An Act To Ensure That DirigoChoice Is Affordable
Maine Legislature, Session 123, LD 1716
Committee: Insurance and Financial Services
Sponsors: TREAT, BRANNIGAN, BERRY, BRAUTIGAM, CONOVER, EBERLE, FAIRCLOTH, MIRAMANT, PINGREE, DAMON
Amends: 24-A MRSA §6910, 24-A MRSA §691

Legislative Document 
No. 1716 
H.P.1199 
House of Representatives, March 23, 2007 
An Act To Ensure That DirigoChoice Is Affordable 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative TREAT of Farmingdale. 
Cosponsored by Senator BRANNIGAN of Cumberland and 
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/J7.7l/d£~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BERRY of Bowdoinham, BRAUTIGAM of Falmouth, CONOVER of 
Oakland, EBERLE of South Portland, FAIRCLOTH of Bangor, MIRAMANT of Camden, 
PINGREE of North Haven, Senator: DAMON of Hancock. 
Printed on recydeJ purer 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §6910, sub-§3, ~A, as enacted by PL 2003, c. 469, Pt. A, 
§8, is amended to read: 
A. Provide the comprehensive health services and benefits as determined by the 
board in accordance with subsection 3-A, including a standard benefit package that 
meets the requirements for mandated coverage for spesific health services, 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; and 
Sec. 2. 24-A MRSA §691O, sub-§3-A is enacted to read: 
3-A. Comprehensive and affordable benefits; standards. The health services and 
benefits provided through Dirigo Health Program coverage must be determined by the 
board to meet standards for a comprehensive and affordable benefit package in 
accordance with the following. 
A. Comprehensive benefits must, at a minimum, include coverage for preventive 
care services, medically necessary services and covered services required by Bureau 
of Insurance Rule Chapter 750 except to the extent that services covered under the 
Dirigo Health Program on the effective date of this subsection exceed services 
required by Rule Chapter 750. To the extent that covered services contained in Rule 
Chapter 750 deviate from or are lesser than the clinical practice guidelines 
established by the federal Agency for Healthcare Research and Quality, a nationally 
recognized professional medical or health association or the National Quality Forum, 
or a successor organization, the services required under the clinical practice 
guidelines adopted by the federal Agency for Healthcare Research and Quality, a 
nationally recognized professional medical or health association or the National 
Quality Forum, or a successor organization, apply. 
For the purposes of this paragraph, "medically necessary services" means a service 
that is reasonably expected to prevent, diagnose, prevent the worsening of, alleviate, 
correct or cure conditions that endanger life, cause suffering or pain, cause physical 
deformity or malfunction, threaten to cause or to aggravate a handicap or result in 
illness or infirmity. "Medically necessary services" includes inpatient and outpatient 
services as mandated under Title XIX of the federal Social Security Act. 
B. 
Comprehensive benefits may not include any lifetime maximum limits, 
coinsurance rates that exceed 20% or any dollar caps on certain services. 
C. Comprehensive benefits may not include deductibles within any income bracket 
that exceeds 10% of income within that bracket and the total out-of-pocket maximum 
amount on any enrollee may not exceed the maximum contribution required for that 
enrollee. 
D. The total out-of-pocket expenses required to be paid by individual enrollees may 
not exceed the following maximum amounts based on an enrollee's income: 
(1) 
An enrollee with a household income at or below 250% of the federal 
poverty level may not be required to contribute any out-of-pocket amount; 
(2) An enrollee with a household income between 251 % and 300% of the federal 
poverty level may not be required to contribute more than 0.5% of taxable 
mcome; 
(3) An enrollee with a household income between 301 % and 350% of the federal 
poverty level may not be required to contribute more than 1 % of taxable income; 
(4) An enrollee with a household income between 351 % and 400% of the federal 
poverty level may not be required to contribute more than 2% of taxable income; 
(5) An enrollee with a household income between 401 % and 500% of the federal 
poverty level may not be required to contribute more than 3% of taxable income; 
(6) An enrollee with a household income between 501% and 600% of the federal 
poverty level may not be required to contribute more than 4% of taxable income; 
(7) An enrollee with a household income between 601% and 700% of the federal 
poverty level may not be required to contribute more than 5% of taxable income; 
(8) An enrollee with a household income between 701% and 800% of the federal 
poverty level may not be required to contribute more than 6% of taxable income; 
and 
(9) An enrollee with a household income above 800% of the federal poverty 
level may not be required to contribute more than 10% of taxable income. 
SUMMARY 
This bill requires that Dirigo Health Program coverage meet certain standards for a 
comprehensive and affordable health benefit package. The bill also limits the amount of 
contributions required by enrollees in the Dirigo Health Program based on an enrollee's 
mcome.