An Act To Implement the Insurance Payment Reform Recommendations of the Advisory Council on Health Systems Development
Maine Legislature, Session 125, LD 0540
Committee Amendment CA_A_H428 (House)
Amends: 24-A MRSA §4320

COMMITTEE AMENDMENT "/1,, to H.P. 423, L.D. 540, Bill, "An Act To 
Implement the Insurance Payment Reform Recommendations of the Advisory Council on 
Health Systems Development" 
Amend the bill by striking out all of sections I to 4 . 
Amend the bill by striking out all of section 6 (page 2, lines 3 to 36 in L.D.) and 
inserting the following: 
'Sec. 6. 24-A MRSA §4320 is enacted to read: 
§4320. Payment reform pilot projects 
1. Pilot projects. Beginning March 1, 2012, the superintendent may authorize pilot 
projects in accordance with this subsection that allow a health insurance carrier that offers 
health plans in this State to implement payment reform strategies with providers through 
an accountable care organization to reduce costs and improve the quality of patient care. 
For purposes of this section, "accountable care organization" means a grOUP of health 
care providers operating under a payment agreement to provide health care services to a 
defined set of individuals with established benchmarks for the quality and cost of those 
health care services consistent with federal law and regulation. 
A. 
The superintendent may approve a pilot project between a carrier and an 
accountable care organization that utilizes payment methodologies and purchasing 
strategies, including, but not limited to: alternatives to fee-for-service models, such as 
blended capitation rates, episodes-of-care payments, medical home models and global 
budgets; pay-for-performance programs; tiering of providers; and evidence-based 
purchasing strategies. 
B. Prior to approving a pilot project, the superintendent shall consider whether the 
proposed pilot project is consistent with the principles for payment reform developed 
by the Advisory Council on Health Systems Development established under former 
Title 2, section 104. 
COMMITTEE AMENDMENT 
c. 
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COMMITIEE AMENDMENT"~:' to H.P. 423, L.D. 540 
2. Rulemaking. The superintendent shall establish by rule procedures and policies 
that facilitate the implementation of a pilot project pursuant to this section, including, but 
not limited to, a process for a health insurance carrier's submitting a pilot project proposal 
and minimum requirements for approval of a pilot project. Rules adopted pursuant to this 
subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A 
and must be adopted no later than December 1, 2011. 
3. Report. Beginning in 20l3, the superintendent shall report by March 1st annually 
to the joint standing committee of the Legislature having jurisdiction over insurance and 
financial services matters on the status of any pilot project approved by the 
superintendent pursuant to this section. The report must include an analysis of the cost 
and benefits of any approved pilot project. in reducing health care costs, including any 
impact on premiums, and in improving the quality of care. 
4. Evaluation. During the First Regular Session of the 129th Legislature, the joint 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters shall conduct an evaluation of the effectiveness of any pilot project 
approved by the superintendent pursuant to this section and make a determination 
whether to continue, amend or repeal the authorization for the pilot project. The joint 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters may report out a bill based on the evaluation to the First Regular Session 
of the 129th Legislature. 
S. Construction. This section may not be construed to restrict or limit the right of a 
carrier to engage in activities expressly permitted by this Title or to require a carrier to 
obtain prior approval as a pilot project to engage in those activities.' 
Amend the bill by inserting after section 7 the following: 
'Sec. 8. Superintendent of Insurance to submit rules. The Superintendent of 
Insurance shall submit copies of the rules adopted pursuant to the Maine Revised 
Statutes, Title 24-A, section 4320, subsection 2 to the Joint Standing Committee on 
Insurance and Financial Services no later than December 1, 2011.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment does the following. 
1. It requires the rule-making process to be completed by December 1, 2011 and that 
copies of the adopted rule be submitted to the Joint Standing Committee on Insurance and 
Financial Services. 
2. It delays the authority to approve any pilot project from January 1, 2012 to March 
1,2012. 
3. It narrows the scope of permissible pilot projects to projects between a health 
insurance carrier and an accountable care organization formed by providers. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "R" to H.P. 423, L.D. 540 
4. It requires that the Department of Professional and Financial Regulation, Bureau 
of Insurance conduct an analysis of the costs and benefits of any approved pilot project 
and report those findings to the Legislature. 
5. It clarifies that the pilot project provision may not be construed to require carriers 
to obtain prior approval from the Bureau of Insurance to engage in activities already 
expressly permitted. 
6. It removes provisions in the bill related to the Advisory Council on Health Systems 
Development, which was repealed by Public Law 2011, chapter 90. 
FISCAL NOTE REQURED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 05124111 
frac:.. 
LD540 
LR 704(02) 
An Act To Implement the Insurance Payment Reform Recommendations of the Advisory Council on 
Health Systems Development 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment I~" 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Additional costs to the Bureau ofInsurance in the Department of Professional and Financial Regulation and to the 
Department of Health and Human Services are expected to be minor and can be absorbed utilizing existing budgeted 
resources. 
LR0704(02) - Fiscal Note - Page 1 of 1