgram thrQugh their employer who are determined eligible 
for 
Main~Care. DirigQ Health may not transfer funds 
for the 
purpose Qf prQviding a state match for federal Medicaid dollars 
for 
individuals 
directly enrQlled 
in 
MaineCare 
due 
to 
any 
expansion in MaineCare eligibility. Dirigo Health shall annually 
set the amount of contribution. 
Sec. 27. 24-A MRSA §6915, as amended by PL 2005, c. 386, Pt. 
D, §3, is further amended to read: 
§6915. Diriqo Health 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 individualsT 
aRY-6av4B~6-~~~~~-~~~~~-~-&&&~~&-991~ 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. 28. 24·A MRSA §6951, first 1r, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
HOUSE AMENDMENT 
~ -... :'. 
\ .. , 
<'.' 
HOUSE 
AMENDMENT ",6" to COMMITTEE 
AMENDMENT 
"A" to H.P. 
L.D. 1845 
1285, 
The Maine Quality Forum, referred to in this subchapter as 
"the forum," is established within Dirigo Health. 
The forum is 
governed by the board with advice from the Maine Quality Forum 
Advisory Council pursuant to section 6952. 
The forum must be 
fundedT-~-Jeas~--~-pa~~7--~~~-~~-sa~i~s-~~~-~aymeRE6 
maQe-~~~~~-~~~~~~-&916 within the limitations of available 
funds. 
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. 29. Terms of Board of Directors of Dirigo Health end on 
September 30, 2006; staggered terms. 
Notwithstanding 
the Maine 
Revised Statutes, Title 24-11., 
section 6904, 
subsection 3, the 
terms of office for voting members of the Board of Directors of 
Dirigo Health who are serving on the board on the effective date 
of this Act end on September 30, 2006. 
Members of the board must 
be 
appointed 
in 
accordance 
with Title 
24-11., 
section 
6904, 
subsection 1. 
The terms of members appointed on or after October 
1, 2006 must be staggered as follows: The Governor shall appoint 
one member for a term of one year, one member for a term of 2 
years and one member for a term of 3 years; and the 2 members 
elected by written ballot pursuant to Title 24-11., section 6904, 
subsection 1 are elected for terms of 3 years. 
Sec. 30. Transfer. 
Notwithstanding any other provision of 
law, beginning in fiscal year 2006-07 the State Controller shall 
transfer $2,700,000 at the beginning of each fiscal year from 
General Fund undedicated revenue to the Dirigo Health Enterprise 
Fund 
for 
the 
purpose 
of 
providing 
subsidies 
to 
eligible 
individuals 
and 
employees 
enrolled in Dirigo 
Health 
Program 
coverage. 
Sec. 
31. 
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 a 
parent or caretaker relative of a MaineCare eligible child when 
the child' s family income is greater than 150'l-o but equal to or 
below 200% of the nonfarm income official poverty line. These 
costs had previously been funded by a transfer of revenue from 
HOUSE AMENDMENT 
.... ,~;~,~ 
~\~., 
\ .. , 
HOUSE 
AMENDMENT ~, to COMMITTEE 
AMENDMENT 
"A" to H. P . 
L.D. 1845 
1285, 
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 
$7,788,165 
$7,788,165 
2006-07 
($7,788,165) 
($7,788,165)' 
This 
amendment 
incorporates 
the 
elements 
of 
Commi ttee 
Amendment "B". 
The amendment ends the terms of current Board of Directors 
of Dirigo Health members on September 30, 2006 and requires that 
the terms of new members be staggered. The amendment retains the 
5-member board but requires that 2 of the 5 members be elected by 
Dirigo enrollees by written ballot. The amendment also adds 2 
nonvoting members appointed by the Governor to represent labor 
and consumer advocacy interests. 
The amendment clarifies that the joint standing committee of 
the Legislature having jurisdiction over insurance and financial 
services matters is the committee of jurisdiction over Dirigo 
Health. The amendment requires the joint standing committee of 
the Legislature having jurisdiction over insurance and financial 
services matters to review the Dirigo Health budget and make 
recommendations 
to 
the 
joint 
standing 
committee 
of 
the 
Legislature having jurisdiction over appropriations and financial 
affairs. 
The 
amendment 
also requires 
that Dirigo 
Health is 
subject to review under the Government Evaluation Act in 2007. 
The 
amendment 
provides 
that 
all 
carriers 
licensed 
to 
transact 
health 
insurance 
in 
this 
State 
may 
offer 
health 
insurance plans eligible for subsidy under the Dirigo Health 
Program if the plan is comparable to the prototype for a health 
benefits package developed by Dirigo Health and certified by the 
Superintendent of Insurance. 
The amendment limits eligibility for Dirigo Health Program 
coverage to employers and individuals who did not have prior 
health insurance 
coverage 
for 
months. 
The 
amendment 
also 
requires that Dirigo Health apply an asset limit that is 3 times 
HOUSE AMENDMENT 
, .. ~~. 
. 
: .. ~., 
\ .. 0:-' 
HOUSE 
AMENDMENT .::.6 .. to COMMITTEE' AMENDMENT 
"A" to H.P. 
L.D. 1845 
1285, 
the limits applied by MaineCare to determine eligibility for 
subsidies in addition to the requirement that an individual's 
income 
be at 
300~ or below the federal 
poverty level. 
The 
amendment requires that the subsidies be applied only to the 
premium cost for Dirigo Health Program coverage. 
The 
amendment repeals the savings offset payment as the 
source of funding for subsidies for the Dirigo Health Program and 
instead appropriates $2,700,000 from the General Fund to support 
subsidies. The amendment also prohibits any funds collected by 
Dirigo 
Health 
from 
being 
used 
as 
the 
state 
share 
for 
an 
individual directly enrolled in MaineCare. 
The 
amendment clarifies that the 
amount of the subsidy 
individuals enrolled in Dirigo Health receive is not included as 
income for the purposes of determining eligibility for MaineCare. 
The amendment requires an annual transfer from General Fund 
undedicated revenue to permit subsidies. 
The amendment adds an appropriations and allocations section 
to the bill. 
FISCAL NOTE REQUIRED 
(See attached) 
SPONSORED BY: 
TOWN: 
South Portland 
HOUSE AMENDMENT 
Approved: 04/26106 ~ac 
LD 1845 
LR 2927(09) 
An Act To Increase Access to Health Insurance Products 
Fiscal Note for House Amendment ·6" to Committee Amendment • .ff-
Sponsor: Rep. Glynn 
Fiscal Note Required: Yes 
Fiscal Note 
Projections 
2005-06 
2006-07 
2007-08 
Net Cost (Savings) 
General Fund 
$0 
$10,488,165 
$11,678,000 
Appropriations/Allocations 
General Fund 
$0 
$7,788,165 
$8,978,000 
Other Special Revenue Funds 
$0 
($7,788,165) 
($8,978,000) 
Revenue 
Other Funds 
$0 
($43,700,000) 
($43,700,000) 
Transfers 
General Fund 
$0 
($2,700,000) 
($2,700,000) 
Other Special Revenue Funds 
$0 
($7,788,165) 
($8,978,000) 
Other Funds 
$0 
$10,488,165 
$11,678,000 
Fiscal Detail and Notes 
Projections 
2008-09 
$12,396,000 
$9,696,Or 
($9,696,0O,-, 
($43,700,000) 
($2,700,000) 
($9,696,000) 
$12,396,000 
Provides a General Fund appropriation of $7.8 million for FY 2006-07 for 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 beginning 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. 
Assumes an ongoing annual transfer of $2.7 million from the General Fund to the Dirigo Health Enterprise Fund for 
the purpose of providing subsidies to eligible individuals and employees enrolled in Dirigo Health Program coverag 
LR2927(9) - Fiscal Note - Page 1 of 2 
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. Further 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(9) - Fiscal Note - Page 2 of2