An Act To Reform Dirigo Health
Maine Legislature, Session 123, LD 1028
Committee: Insurance and Financial Services
Sponsors: MILLS
Amends: 3 MRSA §522-C, 3 MRSA §959, 22 MRSA §3174-D, 24-A MRSA §2736, 24-A MRSA §2736-A, 24-A MRSA §2736-C, 24-A MRSA §2808-B, 24-A MRSA §2, 24-A MRSA §6904, 24-A MRSA §6908, 24-A MRSA §6910, 24-A MRSA §6912, 24-A MRSA §6912-A, 24-A MRSA §6914, 24-A MRSA §6915, 24-A MRSA §6951

Legislative Document 
No. 1028 
S.P.345 
March 6, 2007 
An Act To Reform Dirigo Health 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Senator MILLS of Somerset. 
Printed on recycled paper 
JOY J. O'BRIEN 
Secretary of the Senate 
Be it enaded by the People of the State of Maine as follows: 
Sec. 1. 3 MRSA §522-C is enacted to read: 
§S22-C. Dirigo Health budget review 
The joint standing committee of the Legislature having jurisdiction over insurance 
and finanoial services matters shall review the budget of Dirigo Health biennially and 
submit it& 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, ~, as amended by PL 2003, c. 600, § 1, is further 
amended to read: 
lOB. Tile 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: 
(I) State Employee Health Commission in 2009; aRd 
(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 2007~; and 
(3) Dirigo Health in 2008. 
Sec. 3. 22 MRSA §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 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) 13960 (2003) 
and additional coverage provided under contract by the department. The department may 
not consider the amount 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, ~, 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. 
For the 
fHiTfloses of this calclilation, an)' savings offset payments paid pursuant to section 
6913 must be treated as incurred claims. 
Sec. 5. 24-A MRSA §2736, sub-§4, ~C, as amended by PL 2003, c. 469, Pt. E, 
§ 1 0, 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 adequate, and not unfairly 
discriminatory and in compliance 'Nith the reqliirements of section 6913 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, inadequate, and unfairly discriminatory or not in 
compliance 'with section 6913 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, ~, as enacted by PL 2003, c. 469, Pt. E, 
IS 
§ 12, is repealed. 
Sec. 8. 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. 
For the plirposes of this 
calcl:llation, any savings offset payments paid plirsliant to section 6913 mlist be treated as 
incl:lrred claims. 
Sec. 9. 24-A MRSA §2808-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 I, 2004, 
except that the filing of rates for small grolip health plans are not reqliired to aCcoliRt 
for any saviRgs offset payment or any recovery of that offset paymeRt plirSl:lant to 
slibsection 2 B, paragraph 0 and section 6913 for rates effective before 1lily 1,2005. 
Sec. 10. 24-A MRSA §2808-B, sub-§2-B, ~A, 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 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. ffl 
tAe pl:lffJoses of tAis calculation, any savings offset payments paid pursuant to section 
6913 fAust be treated as incurred eiaifAs. 
Sec. 11. 24-A MRSA §2S0S-B, sub-§2-B, ~, as enacted by PL 2003, c. 469, 
Pt. E, § 16, is repealed. 
Sec. 12. 24-A MRSA §2S0S-B, sub-§2-B, ~, 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 
II 
paragraph E is subject to this paragraph. 
(I) 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 
a written statement detailing the circumstances that justify a hearing, 
notwithstanding the satisfaction of the criteria in paragraph E. 
(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 adequate, and not unfairly 
discriminatory and in cOfApliance 'NitA the requirements of section 6913 remains 
with the carrier. 
Sec. 13. 24-A MRS A §2S39-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 I 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 tAat the carrier Aas included in its experience any savings offset payments or 
recovery of those savings offset paYfAents consistent 'NitA section 6913. The filing also 
must state the number of policyholders, certificate holders aqd 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. 14. 24-A MRS A §6904, sub-§I, as enacted by PL 2003, c. 469, Pt. A, §8, is 
amended to read: 
1. Appointments. The board consists of 5 voting members and 3 ex officio, ~ 
nonvoting members as follows. 
A. 
+he 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. 
+he 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 
II 
(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 interests, respectively. 
IS 
Sec. 15. 24-A MRSA §6904, sub-§2, as enacted by PL 2003, c. 469, Pt. A, §8, is 
amended to read: 
2. Qualifications of voting members. Voting members of the board appointed by 
the Governor: 
A. 
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; or 
(5) State management and bt:tdget; or 
(6) Health care financing; and 
B. 
Except as provided in this paragraph, may not be: 
(I) 
A representative or employee of an insurance carner 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. 
Sec. l6t 24-A MRSA §6904, sub-§4, as enacted by PL 2003, c. 469, Pt. A, §8, is 
amended to~read: 
4. Chair. The Gevemer board shall appeint elect one of the voting members as the 
chair ofthe-hoard. 
Sec. 17. 24-A MRSA §6908, sub-§2, ~, as enacted by PL 2003, c. 469, Pt. A, 
§8, is repealed. 
Sec. 18. 24-A MRSA §6908, sub-§2, ~C, as amended by PL 2005, c. 400, Pt. C, 
§6, is further amended to read: 
C. Determine the eemprehensive serviees and benefits te be ineh:lded in the Dirigo 
Health Program and develop the speeifieations for the Dirigo Health Program 
Develop a prototype for a health benefits package in accordance with the provisions 
in section 6910. Within 30 days of its determination development of the beReHt 
paekage to be offered through prototype for a health benefits package for the Dirigo 
Health Program, the board shaH 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; 
Sec. 19. 24-A MRS A §6908, sub-§2, ~, 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 eontraets 'Nith one or more qualified 
bidders in accordance with sections 6910 and 6912-A; 
Sec. 20. 24-A MRSA §6908, sub-§13, as reallocated by PL 2005, c. 683, Pt. B, 
§20, is repealed and the foHowing enacted in its place: 
13. Report; jurisdiction. The joint standing committee of the Legislature having 
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 Program and budget. Minutes of meetings of the Board of Directors of 
Dirigo Health must be provided to each member of the joint standing committees of the 
Legislature having jurisdiction over insurance and financial services matters, health and 
human services matters and appropriations and financial affairs. 
Sec. 21. 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 all health insurance carriers licensed to 
transact health insurance in this State that apply to the board and 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. 
Sec. 22. 24-A MRSA §6910, sub-§2, as amended by PL 2005, c. 400, Pt. C, §8, 
is repealed. 
Sec. 23. 24-A MRSA §6910, sub-§3, as amended by PL 2005, c. 400, Pt. C, §8, 
is further amended to read: 
3. Carrier participation requirements. To qualify as a carrier of Dirigo Health 
Program coverage, a health insurance carrier must: 
A. 
Provide the comprehensive health services and benefits a health plan comparable 
to the prototype for a health benefits package under section 6908, subsection 2, 
paragraph C as determined developed by the board, inch:lding a standard benefit 
package that meets the requirements for mandated coverage for specific health 
services, and specific diseases and for certain providers of health services under Title 
and this Title and any supplemental benefits the board wishes to make available; 
aOO 
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, citizenship 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 
I 
(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 network~; and 
C. Unless otherwise provided in this chapter, comply with all applicable provisions 
of this Title, including, but not limited to, sections 2736-C and 2808-B and chapters 
and 56-A. 
Health insurance carriers that seek to qualify to provide Dirigo Health Program coverage 
must also qualify as health plans in Medicaid. 
Sec. 24. 24-A MRSA §6910, sub-§4, as amended by PL 2005, c. 400, Pt. C, §8, 
is further amended to read: 
4. Contracting authority. Dirigo Health has contracting authority and powers to 
administer Dirigo Health Insurance as set out in this subsection. 
A. Dirigo Health m!l)' contract with shall permit all health insurance carriers licensed 
to sell health insurance in this State or other private or pl:lblic third party 
administrators to provide Dirigo Health Program coverage. In addition: 
(I) 
Dirigo Health shall issl:le reql:lests for proposals from health insl:lrance 
carriers; 
(2) 
Dirigo Health may incll:lde shall require a carrier to include quality 
improvement, disease prevention, disease management and cost-containment 
provisions in the contracts 'Nith participating health insl:lrance carriers or may 
II 
arrange for the provision of sl:lch ser't'ices throl:lgh contracts 'Nith other entities 
Dirigo Health Program coverage; 
(3) Dirigo Health shall reql:lire participating health insl:lrance carriers to offer a 
benefit plan identical to the Dirigo Health Program, for which no Dirigo Health 
sl:lbsidies are available, in the general small grol:lp market; 
(4) Dirigo Health shall make payments to participating health insl:lrance carriers 
I 7 
I:Inder a Dirigo Health Program contract to provide Dirigo Health Program 
benefits to plan enrollees not enrolled in MaineCare; 
(5) Dirigo Health may set allowable rates for administration and underwriting 
gains for the Dirigo Health Program; 
(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 
(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 and' other reporting forms and 
procedures necessary for the efficient administration of contracts. 
(2) Dirigo Health shall collect payments from participating employers and plan 
enrollees to cover the cost of: 
(a) The Dirigo Health Program for enrolled employees and dependents in 
contribution amounts determined by the board; 
(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 establish the minimum required contribution levels, not 
to exceed 60%, 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 
J 0 
establish a separate minimum contribution level to be paid by employers toward 
J J 
coverage for dependents of the employers' enrolled employees. 
J 2 
(4) Dirigo Health shall require participating employers to certify that at least 
J 3 
75% of their employees that work 30 hours or more per week and who do not 
J 4 
have other creditable coverage are enrolled in the Dirigo Health Program and that 
J 5 
the employer group otherwise meets the minimum participation requirements 
J 6 
specified by section 2808-B, subsection 4, paragraph A. 
J 7 
(5) Dirigo Health shall reduce the payment amounts for plan enrollees eligible 
J 8 
for a subsidy under section 69 J 2 accordingly. Dirigo Health shall return any 
J 9 
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. 
(9) 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. 
(J 0) 
Notwithstanding section 2849-B, a carrier that provides Dirigo Health 
Program coverage may impose a preexisting condition exclusion not to exceed 6 
J 
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. 
(J) 
Dirigo Health may establish contract and other reporting forms and 
procedures necessary for the efficient administration of contracts. 
(2) Dirigo Health may collect payments from eligible individuals participating 
in the Dirigo Health Program to cover the cost of: 
(a) Enrollment in the Dil';go Health Program for eligible individuals and 
dependen~; 
Pag~ R - 123LR1J98(OI)-l 
I 
(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. 
(5) Dirigo HealtH may require an eligible individual who is cmrently employed 
by an eligible employer tHat does not offer HealtH insHrance to certify that tHe 
current employer did not provide access to an employer sponsored benefits plan 
in tHe 
montH period immediately preceding tHe eligible individHal's 
application. 
(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 to certify that the individual 
was uninsured for the 6-month period immediately preceding the eligible 
individual's application. 
(9) Notwithstanding section 2849-B, a carrier that provides Dirigo Health 
Program coverage may impose a preexisting condition exclusion not to exceed 6 
months for an eligible individual except that a preexisting condition exclusion 
may not be imposed on an eligible individual who is a federally eligible 
individual. 
Sec. 25. 24-A MRSA §6912, first~, as amended by PL 2005, c. 400, Pt. A, §7, is 
further amended to read: 
Dirigo Health may establish sliding-scale subsidies for the purchase of Dirigo Health 
Program coverage paid by eligible individuals or employees WHose income is Hnder 
300% of tHe federal poverty level in accordance with the eligibility requirements in 
subsection 2. Dirigo Health may also establish sliding-scale subsidies for the purchase of 
I 
employer-sponsored health coverage paid by employees of businesses with more than 50 
employees, WHose income is Hnder 300% of tHe federal poverty level in accordance with 
the eligibility requirements in subsection 2. 
Sec. 26. 24-A MRS A §6912, suh-§2, as amended by PL 2005, c. 400, Pt. A, §8, 
is further amended to read: 
2. Eligibility for subsidy. To be eligible for a subsidy an individual or employee 
must: 
A. 
Be enrolled in the Dirigo Health Program and covered by a health plan certitied 
pursuant to section 6912-A, have an income under 300% of the federal poverty level 
I 
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 aRd~ 
have an income under 300% 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. 27. 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. Dirigo 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. 28. 24-A MRSA §6912-A is enacted to read: 
§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 those health plans because the plan provides a comparable health benefits 
package developed by Dirigo Health in accordance with section 6908, subsection 2, 
paragraph C and meets the requirements of section 6910. The superintendent may adopt 
rules as necessary for the administration of this section. Rules adopted pursuant to this 
section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 29. 24-A MRS A §6913, as amended by PL 2005, c. 683, Pt. A, §§43 and 44, 
is repealed. 
Sec. 30. 24-A MRSA §6914, as amended by PL 2005, c. 400, Pt. A, § 14, IS 
further amended to read: 
§6914. Intragovernmental transfer 
Starting July 1, 2004, Dirigo Health shall transfer funds, as necessary, to a special 
dedicated, non lapsing 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 
I 
individuals directly enrolled in MaineCare due to any expansion in MaineCare eligibili!y. 
Dirigo Health shall annually set the amount of contribution. 
Sec. 31. 24-A MRSA §6915, as amended by PL 2005, c. 386, Pt. D, §3, is further 
amended to read: 
§6915. Dirigo 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 
individuals, any savings offset payments made pI:lFSl:lant to section 6913 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 ofthis chapter. 
II 
Sec. 32. 24-A MRSA §6951, first ~, 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 governed by the board with advice from 
the Maine Quality Forum Advisory Council pursuant to section 6952. The forum must be 
funded, at least in part, thFOl:lgh the savings offset payments made pl:IFSl:lant to section 
e9+J. 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 I, 
chapter 13, subchapter 1. The forum shall perform the following duties. 
Sec. 33. Terms of Board of Directors of Dirigo Health end on September 
30, 2007; staggered terms. Notwithstanding the Maine Revised Statutes, Title 24-A, 
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, 2007, after which members of the board must be appointed in 
accordance with Title 24-A, section 6904, subsection I. The terms of initial members 
appointed on or after October I, 2007 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-A, section 6904, subsection I are elected for terms of 3 years. 
Sec. 34. Transfer. Notwithstanding any other provision of law, beginning in fiscal 
year 2007-08 the State Controller shall transfer $15,000,000 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. 
SUMMARY 
This bill does the following. 
The bill ends the terms of current members of the Board of Directors of Dirigo Health 
on September 30,2007 and requires that the terms of new members be staggered. The bill 
retains the 5-member board but requires that 2 of the 5 members be elected by Dirigo 
I 
plan enrollees by written ballot. The bill also adds 2 nonvoting members appointed by the 
Governor to represent labor and consumer advocacy interests. 
The bill 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 bill 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 bill also 
requires that Dirigo Health be subject to review under the State Government Evaluation 
Act in 2008 
II 
The bill 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 bill limits eligibility for Dirigo Health Program coverage to employers and 
individuals who did not have prior health insurance coverage for 6 months. The bill also 
requires that Dirigo Health apply an asset limit that is 3 times the limits applied by 
MaineCare to determine eligibility for subsidies in addition to the requirement that an 
individual's income be under 300% of the federal poverty level. The bill requires that the 
subsidies be applied only to the premium cost for Dirigo Health Program coverage. 
The bill repeals the savings offset payment as the source of funding for subsidies for 
the Dirigo Health Program and instead appropriates $15,000,000 from the General Fund 
to support subsidies. The bill also prohibits any funds collected by Dirigo Health from 
being used as the state share for an individual directly enrolled in MaineCare. 
The bill 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 bill requires an annual transfer from General Fund undedicated revenue to permit 
subsidies. 
Pdge 12 - 123LR139S(OJ)-J