An Act To Make Health Care Affordable, Accessible and Effective for All
Maine Legislature, Session 123, LD 1890
Committee Amendment CA_C-SA_A_S379 (Senate)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2839-B, 24-A MRSA §6908, 24-A MRSA §6915, 36 MRSA §4365, 36 MRSA §4365-F, 36 MRSA §4365-G, 36 MRSA §4366-A, 36 MRSA §4385, 36 MRSA §4403, 36 MRSA §4403-A, 24-A MRSA §2736, 24-A MRSA §2736-A, 24-A MRSA §2, 24-A MRSA §6951

SENA TE AMENDMENT "A " to COMMITTEE AMENDMENT "C" to H.P. 
1322, L.D. 1890, Bill, "An Act To Make Health Care Affordable, Accessible and 
Effective for All" 
Amend the amendment in Part D by striking out all of section 1 (page 4, lines 16 to 
and page 5, lines 1 to 24 in amendment) and inserting the following: 
'Sec. D-l. 24-A MRSA §2736-C, sub-§2-A is enacted to read: 
2-A. Reinsurance requirement. Carriers providing individual health plans are 
subject to the requirements of chapter 54.' 
Amend the amendment in Part D in section 2 in the chapter headnote in the 2nd line 
(page 5, line 27 in amendment) by striking out the following: "HIGH-RISK" 
Amend the amendment in Part D in section 2 in §390 1 in the first paragraph in the 
first line (page 5, line 30 in amendment) by striking out the following: "High-risk" 
Amend the amendment in Part D in section 2 in §3902 in subsection 1 in the first line 
(page 5, line 35 in amendment) by striking out the following: "High-risk" 
Amend the amendment in Part D in section 2 in §3902 in subsection 3 in the 2nd line 
(page 6, line 2 in amendment) by striking out the following: "exclusive of dependents" 
and inserting the following: 'including dependents' 
Amend the amendment in Part D in section 2 in §3903 in the first line (page 7, line 10 
in amendment) by striking out the following: "High-risk" 
Amend the amendment in Part D in section 2 in §3903 in subsection 1 in the first line 
(page 7, line II in amendment) by striking out the following: "High-risk" 
Amend the amendment in Part D in section 2 in §3903 in subsection 2 in paragraph A 
in subparagraph (1) in division (b) in the first line (page 7, line 23 in amendment) by 
3] 
striking out the following: "Two members" and inserting the following: 'One member' 
Amend the amendment in Part D in section 2 in §3903 in subsection 2 in paragraph A 
in subparagraph (1) by inserting after division (b) the following: 
SENATE AMENDMENT 
· .\,. 
." ",' 
II 
SENA TE AMENDMENT ",4 " to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
'(c) One member must be the Executive Director of Dirigo Health or the 
director's designee;' 
Amend the amendment in Part D in section 2 in §3903 in subsection 2 in paragraph A 
in subparagraph (I) by relettering the divisions to read consecutively. 
Amend the amendment in Part D in section 2 in §3905 in subsection 1 in paragraph D 
in the last line (page 8, line 25 in amendment) by inserting after the following: "assets;" 
the following: 'and' 
Amend the amendment in Part D in section 2 in §3905 in subsection I in paragraph E 
in the last line (page 8, line 34 in amendment) by striking out the following: "insurer; 
and" and inserting the following: 'insurer.' 
Amend the amendment in Part D in section 2 in §3905 in subsection I by striking out 
all of paragraph F (page 8, lines 35 to 37 in amendment) 
Amend the amendment in Part D in section 2 in §3905 in subsection 2 by striking out 
all of paragraph E (page 9, lines 13 and 14 in amendment) 
Amend the amendment in Part D in section 2 in §3905 in subsection 2 by relettering 
the paragraphs to read consecutively. 
Amend the amendment in Part D in section 2 in §3906 in subsection 3 by striking out 
all of paragraph B (page 10, lines 17 to 21 in amendment) 
Amend the amendment in Part D in section 2 in §3906 in subsection 3 by relettering 
the paragraphs to read consecutively. 
Amend the amendment in Part D in section 2 by striking out all of §3908 (page 12, 
lines I to 27 in amendment) and inserting the following: 
'§3908. Requirements for coverage 
1. Coverage for reinsurance. For individual health plans issued or renewed on or 
after January 1, 2009, an insurer may designate through the use of individual health 
statements or other reasonable means a person covered under an individual health plan to 
be reinsured by the association in accordance with section 3909 and rules adopted by the 
association. ' 
Amend the amendment in Part D in section 2 in §3909 in subsection I in the first and 
2nd lines (page 12, lines 29 and 30 in amendment) by striking out the following: 
"offering the coverage options approved by the association pursuant to section 3908, 
subsection I" 
Amend the amendment in Part D in section 2 in §3909 in subsection I in the 3rd line 
(page 12, line 31 in amendment) by inserting after the following: "in this subsection" the 
following: 'for individual health plans designated by the insurer pursuant to section 3908' 
Amend the amendment in Part D in section 2 by striking out all of §3910 (page 13, 
lines 21 to 43 and page 14, lines I to 34 in amendment) 
Amend the amendment in Part D in section 2 in §3912 by striking out all of 
subsection I (page IS, lines 4 to 22 in amendment) and inserting the following: 
SENATE AMENDMENT 
.~' 
{\ .. 
I 
SENATE AMENDMENT ";1 " to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
'l. Reimbursement. An insurer may seek reimbursement from the association and 
the association shall reimburse the insurer to the extent claims paid by the insurer after 
January 1, 2009 meet the requirements for reinsurance pursuant to section 3909 and the 
insurer meets the following criteria: 
A. 
The insurer sold an individual health plan between December 1, 1993 and 
December 31, 2008, and the policy that was sold has been continuously renewed by 
the covered person; 
B. The insurer is able to determine through the use of individual health statements, 
claims history or any reasonable means that at any time while the policy was in 
effect. the covered person was diagnosed with one of the following medical 
conditions: acquired immune deficiency syndrome, angina pectoris, ascites, chemical 
dependency, cirrhosis of the liver, coronary occlusion, cystic fibrosis, Friedreich's 
ataxia, hemophilia, Hodgkin's disease, Huntington's chorea, juvenile diabetes, 
leukemia, metastatic cancer, motor or sensory aphasia, mUltiple sclerosis, muscular 
dystrophy, myasthenia gravis, myotonia, heart disease requiring open-heart surgery, 
Parkinson's disease, polycystic kidney disease, psychotic disorders, quadriplegia, 
stroke, syringomyelia or Wilson's disease; and 
C. The insurer has closed its book of business for individual health plans sold prior 
to January 1, 2009.' 
Amend the amendment in Part D in section 2 by renumbering the sections to read 
consecutively. 
Amend the amendment in Part D by striking out all of section 3 (page 15, lines 26 to 
in amendment) and inserting the following: 
'Sec. D-3. 
Maine Individual Reinsurance Pool Association; staggered 
terms. 
Notwithstanding the Maine Revised Statutes, Title 24-A, section 3903, 
subsection 2, paragraph B, the terms for initial appointments to the Maine Individual 
Reinsurance Pool Association are as follows. Of those members of the board appointed 
by the superintendent, 2 members serve for a term of one year, 2 members for a term of 2 
years and 2 members for a term of 3 years. Of those members appointed by insurers, one 
member serves for a term of one year, one member serves for a term of 2 years and one 
member serves for a term of 3 years. The appointing authority shall designate the period 
of service of each initial appointee at the time of appointment. 
Sec. D-4. Assessment. By January 1, 2012, the Maine Individual Reinsurance 
Pool Association shall determine whether the maximum assessment provided in the 
Maine Revised Statutes, Title 24-A, section 3907, subsection 2 is adequate to meet the 
reinsurance requirements of Title 24-A, chapter 54. The association shall submit a report 
to the joint standing committee of the Legislature having jurisdiction over insurance 
matters with its recommendations, if any, for changes to the assessment amount. The 
committee may submit a bill to the Second Regular Session of the 125th Legislature 
relating to the assessment.' 
SENATE AMENDMENT 
.,ii' 
" f, '~~ 
SENATE AMENDMENT" A "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
Amend the amendment in Part E by striking out all of section I (page 15, lines 36 to 
in amendment) 
Amend the amendment in Part E in section 2 by striking out all of paragraph D (page 
16, lines 3 to 28 in amendment) and inserting the following: 
'D. 
A carrier may vary the premium rate due to age, occupation or industry and 
geographic area oBly HBder the following schedule and withiR the listed percentage 
baRds in accordance with the limitations set out in this paragraph. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between December I, 1993 and 
July 14, 1994, the premium rate may not deviate above or below the community 
rate filed by the carrier by more than 50%. 
(2) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 15, 1994 and July 
14, 1995, the premium rate may not deviate above or below the community rate 
filed by the carrier by more than 33%. 
(3) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State aftef between July 15, 1995 and 
December 31, 2007, the premium rate may not deviate above or below the 
community rate filed by the carrier by more than 20%. 
(4) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State after January I, 2008, the 
premium rate may not deviate above the community rate on the basis of age by 
more than 33% and may not deviate below the community rate on the basis of 
age by more than 66%. 
(5) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State after January I, 2008, the 
premium rate may not deviate above or below the community rate filed by the 
carrier on the basis of geographic area and occupation or industry by more than 
20%. ' 
Amend the amendment in Part E by inserting after section 3 the following: 
'Sec. E-4. 24-A MRSA §2736-C, sub-§2, ~ 
is enacted to read: 
H. 
A carrier that adjusts its rate shall account in its experience for the impact of the 
Maine Individual Reinsurance Pool Association established in chapter 54. 
Sec. E-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 
SENATE AMENDMENT 
':-~.,s .,. 
SENATE AMENDMENT" A " to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
in force by the carrier for the period for which coverage is to be provided wiIl return to 
policyholders at least ~ 
78% 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 purposes of this 
calculation, any savings offset payments paid pursuant to former section 6913 must be 
treated as incurred claims. If incurred claims were less than 78% of aggregate earned 
premiums over a continuous 36-month period, the carrier shall refund total excess 
premiums to current in-force policyholders. 
The excess premium is the amount of 
premium above that amount necessary to achieve a 78% loss ratio for all of the carrier's 
individual policies during the same 36-month period. The refund must be distributed to 
policyholders in an amount reasonably calculated to correspond to the aggregate 
experience of all policyholders holding policies having similar benefits. The total of all 
refunds must equal the excess premiums. The superintendent may require further support 
for the unpaid claims estimate and may require refunds to be recalculated if the estimate 
is found to be unreasonably large. The superintendent shall adopt rules setting forth 
appropriate methodologies for determining incurred claims experience and earned 
premiums and for calculating refunds pursuant to this subsection. Rules adopted pursuant 
to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 
2-A.' 
Amend the amendment in Part F in section I in subsection 3 in the 4th line (page 16, 
line 39 in amendment) by striking out the following: "High-risk" 
Amend the amendment in Part J by striking out all of sections 3 to 5 (page 20, lines 
to 39 and page 2 I, lines I to 17 in amendment) and inserting the following: 
'Sec. J-3. 24-A MRSA §2839-B, sub-§2, as enacted by PL 2003, c. 469, Pt. E, 
§ I 7, 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 that the carrier has included in its experience any savings offset payments or 
recovery of those savings offset payments consistent with former section 6913. 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. J-4. 24-A MRSA §6908, sub-§l, ~A, as enacted by PL 2003, c. 469, Pt. A, 
§8, is amended to read: 
A. 
Take any legal actions necessary or proper to recover or collect savings offset 
payments provided in former section 6913 due Dirigo Health or that are necessary for 
the proper administration of Dirigo Health; 
SENATE AMENDMENT 
{'o' .,. 
I 
II 
SENATE AMENDMENT ':A "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
Sec. J-5. 24-A MRSA §6908, sub-§2, ~, as enacted by PL 2003, c. 469, Pt. A, 
§8, is amended to read: 
B. 
Collect the saviflgs offset payments provided in former section 6913;' 
Amend the amendment in Part J by striking out all of section 9 (page 21, line 39 and 
Amend the amendment in Part J by striking out all of sections II and 12 (page 22, 
lines 6 to 39 and page 23, lines 1 to 7 in amendment) 
Amend the amendment in Part J by striking out all of section 13 (page 23, lines 8 to 
in amendment) and inserting the following: 
'Sec. J-13. 24-A MRSA §6915, as enacted by PL 2003, c. 469, Pt. A, §8 and 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 saviRgs offset payments made pursuant to former section 6913, revenues 
transferred pursuant to Title 36, sections 4385 and 4403-A and any funds received from 
any public or private source. The fund may be used by Dirigo Health to exercise its 
powers and duties pursuant to this chapter. The fund may not lapse, but must be carried 
forward to carry out the purposes ofthis chapter.' 
Amend the amendment in Part J by striking out all of sections 14 to 16 (page 23, lines 
to 43 and page 24, lines 1 to 23 in amendment) and inserting the following: 
'Sec. J-14. 36 MRSA §4365, as amended by PL 2005, c. 457, Pt. AA, §1 and 
affected by §8, is further amended to read: 
§4365. Rate of tax 
A tax is imposed on all cigarettes imported into this State or held in this State by any 
person for sale at the rate of tOO 137.5 mills for each cigarette. Payment of the tax is 
evidenced by the affixing of stamps to the packages containing the cigarettes. 
Sec. J-15. 36 MRSA §4365-F, as enacted by PL 2005, c. 457, Pt. AA, §3 and 
affected by §8, is repealed. 
Sec. J-16. 36 MRSA §4365-G is enacted to read: 
§4365-G. Application of cigarette tax rate increase effective October 1,2007 
The following provisions apply to cigarettes held for resale on October 1, 2007. 
1. Stamped rate. Cigarettes stamped at the rate of 100 mills per cigarette and held 
for resale after September 30, 2007 are subject to tax at the rate of 137.5 mills per 
cigarette. 
SENATE AMENDMENT 
,~. 
'I> 1, 
i/:('~ 
SENA TE AMENDMENT ",A " to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
2. Liability. A person possessing cigarettes for resale is liable for the difference 
between the tax rate of 137.S mills per cigarette and the tax rate of 100 mills per cigarette 
in effect before October 1, 2007. Stamps indicating payment of the tax imposed by this 
section must be affixed to all packages of cigarettes held for resale as of October 1, 2007, 
except that cigarettes held in vending machines as of that date do not require that stamp. 
3. Vendine machines. Notwithstanding any other provision of this chapter, it is 
presumed that all cigarette vending machines are filled to capacity on October 1, 2007 
and that the tax imposed by this section must be reported on that basis. A credit against 
this inventory tax must be allowed for cigarettes stamped at the rate of 137.S mills per 
cigarette placed in vending machines before October 1,2007. 
4. Payment. Payment of the tax imposed by this section must be made to the 
assessor by January I, 2007, accompanied by forms prescribed by the assessor. 
Sec. J-17. 36 MRSA §4366-A, sub-§2, as amended by PL 200S, c. 622, §25 and 
affected by §34, is further amended to read: 
2. Provided to sellers. The State Tax Assessor shall provide stamps suitable to be 
affixed to packages of cigarettes as evidence of the payment of the tax imposed by this 
chapter. The assessor may permit a licensed distributor to pay for the stamps within 30 
days after the date of purchase, if a bond satisfactory to the assessor in an amount not less 
than SO% of the sale price of the stamps has been filed with the assessor conditioned upon 
payment for the stamps. Such a distributor may continue to purchase stamps on a 30-day 
deferral basis only if it remains current with its cigarette tax obligations. The assessor 
may not sell additional stamps to a distributor that has failed to pay in full within 30 days 
for stamps previously purchased until such time as the overdue payment is received. The 
assessor shall sell cigarette stamps to licensed distributors at the following discounts from 
their face value: 
A. 
For stamps at the face value of37 mills sold through September 30,2001, 2.S%; 
B. 
For stamps at the face value of 50 mills sold prior to July I, 2002, 2.16%; 
C. 
For stamps at the face value of 50 mills sold on or after July 1, 2002, 2.03%; aftd 
D. 
For stamps at the face value of 100 mills, l.lS%~; and 
E. For stamps at the face value of 137.S mills, 0.88%. 
Sec. J-18. 36 MRSA §4385 is enacted to read: 
§4385. Applications of revenues 
1. Credited to suspense account. Revenues derived from the tax equal to 37.5 mills 
imposed on cigarettes pursuant to section 436S must be credited to a General Fund 
suspense account. 
2. Transfers in 2008 and thereafter. Except as provided in subsection 3, on or 
before the last day of each month of calendar year 2008 and each calendar year thereafter, 
the State Controller shall transfer the revenues credited to the suspense account under 
subsection I during the month to the Dirigo Health Enterprise Fund established by Title 
24-A, section 691S. 
SENATE AMENDMENT 
,,\. 
'.#! ... 
"'\'" 
II 
SENATE AMENDMENT "A " to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
3. Transfer to General Fund. The State Controller shall transfer into the General 
Fund the revenues necessary to maintain the level of cigarette tax revenue at the level that 
was budgeted for the General Fund in fiscal year 2006-07. Beginning in fiscal year 2007-
08, the State Controller shall transfer to the General Fund the revenues necessary to 
maintain the level of cigarette tax revenue in the previous year less 3%. The Treasurer of 
State shall annually review the recommendations of the Revenue Forecasting Committee 
to determine whether any change in the reduction rate is required and, if so, shall change 
the rate accordingly. 
Sec. J-19. 36 MRSA §4403, sub-§2, as amended by PL 2005, c. 627, §8, is 
further amended to read: 
2. Other tobacco. A tax is imposed on cigars, pipe tobacco and other tobacco 
intended for smoking at the rate of ~ 
78% of the wholesale sales price beginning 
October I, ~ 
2007. 
Sec. J-20. 36 MRSA §4403-A is enacted to read: 
§4403-A. Applications of revenues 
1. Credited to suspense account. Revenues derived from the tax equal to 58% of 
the wholesale sales price of tobacco products pursuant to section 4403, subsection 2 must 
be credited to a General Fund suspense account. 
2. Transfers in 2008 and thereafter. On or before the last day of each month of 
calendar year 2008 and each calendar year thereafter, the State Controller shall transfer 
100% of the revenues credited to the suspense account under subsection I during the 
month to the Dirigo Health Enterprise Fund established by Title 24-A, section 6915.' 
Amend the amendment in Part K by striking out all of sections 3 to II and inserting 
the following: 
'Sec. K-3. 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, not unfairly 
discriminatory and in compliance with the requirements of former section 6913 
remains with the insurer. 
Sec. K-4. 24-A MRSA §2736-A, as amended by PL 2003, c. 469, Pt. E, § 11, is 
further amended to read: 
§2736-A. Hearing 
If at any time the superintendent has reason to believe that a filing does not meet the 
requirements that rates not be excessive, inadequate, unfairly discriminatory or not in 
compliance with former section 6913 or that the filing violates any of the provisions of 
chapter 23, the superintendent shall cause a hearing to be held. 
SENATE AMENDMENT 
.{~~# .. .,. 
SENATE AMENDMENT "/1 "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
Hearings held under this section must conform to the procedural requirements set 
forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter 4. 
Sec. K-S. 24-A MRSA §2736-C, sub-§2, ~, 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 
former section 6913. 
Sec. K-6. 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, 2004, 
except that the filing of rates for small group health plans are not required to account 
for any savings offset payment or any recovery of that offset payment pursuant to 
subsection 2-B, paragraph 0 and former section 6913 for rates effective before Jt:lly 
1,2005 
Sec. K-7. 24-A MRSA §2S0S-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. For 
the purposes of this calculation, any savings offset payments paid pursuant to former 
section 6913 must be treated as incurred claims. 
Sec. K-S. 24-A MRSA §2S0S-B, sub-§2-B,~, 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 former section 6913. 
Sec. K-9. 24-A MRS A §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 
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 
a written statement detailing the circumstances that justify a hearing, 
notwithstanding the satisfaction of the criteria in paragraph E. 
SENATE AMENDMENT 
,~';' 
i<'" .' 
I 
1 
SENATE AMENDMENT "A "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
(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, not unfairly 
discriminatory and in compliance with the requirements of former section 6913 
remains with the carrier. 
Sec. K-IO. 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, through the savings offset payments made pursuant to former 
section 6913. 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 I. The forum 
shall perform the following duties.' 
Amend the amendment by striking out all of Part L and inserting the following: 
'PARTL 
Sec. L-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Revenue Services - Bureau of 0002 
Initiative: Provides funds for Maine Revenue Services administrative costs associated 
with the cigarette and other tobacco products tax increase. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL - ALL FUNDS 
DIRIGO HEALTH 
2007-08 
$88,000 
$88,000 
2007-08 
$88,000 
$88,000 
SENATE AMENDMENT 
2008-09 
$0 
$0 
2008-09 
$0 
$0 
SENATE AMENDMENT /t "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
Dirigo Health Fund 0988 
Initiative: Deallocates funds for Dirigo Health costs that were funded by the savings 
offset payment. 
DIRIGO HEALTH FUND 
All Other 
DIRIGO HEALTH FUND TOTAL 
Dirigo Health Fund 0988 
2007-08 
2008-09 
$0 
($13,720,000) 
$0 
($13,720,000) 
Initiative: Allocates funds for Dirigo Health costs to be funded by a cigarette and other 
tobacco products tax increase. 
DIRIGO HEALTH FUND 
All Other 
DIRIGO HEALTH FUND TOTAL 
DIRIGO HEALTH 
DEPARTMENT TOTALS 
DIRIGO HEALTH FUND 
DEPARTMENT TOTAL - ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
DIRIGO HEALTH FUND 
SECTION TOTAL - ALL FUNDS 
2007-08 
$35,649,622 
$35,649,622 
2007-08 
$35,649,622 
$35,649,622 
2007-08 
$88,000 
$35,649,622 
2008-09 
$48,014,799 
$48,014,799 
2008-09 
$34,294,799 
$34,294,799 
2008-09 
$0 
$34,294,799 
$35,737,622 
$34,294,799 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
SENATE AMENDMENT 
•. ~ 
.... 
'~\ . ., 
SENATE AMENDMENT ")1 "to COMMITTEE AMENDMENT "C" to H.P. 1322, L.D. 1890 
SUMMARY 
This amendment does the following. 
I. It maintains guaranteed issue in the individual market. 
2. It modifies the reinsurance pool to make it clear that individuals will not be placed 
in a separate risk pool or be covered under different health plans than those available in 
the individual market. The amendment permits carriers in the individual market to use an 
individual health assessment to designate persons covered under an individual health plan 
for inclusion in the reinsurance pool at the time a policy is issued. 
3. The amendment requires carriers to account for the impact of the reinsurance pool 
in rates for individual health plans filed for approval with the Superintendent of 
Insurance. 
4. 
The amendment modifies the community rating provisions in the committee 
amendment to permit premium rates to vary on the basis of age up to 33% above or up to 
66% below the community rate. The amendment would maintain the requirement in 
current law that permits premium rates to vary on the basis of geographic area and 
occupation or industry up to 20% above or below the community rate. 
5. The amendment adds a requirement that carriers in the individual market maintain 
a loss ratio of 78%. 
6. The amendment removes the provisions in the committee amendment that impose 
a I % assessment on carriers and increase the hospital tax by I % to fund the Dirigo Health 
Program. This amendment increases the tax on cigarettes by 75¢ and equalizes the rate of 
tax on all other tobacco products. The amendment requires that all of the revenues from 
the tax increases be credited to the Dirigo Health Enterprise Fund to support the Dirigo 
Health Program. 
7. The amendment removes the provision in the committee amendment establishing 
a voluntary checkoff on individual income tax returns for contributions to the Dirigo 
Health Enterprise Fund. 
FISCAL NOTE REQUIRED 
(See attached) 
SPONSOREDBY:~~ J~~ 
(Senator SULLIVAN) (/ 
COUNTY: York 
SENATE AMENDMENT 
Approved: 06/20107 ;f!;p'ac 
LD 1890 
LR 2620(11) 
An Act To Make Health Care Affordable, Accessible and Effective for All 
Fiscal Note for Senate Amendment "A " to Committee Amendment "c" 
Sponsor: Sen. Sullivan of York 
Fiscal Note Required: Yes 
Fiscal Note 
Projections 
2007-08 
2008-09 
2009-10 
Net Cost (Savings) 
General Fund 
($1,036,716) 
($1,513,335) 
($1,499,884) 
Appropriations! Allocations 
General Fund 
$88,000 
$0 
$0 
Federal Expenditures Fund 
$0 
($2,595,710) 
($2,595,710) 
Other Special Revenue Funds 
$0 
($1,520,444) 
($1,509,702) 
Dirigo Health Fund 
$35,649,622 
$6,908,243 
$6,952,259 
Revenue 
General Fund 
$1,124,716 
$1,513,335 
$1,499,884 
Other Special Revenue Funds 
$60,443 
$81,328 
$82,272 
Dirigo Health Fund 
$35,649,622 
$5,387,799 
$5,442,557 
Transfers 
Other Special Revenue Funds 
$0 
($1,520,444) 
($1,509,702) 
Dirigo Health Fund 
$0 
$1,520,444 
$1,509,702 
Fiscal Detail and Notes 
Projections 
2010-11 
$1,488,169 
$0 
($2,595,710) 
($1,509,702) 
$7,013,813 
$1,488,169 
$81,630 
$5,504,111 
($1,509,702) 
$1,509,702 
This amendment retains the repeal of the Saving Offset Payment but replaces the 1 % increase in the hospital 
assessment and the 1 % health insurance carriers assessment with the cigarette and other tobacco products tax increase. 
The amendment would no longer require a transfer from Dirigo to the MaineCare program and the increased 
MaineCare allocations because the elimination of the increase in the hospital assessment would not produce the 
increase in MaineCare cost. 
LR2620(l I) - Fiscal Note - Page 1 of2 
The amendment does not include the checkoff provision and therefore does not require an Other Special Revenue 
Funds allocation of $16, 154 in fiscal year 2008-09 for Maine Revenue Services' administrative costs associated with 
the Dirigo Health Enterprise 
The remaining fiscal impact of the bill as amended is as follows: 
Projections 
Projections 
Dirigo Health Fund Summary 
2007-08 
2008-09 
2009-10 
2010-11 
Revenue Changes: 
Elimination of the Savings Offset Payment 
$0 
($13,720,000) 
($34,300,000) 
($34,300,000) 
Tobacco Tax Increase 
$35,649,622 
$48,014,799 
$48,069,557 
$48,131, III 
Subtotal Revenue Changes 
$35,649,622 
$34,294,799 
$13,769,557 
$13,831,111 
Transfers: 
$0 
$0 
$0 
$0 
Net Change in Dirigo Allocation 
$35,649,622 
$34,294,799 
$13,769,557 
$13,831,111 
LR2620( 11) - Fiscal Note - Page 2 of 2