An Act To Modify Rating Practices for Individual and Small Group Health Plans and To Encourage Value-based Purchasing of Health Care Services
Maine Legislature, Session 125, LD 1333
Committee Amendment CA_A-SA_H_S96 (Senate)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2

FmST REGULAR SESSION 
SENATE AMENDMENT "H "to COMMITTEE AMENDMENT "A''-to H.P. 979, 
L.D. 1333, Bill, "An Act To Modify Rating Practices for Individual and Small Group 
Health Plans and To Encourage Value-based Purchasing of Health Care Services" 
Amend the amendment in Part A in section I by striking out all of paragraph C (page 
I, lines 17 to 2 I in amendment) and inserting the following: 
'C. 
A carrier may vary the premium rate due to smoking status and family 
membership. 
The superintendent may adopt rules setting forth appropriate 
metflodologies regarding rate Eliseounts based on smoking status. 
Rules adopted 
pursuant to this paragraph are routine teehnical rules as defined in Title 5, ohapter 
375, subehapter II l' • .' 
Amend the amendment in Part A by inserting after section I the following: 
'Sec. A-2. 24-A MRSA §2736-C, sub-§2, ~C-l is enacted to read: 
C-l. A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph. For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after July 1, 2012, the rating factor used by a carrier for geographic area may not 
exceed 1.5.' 
. 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (6) in 
the 4th line (page 2, line 37 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (7) in 
the 4th line (page 2, line 42 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 4 in paragraph I in the 6th line (page 3, 
line 13 in amendment) by inserting after the following: "paragraph" the following: 'and 
paragraphs C and C-l ' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (4) in 
the 4th line (page 3, line 32 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
SENATE AMENDMENT 
SENATE AMENDMENT "H "to COMMITTEE AMENDMENT"A"to H.P. 979, L.D. 1333 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (5) in 
the 4th line (page 3, line 37 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 5 by striking out all of paragraph C (page 
4, lines 16 to 22 in amendment) and inserting the following: 
'C. A carrier may vary the premium rate due to occupation and industry, family 
membership, smoking status, participation in wellness programs and group size. The 
superintendent may adopt rules setting forth appropriate methodologies regarding rate 
discounts for participation in wellness programs and rating for occupation and 
industry and group size pursuant to this paragraph. Rules adopted pursuant to this 
paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 
H-A2-A.' 
Amend the amendment in Part A by inserting after section 5 the following: 
'Sec. A-6. 24-A MRSA §2S0S-B, sub-§2, ~C-l is enacted to read: 
C-l. A carrier may vary the premIum rate due to geographic area in accordance with 
the limitation set out in this paragraph. For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after October 1, 201 I, the rating factor used by a carrier for geographic area may not 
exceed 1.5.' 
Amend the amendment in Part A in section 6 in paragraph 0 in subparagraph (7) in 
the 4th line (page 5, line 16 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (8) in 
the 4th line (page 5, line 21 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 8 in paragraph H in the 6th line (page 5, 
line 35 in amendment) by inserting after the following: "paragraph" the following: 'and 
paragraphs C and C-I ' 
. 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (4) in 
the 4th line (page 6, line 12 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (5) in 
the 4th line (page 6, line 17 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part B in section 6 in subsection 3 by striking out all of 
paragraph F (page 8, lines 15 to 17 in amendment) 
Amend the amendment in Part C in section 4 in §405-B in subsection 1 in the first 
line (page 19, line 1 in amendment) by striking out the following: "subsidiary" and 
inserting the following: 'comorate affiliate' 
SENATE AMENDMENT 
SENATE AMENDMENT "Ii ,; to COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
I 
Amend the amendment in Part C in section 4 in §405-B in subsection 3 in the 4th line 
(page 19, line 13 in amendment) by striking out the following: "subsidiary" and inserting 
the following: 'corporate affiliate' 
Amend the amendment in Part D by striking out all of section 5. 
Amend the amendment in Part F in section 7- by striking out all of subsection I (page 
24, lines 31 to 35 in amendment) and inserting the following: 
'I. Demonstration of adequate access to providers. A carrier offering or renewing 
a managed care plan shall provide to its members reasonable access to health care 
services. A carrier may provide incentives to members to use designated providers based 
on cost or quality, but may not require members to use designated providers of health 
II 
care services.' 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
SUMMARY 
This amendment makes changes to Committee Amendment "A" as follows. 
I. The amendment restricts rating in the individual and small group market on the 
basis of geographic area using language previously enacted to a rating factor of 1.5 
instead of allowing rating on the basis of geographic area outside of the age rating band. 
2. The amendment clarifies that the expansion of the rating bands in the individual 
and small group market to 4 to 1 and 5 to I is allowed to the extent permitted by the 
federal Patient Protection and Affordable Care Act. 
3. The amendment clarifies that carriers offering managed care plans may provide 
incentives to members to use designated providers based on cost or quality, but may not 
require members to use desi 
iders of hea 
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COUNTY: Cumberland 
SENA TE AMENDMENT