An Act To
Maine Legislature, Session 124, LD 1264
Committee Amendment CA_B_H491 (House)

COMMITTEE AMENDMENT "fy" to H.P. 883, L.D. 1264, Bill, 
Stabilize Funding and Enable DirigoChoice To Reach More Uninsured" 
"An Act To 
Amend the bill in section 4 in §69I7 by striking out all of subsection I (page 1, lines 
to 37 in L.D.) and inserting the following: 
'I. 
Access payments required from health insurance carriers, 3rd-party 
administrators and employee benefit excess insurance carriers. All health insurance 
carriers, 3rd-party administrators and employee benefit excess insurance carriers shall 
pay an access payment as specified in paragraph A on all paid claims, except claims 
under accidental injury, specified disease, hospital indemnity, dental, vision, disability 
income, long-term care, Medicare supplement or other limited benefit health insurance. 
The following provisions govern access payments. 
A. The amount of the access payment is established as follows: 
(1) From September 1,2009 to August 31, 2010, the access payment is 2.14%; 
(2) From September 1, 2010 to August 31, 20 11, the access payment is 1.605%; 
(3) From September J, 2011 to August 31, 2012, the access payment is 1.07%; 
(4) From September 1,2012 to August 3 J, 2013, the access payment is 0.535%; 
and 
(5) 
Beginning September 1, 2013, a health insurance carrier, 3rd-party 
administrator and employee benefit excess insurance carrier is not required to pay 
an access payment. 
A health insurance carrier or employee benefit excess insurance carrier may not be 
required to pay an access payment on policies or contracts insuring federal 
employees. 
B. Access payments apply to claims paid beginning on or after September 1,2009. 
Page I - 124LR1932(03)-1 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT~" to H.P. 883, L.D. 1264 
C. Access payments must be made monthly to Dirigo Health, are due 30 days after 
the end of each month and must accrue interest-at 12% per annum on or after the due 
date, except that access payments for 3rd-party administrators;.for.., .. groups of 500 or . 
fewer members may be made annually not less than 60 days after the close of the 
plan year. 
D. Access payments received by Dirigo Health must be pooled with other revenues 
of the agency in the Dirigo Health Enterprise Fund established in section 6915.' 
Amend the bill by striking out all of section 6 and inserting the following: 
'Sec. 6. Changes to Dirigo Health. The Board of Trustees of Dirigo Health, or 
"the board," shall: 
II 
1. 
Develop products, procedures. 
Develop· more affordable products and 
procedures that can reach uninsured and underinsured residents of the State to reduce 
uncompensated care; 
2. Maximize federal initiatives. Seek to secure federal funding to support the 
IS 
Dirigo Health Program and the Maine Individual Reinsurance Association established in 
the Maine Revised Statutes, Title 24-A, chapter 54 and use subsidies to maximize federal 
initiatives, including Medicaid and any national health reform; 
3. Asset tests . .Establish an asset test for determining eligibility; 
4. Voucher program. Consider offering a voucher-based program to provide health 
insurance benefits; and 
5. Redesign. Redesign the DirigoChoice product or products, including adding a 
requirement that requires any new enrollees to be uninsured before enrolling in 
DirigoChoice. 
i4 
The board shall report to the Joint Standing Committee on Insurance and Financial 
Services regarding changes that will be made to the Dirigo Health Program consistent 
with this section by January 1,2010.' 
. Amend the bill by inserting after section 7 the following: 
'Sec. 8. Legislative commitment to funding. Notwithstanding the reduction in 
the amount of the access payment pursuant to the Maine Revised Statutes, Title 24-A, 
section 6917, subsection I, paragraph A beginning September 1,2010, it is the intent of 
the Legislature that funding for Dirigo Health be provided through the General Fund as 
necessary to, at a minimum, maintain enrollment in Dirigo Health at the same level as 
enrollment on the effective date of this Act. 
Sec. 9. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
DOOGO HEALTH 
Dirigo Health Fund 0988 
Initiative: Adjusts funding to reflect the impact of replacing the savings offset payment 
with a new access payment to be paid by health insurance carriers, 3rd-party 
COMMI 
EE AMENDMENT· 
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COMMIITEE AMENDMENT ~"to H.P. 883, L.D. 1264 
administrators and employee benefit excess insurance carriers of 2.14% on paid claims 
beginning September 1, 2009 and decreasingby25% each year thereafter. 
,. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
DIRIGO HEALTH FUND 
All Other 
DIRlGO HEALTH FUND TOTAL 
2009-10 
$0 
$0 
2009-10 
$0 
$0 
Sec. 10. Effective date. This Act takes effect October 1,2009.' 
SUMMARY 
2010-11 
$8,370,833 
$8,370,833 
2010-11 
($8,370,833 ) 
($8,370,833) 
This amendment is the minority report of the. committee. After the first year the 
access payment is implemented, it is reduced by 25% the 2nd year, 50% the 3rd year, 
75% the 4th year and then eliminated. In addition to the duties included in the bill, the 
amendment directs the Board of Trustees of Dirigo Health to establish an asset test for 
eligibility, to require any new enrollees after the redesign of the DirigoChoice productto 
be uninsured before enrolling and to seek adequate federal funding to support the Dirigo 
Health Program and the Maine Individual Reinsurance Association. 
The amendment expresses the Legislature's intent that the funding provided to Dirigo 
Health pursuant to the Maine Revised Statutes, Title 24-A, section 6917 be supplemented 
by the General Fund to maintain enrollment at the same level as on the effective date of 
the bill. The amendment also establishes an effective date of October 1, 2009. The 
amendm~nt also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/31109 frac.. 
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-124th.MAINE LEGISLATURE 
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LD 1264 
LR 1932(03) 
An Act To Stabilize Funding and Enable DirigoChoice To Reach More Uninsured 
Fiscal Note for Bill as Amended by Committee Amendment:!3" 
Committee: Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Dirigo Health Fund 
Revenue 
Dirigo Health Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
2009-10 
$0 
$0 
$0 
$2,033,333 
2010-11 
$8,370,833 
$8,370,833 
($8,370,833) 
($8,370,833) 
Projections 
2011-12 
$19,295,833 
$19,295,833 
($19,295,833) 
($19,295,833) 
Projections 
2012-13 
$29,820,833 
$29,820,833 
($29,820,833) 
($29,820,833) 
Provides an appropriation of $8,370,833 in 2010-11 to the Dirigo Health Agency t6 offset the difference between 
budgeted Dirigo Savings Offset Payment (SOP) revenue and estimated access payment revenue. The replacement of 
the current Dirigo SOP. with a 2.14% access payment on claims paid by health insurance carriers, 3rd party 
administrators and employee benefit excess insurance carriers beginning September 1,2009, deceasing by 25% each 
year thereafter, is projected to result in a net increase of Dirigo Health Fund revenue of $2,033,333 in 2009-10 but 
decrease net revenue thereafter. This decrease will be made up by General Fund appropriations to the Dirigo Health 
program. 
This estimate is based on a comparison of 20 1 0-20 11 budgeted SOP revenue calculated on an accrual basis with 
estimated access payments calculated on a one month accrual basis (i.e., for 2009-10, 10 months of payments are 
assumed to be collected). It is assumed that other changes to the Dirigo program detailed in the bill will be 
implemented within existing budgeted resources. 
Projections 
Projections 
2009-10 
2010-11 
2011-12 
2012-13 
Dirigo Revenue Impact SU!Dmary 
Budgeted SOP Revenue 
$38,600,000 
$41,700,000 
$42,100,000 
$42,100,000 
SOP Collections Prior to Repeal 
$5,550,000 
$0 
$0 
$0 
Impact of SOP repeal 
-$33,050,000 
-$41,700,000 
-$42,100,000 
-$42,100,00r 
Access Payments 
$35,083,333 
$33,329,167 
$22,804,167 
$12,279,167 
Net Change In Dirigo Revenue 
$2,033,333 
-$8,370,833 
-$19,295,833 
-$29,820,833 
LR1932(03) - Fiscal Note ~ Page 1 of 1 
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