An Act To Implement Managed Care in the MaineCare Program
Maine Legislature, Session 126, LD 1487
Committee Amendment CA_B_S419 (Senate)
Amends: 22 MRSA §3174-W, 22 MRSA §3174-G

COMMITTEE AMENDMENT" B " to S.P. 552, L.D. 1487, Bill, "An Act To 
Implement Managed Care in the MaineCare Program" 
Amend the bill by striking out the title and SUbstituting the following: 
'An Act To Provide Fiscal Predictability to the MaineCare Program and Health 
Security to Maine People' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 22 MRSA §3174-WW is enacted to read: 
§3174-WW. Patient-centered MaineCare reform 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
"Managed care plan" means an entity that contracts with the department to 
provide managed care in the MaineCare program, through a health insurer or health 
maintenance organization authorized under Title 24-A that bears full risk under a 
capitated payment. 
B. "Managed care program" means the program of integrated managed care for all 
covered MaineCare services implemented in accordance with this section. 
2. 
Managed care program. The department shall implement a managed care 
program for all covered MaineCare services. The department shall include in the requests 
for proposals and in the contract with each managed care plan the requirement that the 
provision of services to members of the MaineCare program must be managed on a 
phased-in schedule over 3 years as provided in this subsection. 
A. The following members must be enrolled in the first year of the implementation 
of managed care and in each year thereafter: 
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(1) Persons who are eligible for MaineCare under section 3174-G, subsection 1, 
paragraphs A, E, G, H and I; and 
(2) Nondisabled children who are eligible under section 3174-G, subsection 1, 
paragraph B or D. 
B. All of the eligibility groups under section 3174-G not included in paragraph A 
must be required to enroll in the managed care program after the first year of 
implementation and in subsequent years on a schedule as required by the department 
after the department has sought stakeholder input and approval from the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid 
Services and after the department adopts rules. 
C. 
A member who is not in an enrollment group required to be enrolled under 
paragraph A or B may voluntarily enroll in a managed care plan that provides 
services in the region of the State in which the member lives. 
D. A member may not be required to enroll in a managed care plan unless there are 
at least 3 unrelated issuers of statewide managed care plans that can each meet all the 
requirements in this section. 
3. 
Managed care plans. 
The following requirements apply to contracts with 
managed care plans. 
A. The department shall require services in the managed care program to be provided 
by managed care plans that are capable of coordinating and delivering all MaineCare 
covered services on a statewide basis to all enrollees. 
B. The department shall select managed care plans using requests for proposals. The 
procurement method must give the department broad flexibility and power to 
negotiate value and must provide potential bidders the broad flexibility to innovate. 
C. The department shall use a procurement method that results in a minimum of 3 
and a maximum of 4 plans that the department authorizes to enroll MaineCare 
members upon negotiation of rates consistent with this section and applicable 
requirements of the federal Department of Health and Human Services, Centers for 
Medicare and Medicaid Services. 
D. 
At least one of the managed care plans must be operated by a nonprofit 
organization that may be controlled by a health care provider or providers or an 
affiliate of a provider or providers, unless no organization meeting this description 
meets the minimum criteria for selection established in the request for proposals. 
E. The department shall consider quality factors in the selection of managed care 
plans, including, but not limited to: 
(1) Accreditation by a nationally recognized accrediting body; 
(2) Documented policies and procedures for preventing fraud and abuse; 
(3) Expelience in serving enrollees and achieving quality standards; 
(4) Availability and accessibility of primary and specialty care physicians in the 
relevant network; 
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(5) Provision of nonmandatory benefits, particularly dental care and disease 
management, and other initiatives that improve health outcomes; and 
(6) An office or a commitment to establishing an office for the managed care 
plan in the State. 
F. After negotiations are conducted, the department shall select managed care plans 
that the department detennines to be responsive, to have signed contracts with 
providers of covered services in sufficient numbers to meet access standards 
established in this section and by rule and to provide the best value to the department. 
G. 
All contracts with managed care plans entered into under this section are 
contingent upon the appropriation and allocation by the Legislature for the managed 
care program of sufficient funding to pay for the managed care program. 
H. 
All contracts with managed care plans entered into under this section are 
contingent upon the plan having signed provider contracts as required in paragraph F. 
4. 
Plan accountability. 
The following provisions on managed care plan 
accountability apply to all managed care plan contracts entered into under this section and 
provide standards for plan accountability. 
A. The tenn of a contract with a managed care plan under this section is 5 years or 
less, with an option for the department to renew for a period or periods of 2 years. At 
the end of a contract period the department may authorize a short-tenn extension of 
the contract if needed to provide for a transition to a new managed care plan with 
minimal disruption of services and care provided to MaineCare members. 
B. The department shall establish contract requirements that are necessary for the 
operation of the managed care program and consistent with the requirements of this 
section. In addition to any other provisions the department may detennine to be 
necessary, the contract must contain the following contractual obligations. 
(1) The managed care plan shall participate in and coordinate with departmental 
efforts in health care payment refonn including value-based purchasing; quality 
improvement; delivery system improvement; improvement in patients' experience 
of care; participation in other departmental initiatives, including the state 
innovation model grant initiative under the federal Patient Protection and 
Affordable Care Act; and participation in the patient-centered medical home 
initiative, including the financial support of qualifying primary care medical 
homes. The department may require the managed care plan to participate in 
initiatives regarding compensation for physicians for coordination of care, 
management of chronic disease and avoidance of the need for more costly 
serVIces. 
(2) Each managed care plan shall meet the large group minimum medical loss 
ratio of at least 85% as defined in 42 United States Code, Section 300gg-18. The 
department, with advice from any stakeholder or advisory group fOlmed to advise 
the department on managed care and after finally adopting major substantive 
rules may adjust the components of the medical loss ratio if necessary to account 
for factors unique to MaineCare and not applicable to the large group minimum 
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medical loss ratio as dermed in 42 United States Code, Section 300gg-18, except 
that the medical loss ratio may not be reduced to less than 85%. 
(3) The managed care plan shall meet established access standards that are 
specific, population-based standards for the number, type and regional 
distribution of providers in managed care plan networks. The access standards 
must ensure access to care for both adult members and child members that is 
equal to or greater than available access to care that nonmembers have in the 
same geographic area. 
The access standards must ensure that payments to 
providers of MaineCare services and benefits reflect mutually acceptable rates, 
methods and terms of payment, are consistent with efficiency, economy and 
quality of care and are sufficient to enlist an adequate number of providers 
throughout the State. The access standards must require the managed care plan to 
pay for out-of-network care at a generally applicable rate when the plan is not 
able to deliver medically necessary services covered under the contract due to 
lack of network availability or lack of timely access to necessary care as defined 
through rulemaking. 
(4) The managed care plan shall maintain an accurate and complete electronic 
database, available on the publicly accessible website of the managed care plan 
or other accessible site that is updated peliodically, and that contains but is not 
limited to the following infonnation: 
(a) . A list of contracted providers, including necessary information to assist 
enrollees and participants in plan selection and ongoing access to providers, 
as determined by the department through rulemaking; and 
(b) A preferred drug list that is searchable by members and providers, that is 
updated within 24 hours after any change is made and that includes prior 
authorization infonnation and a prior authorization process for prescribed 
drugs that is readily accessible to providers, displays appropriate contact 
information and provides timely responses to providers that meet or exceed 
the standards prescribed by 42 United States Code, Section 1396r-8(d)(1)(A). 
(5) The managed care plan shall maintain and submit encounter and claims data 
for all services provided to MaineCare members in a manner and format and in 
accordance with a time schedule specified by the department. Claims data for 
each encounter submitted under this subparagraph must include the amount paid 
by the managed care plan to all providers of services attributable to the 
encounter. 
(6) 
The managed care plan shall meet specific performance standards and 
benchmarks or timelines for improving performance over the term of the 
contract. 
(a) 
A managed care plan shall establish an internal health care quality 
improvement system, including member satisfaction surveys as measured by 
a nationally recognized assessment tool and disenrollment surveys. 
(b) A managed care plan must be accredited by a nationally recognized 
accrediting body, or have initiated the accreditation process, within one year 
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after the contract with the department lS executed and must meet the 
requirements for external quality review. 
(7) 
The managed care plan shall establish program integrity functions and 
activities to reduce the incidence of fraud and abuse, including, at a minimum, a 
provider credentialing system and ongoing provider monitoring, procedures for 
reporting instances of fraud and abuse and designation of a program integrity 
compliance officer. 
(8) The managed care plan shall establish an internal process for reviewing and 
responding to grievances from enrollees and providers and submit quarterly 
reports including the number, description and outcome of grievances filed by 
enrollees. The grievance procedure must provide for oral or written appeal of 
actions taken by the managed care plan. The grievance procedure must permit 
members or their authorized representatives access to the department's 
administrative fair hearing process prior to exhausting the internal grievance 
appeal process of the managed care plan. The grievance procedure must provide 
for publication and access for the public to all final decisions of the department 
and the managed care plan except that all information that could directly or 
indirectly identify the member must be redacted prior to the publication or the 
provision of public access to the information. 
(9) A managed care plan shall comply with requirements established by the 
department for enrollment reduction and withdrawal and for reporting encounter 
data. The requirements must provide for penalties or termination of a contract as 
a consequence of failure to meet the requirements. 
(l0) A managed care plan and the plan's fiscal agent or intennediary shall 
comply with the prompt payment requirements applicable to health carriers and 
health plans pursuant to Title 24-A. 
(11) A managed care plan shall apply nationally endorsed quality standards that 
are coordinated and consistent with department quality initiatives and shall at 
least include population improvement goals, improved health outcomes and 
improvement in early periodic screening, diagnosis and treatment periodicity 
compliance. The managed care plan shall regularly track, monitor and publicly 
report on health plan performance in a format approved by the department 
pursuant to rulemaking. 
(12) 
During a transition period to be detenruned by the department with 
stakeholder input, a managed care plan shall contract with any existing and 
qualified provider willing to accept the terms, conditions and rates associated 
with the managed care plan. After the transition peliod, the standards must allow 
managed care plans to limit providers in their networks based on credentials, 
quality indicators and price, but any limitation penrutted by this subparagraph 
may not be construed to modify or excuse noncompliance with the access 
standards established pursuant to paragraph B, subparagraph (3), including 
without limitation access to family planning and family planning related services. 
In addition, after the transition period, the managed care plan shall contract with 
any willing and qualified provider who is a federally qualified health center, a 
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COMMITTEE AMENDMENT" B "to S.P. 552, L.D. 1487 
rural health clinic or a school-based health clinic or a provider who serves high-
risk populations or specialize in conditions that require costly treatment. 
(13) A managed care plan shall provide for continuation of health care benefits 
and services at prior authorized levels when a member files a grievance or appeal 
of a denial of a renewed prior authorization request. The managed care plan shall 
provide that the member may not be charged for services provided during the 
grievance or appeal process. 
(14) A managed care plan shall provide that the commissioner and the medical 
director of the MaineCare program have the authority to override any denial of 
care by the managed care plan on the basis of medical necessity. 
(15) A managed care plan shall provide that MaineCare members enrolled in the 
plan and providers are 3rd-partv beneficiaries under any contract between the 
managed care plan and the department. 
(16) A managed care plan must be subject to financial consequences, backed by 
a perfonnance bond or similar guarantee, for failure to meet quality standards, 
access standards, patient satisfaction standards or other requirements of law or 
rule or of the contract between the department and the managed care plan. 
(17) A managed care plan is subject to the jurisdiction and oversight of the 
Department of Professional and Financial Regulation, Bureau of Insurance and 
shall comply with provisions of Title 24-A, including chapter 56-A. 
(18) A managed care plan when providing to members and prospective members 
written cOlmnunications, including but not limited to notices, decisions and 
explanations of benefits, shall provide those communications in a manner that is 
readable at or near a 6th-grade reading level and offer translated versions of 
materials, as required by the department. 
(19) A managed care plan may allow for cost sharing in accordance with the 
provisions of 42 United States Code, Section 13960. 
(20) A managed care plan shall provide a reasonable contribution to pay for the 
funding of the ombudsman program under subsection 7. 
5. Payments to managed care plans. The following provisions apply to payments 
to managed care plans by the department. 
A. The department shall pay managed care plans on the basis of per member, per 
month payments negotiated pursuant to this subsection. Payments must be at risk-
adjusted rates based on historical utilization and spending data, projected and 
adjusted to reflect the eligibility categOlY, geographic area and clinical risk profile of 
the members with the provision for subsequent adjustment based on actual 
enrollments and encounter data when available. In negotiating rates with the plans, 
the department shall consider any adjustments necessary to encourage plans to use 
the most cost-effective means of improving outcomes and providing specialized 
management of particular subgroups of populations with complex or high-cost needs. 
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COMMITTEE AMENDMENT ""8 "to S.P. 552, L.D. 1487 
B. For that portion of the MaineCare enrolled population covered by managed care 
plans in the 4th fiscal year of the provision of managed care coverage, the total 
amount expended by the department in that fiscal year to cover services to that 
portion of the population may not exceed 95% of the amount that would have been 
expended to cover the same number of enrollees for the same services in the same 
fiscal period in the absence of a managed care plan. 
This limitation must be 
calculated on the basis of historical experience, adjusted for actual increases in health 
care costs and reasonable projections of the trend in those costs. The method of 
calculation of the limitation must be established in rules adopted by the department. 
6. Enrollment; choice counseling; eligibility. Except as otherwise provided by 
law, the following provisions apply to enrollment of MaineCare members in and choice 
counseling and eligibility for managed care plans. 
A. A MaineCare member must be provided a choice of plans and may select any 
available plan unless that plan is restricted by contract with the department to a 
specific population that does not include the member. A MaineCare member must be 
provided at least 30 days in which to make a choice of plans. The department and 
managed care plans must provide notices about enrollment rules that cunent and 
potential enrollees can easily understand. 
B. The department shall implement a choice counseling system to ensure that a 
MaineCare member has timely access to accurate information on the available 
managed care plans. Counselors providing enrollment support must reflect the ethnic, 
linguistic and cultural demographics of the population served. 
The counseling 
system must include plan-to-plan comparative information on benefits, provider 
networks, prefened drug lists, quality measures and other data points as determined 
by the department. Choice counseling must be made available through face-to-face 
interaction, through the publicly accessible website of the department, by telephone 
and in writing and through other forms of relevant media. Materials must be provided 
in a culturally appropriate manner, readable at or below a 6th-grade reading level and 
consistent with federal requirements. The department shall implement a competitive 
bidding process for procurement of choice counseling functions. The choice 
counseling system may not be administered by a managed care plan. 
e. After a MaineCare member has enrolled in a managed care plan, the member 
must have 90 days to voluntarily disenroll and select another plan. After 90 days, no 
further changes may be made except for good cause or during the annual open 
enrollment period. Good cause for dis enrollment must include at a minimum: 
(1) The plan does not cover a service the member seeks based on religious or 
moral beliefs; 
(2) 
The member needs related services that are not available in the plan's 
network and the member's provider determines that receipt of the services 
separately would subject the member to unnecessary risk; and 
(3) Other reasons, including but not limited to poor quality of care or lack of 
access to covered services and experienced providers. 
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COMMITTEE AMENDMENT "B "to S.P. 552, L.D. 1487 
D. 
The department shall automatically enroll in a managed care plan those 
MaineCare members who do not choose a plan. Except as otherwise described in this 
section, the department may not engage in practices that are designed to favor one 
managed care plan over another. 
E. 
A member eligible for coverage pursuant to section 3174-0, subsection 1, 
paragraphs H and I must be required to participate in the Private Health Insurance 
Premium Program in accordance with section 18. The department shall identify all 
members who have access to group health plan coverage and shall inform the 
member that participation is mandatory for that member. 
7. Ombudsman program. The department shall ensure the establishment of an 
external and independent ombudsman who is not within the control of a managed care 
plan. The ombudsman shall identify and report to the department and the committee of 
jurisdiction within the Legislature on systemic issues and possible solutions to those 
issues and assist MaineCare members and providers with grievances and appeals either 
within the ombudsman program or under contract with an external entity. 
The 
department and any plan that provides services to MaineCare members must provide 
data, from which personally identifying infonnation has been removed, to the 
ombudsman as necessary for the ombudsman to carry out the functions of the position 
required by this subsection. The ombudsman program required by this subsection must 
operate and be funded completely independently from and must not interfere with the 
authority or operation of any ombudsman program established under state or federal law, 
including but not limited to sections 4087-A and 5107-A. 
8. MaineCare benefits under managed care plans. The following provisions 
govern benefits under managed care plans. 
A. A managed care plan shall provide coverage for all services and benefits required 
by the department for the applicable category of eligible members. 
B. As approved by the department, a managed care plan may customize benefit 
packages for nonpregnant adults and provide coverage for additional services. 
Customized benefit packages must provide all services and benefits that were 
provided to nonpregnant adults on April 1, 2014. The department shall evaluate the 
proposed benefit packages to ensure services are sufficient to meet the needs of the 
plan's enrollees and to verify actuarial equivalence. 
9. Rulemaking. The department shall adopt rules as necessary to implement this 
section. 
Rules adopted pursuant to this subsection are major substantive rules as 
described in Title 5, chapter 375, subchapter 2-A. 
Sec. A-2. 
Stakeholder group on capitated managed care in the 
MaineCare program. By August 1, 2014 the Commissioner of Health and Human 
Services shall convene a stakeholder group to design and plan for the implementation of a 
capitated managed care program for MaineCare members. The stakeholder group shall 
make recommendations to the department regarding the implementation of the Maine 
Revised Statutes, Title 22, section 3174-WW, including, but not limited to, the following 
issues: the development of the selection and phase-in process; consumer choice and 
access to providers and network adequacy; accountability and transparency; incentives to 
encourage and reward healthy behaviors; alignment with existing efforts related to 
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COMMITTEE AMENDMENT""B> "to S.P. 552, LD. 1487 
payment reform and care coordination; establishment of clear quality metrics and quality 
improvements; comprehensive and coordinated data analytics and access to data; usage 
and payment of emergency department services; and consumer protections. 
The 
membership of the stakeholder group must include, but is not limited to, representatives 
of the following: MaineCare members and advocates representing MaineCare members; 
consumer advocates; health insurance carriers; primary health care providers; acute care 
and critical access hospitals; behavioral health providers, including substance abuse 
providers; academics with a concentration in health care policy; pharmacies; pharmacy 
benefits managers; nursing facilities; the Department of Health and Human Services; the 
Department of Professional and Financial Regulation, Bureau of Insurance; and 
representatives of the state innovation model grant process. The stakeholder group shall 
work until the managed care program under Title 22, section 3174-WW is implemented 
and the phase-in of all mandatory populations is fully complete. The stakeholder group 
shall provide input to the department on the implementation of Title 22, section 
3l74-WW. 
Sec. A-3. Issuance of request for information. 
By October 1, 2014, the 
Department of Health and Human Services shaH issue a request for information based 
upon the provisions of the Maine Revised Statutes, Title 22, section 3 1 74-WW and the 
criteria developed through the stakeholder process established pursuant to section 2 of 
this Part. The purpose of the request for information process is to determine whether 
there is sufficient interest among managed care companies to provide full-risk capitated 
managed care to all or part of the MaineCare program in a manner that is consistent with 
and compatible with the goals and structure of the value-based purchasing initiatives 
being undertaken by the department, including but not limited to health homes, patient-
centered medical homes, accountable communities, peer support organizations and other 
issues that are identified in the responsibilities to the managed care stakeholder group. 
Sec. A-4. Report to the Legislature. By March 1, 2015, the Department of 
Health and Human Services shall report to the joint standing committee of the l27th 
Legislature having jurisdiction over health and human services matters on the status of 
implementation of the managed care program pursuant to the Maine Revised Statutes, 
Title 22, section 3174-WW, each of the areas addressed by the stakeholder group 
established pursuant to section 2 of this Part, the specific recommendations of the 
stakeholder group and the department's value-based purchasing initiative, including 
accountable care. The report must include actual and projected cost savings and the 
structure of the managed care program. Beginning April 1, 2015 the department shall 
provide a report every month to the joint standing cOlmnittee of the Legislature having 
jurisdiction over health and human services matters on the implementation of the 
managed care program. 
Sec. A-S. Rulemaking required. The following rulemaking requirements apply 
to the implementation of the managed care program in the MaineCare program by the 
Department of Health and Human Services pursuant to the Maine Revised Statutes, Title 
22, section 3174-WW. 
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By May 1, 2015, the depatiment shall propose major substantive rules to 
implement managed care based on the recommendations of the stakeholder group 
established pursuant to section 2 of this Part. 
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2. By September 1, 2015, the department shall provisionally adopt a managed care 
rule and provide copies of the rule to the Executive Director of the Legislative Council 
and the joint standing committee of the Legislature having jurisdiction over health and 
human services matters in accordance with the provisions of Title 5, section 8072, 
subsections 3 and 4. 
3. By January 15, 2016, the joint standing committee of the Legislature having 
jurisdiction over health and human services matters shall make its recommendation to the 
full Legislature on the managed care major substantive rule in accordance with Title 5, 
section 8072, subsection 5. 
4. The department shall issue a request for proposals to prospective bidders no later 
than 30 days following final legislative action on the provisional managed care rule. 
5. 
Within 6 months of awarding contracts for managed care in the MaineCare 
program the department shall start implementation of managed care. 
Sec. A-6. State plan amendment and waivers; contingent effective date. 
The Department of Health and Human Services shall apply to the federal Department of 
Health and Human Services, Centers for Medicare and Medicaid Services for approval of 
a state plan amendment under the United States Social Security Act, Section 1932(a) to 
implement the provisions of this Part and for all necessary waivers. The provisions of this 
Part take effect upon notification from the Department of Health and Human Services to 
the Revisor of Statutes that all necessary approvals under this section have been granted. 
Sec. A-7. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Office of MaineCare Services 0129 
Initiative: Provides funds for the initial implementation of the managed care program for 
MaineCare services including convening and supporting the stakeholder group, preparing 
and issuing a request for information and preparing a report to the Legislature on the 
status of implementation and for required rulemaking. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
$250,000 
$250,000 
2014-15 
$250,000 
$250,000 
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COMMITTEE AMENDMENT "B, "to S.P. 552, L.D. 1487 
HEAL TH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
DEPARTMENT TOTAL-ALL FUNDS 
PARTB 
2013-14 
$0 
$0 
$0 
2014-15 
$250,000 
$250,000 
$500,000 
Sec. B-1. 22 MRSA §3174-G, sub-§l, ~, as amended by PL 2011, c. 380, Pt. 
KK, §2, is further amended to read: 
F. A person 20 to 64 years of age who is not otherwise covered under paragraphs A 
to E when the person's family income is below or equal to 125% of the nonfann 
income official poverty line, provided that the commissioner shall adjust the 
maximum eligibility level in accordance with the requirements of the paragraph. 
(2) If the commissioner reasonably anticipates the cost of the program to exceed 
the budget of the population described in this paragraph, the commissioner shall 
lower the maximum eligibility level to the extent necessary to provide coverage 
to as many persons as possible within the program budget. 
(3) The commissioner shall give at least 30 days' notice of the proposed change 
in maximum eligibility level to the joint standing committee of the Legislature 
having jurisdiction over appropriations and financial affairs and the joint standing 
committee of the Legislature having jurisdiction over health and human services 
matters; aftd 
Sec. B-2. 22 MRSA §3174-G, sub-§l, ~G, as enacted by PL 2011, c. 380, Pt. 
KK, §3, is amended to read: 
G. A person who is a noncitizen legally admitted to the United States to the extent 
that coverage is allowable by federal law if the person is: 
(l) A woman dUling her pregnancy and up to 60 days following delivery; or 
(2) A child under 21 years of age~~ 
Sec. B-3. 22 MRSA §3174-G, sub-§l, ~~ and I are enacted to read: 
H. Beginning July 1, 2014, a person 21 to 64 years of age who is not otherwise 
eligible for medical assistance under this section, who qualifies for medical assistance 
pursuant to 42 United States Code, Section 1396a(a)(lO)(A)(i)(VIII) and whose 
income is equal to or below 133% of the nonfann income official poverty line plus 
5% for the applicable family size as required by federal law. A person eligible for 
medical assistance under this paragraph must receive the same coverage as is 
provided to a person eligible under paragraph E; and 
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COMMITTEE AMENDMENT "& "to S.P. 552, L.D. 1487 
1. Beginning October 1, 2019, a person 19 or 20 years of age who is not otherwise 
eligible for medical assistance under this section, who qualifies for medical assistance 
pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and whose 
income is equal to or below 133% of the nonfarm income official poverty line plus 
5% for the applicable family size as required by federal law. A person eligible for 
medical assistance under this paragraph must receive the same coverage as is 
provided to a person eligible under paragraph E. 
Sec. B-4. Contingent repeal. 
The Maine Revised Statutes, Title 22, section 
3174-G, subsection 1, paragraphs H and I are repealed upon the earlier of the following: 
1. The meeting of all of the following conditions: 
A. The enhanced Federal Medical Assistance Percentage with respect to amounts 
expended for medical assistance for newly eligible Medicaid individuals described in 
United States Code, Section 1396a(a)(l0)(A)(i)(VIII) is reduced below 100% for 
any calendar quarter in 2014,2015 or 2016; 
B. The reduction in the enhanced Federal Medical Assistance Percentage described in 
paragraph A has taken effect; and 
C. After the reduction of the enhanced Federal Medical Assistance Percentage as 
described in paragraphs A and B, the Legislature has convened and conducted a 
session of at least 30 calendar days; and 
2. December 31,2016. 
PARTe 
Sec. C-l. 
Research organization evaluation. 
The Office of Fiscal and 
Program Review shall contract with a nonpartisan research organization, referred to in 
this section as "the research organization," to study the impact of the MaineCare 
expansion authorized in the Maine Revised Statutes, Title 22, section 3174-G, subsection 
1, paragraphs H and I on programs and services under this Part that do not currently 
receive Federal Medical Assistance Percentage matching funds or do not qualify for 
enhanced Federal Medical Assistance Percentage matching funds under the federal 
Patient Protection and Affordable Care Act, 42 United States Code, Section 18001, et 
seq., with the goal of identifying and maximizing General Fund savings. 
The 
Commissioner of Health and Human Services, the Commissioner of Corrections and the 
Executive Director of the State Board of Corrections shall provide to the research 
organization information and assistance requested for preparation of the evaluation. In 
evaluating the programs and services under this Part, the research organization shall at a 
minimum evaluate the impact on the following programs and services: the state-funded 
Mental Health Services - Community, Office of Substance Abuse and General Assistance 
- Reimbursement to Cities and Towns programs; the elderly low-cost drug program under 
Title 22, section 254-D; services provided for individuals 21 to 64 years of age who are 
currently eligible for MaineCare under the medically needy program; services provided 
under the State's demonstration project waiver under Section 1115 of the United States 
Social Security Act, 42 United States Code, Section 301, et seq., for individuals with 
HIV/AIDS; services provided for parents paliicipating in family reunification activities; 
services provided for disabled individuals 21 to 64 years of age with incomes below 
COMMITTEE AMENDMENT 
.; 
o~ ~ 
~ 
COMMITTEE AMENDMENT" 'IS" to S.P. 552, L.D. 1487 
139% of the federal poverty level as defined by the federal Depatiment of Health and 
Human Services and updated annually in the Federal Register under authority of 42 
United States Code, Section 9902(2); services provided to individuals awaiting a 
MaineCare disability determination who are subsequently determined disabled; services 
provided to individuals who would have been considered eligible on the basis of a 
disability but for whom the full determination process was not completed; and medical 
services provided to persons in the care and custody of the Department of Corrections or 
a county correctional facility. The research organization also shall examine the amount 
of payment for services that hospitals received during fiscal years 2014-15 and 2015-16 
as a result of the expansion of MaineCare eligibility pursuant to Title 22, section 3I74-G, 
subsection 1, paragraphs Hand 1. In addition, the research organization shall evaluate 
any savings and the impact on health outcomes achieved through initiatives implemented 
pursuant to the state innovation models initiative grant. 
The research organization shall report twice, no later than February 15, 2015 and 
February 15, 2016, respectively, to the joint standing committee of the Legislature having 
jurisdiction over appropriations and financial affairs, the joint standing committee of the 
Legislature having jurisdiction over health and human services matters and the joint 
standing cOlmnittee of the Legislature having jurisdiction over criminal justice and public 
safety matters on the amount of General Fund savings resulting from the MaineCare 
expansion authorized in Title 22, section 3174-G, subsection 1, paragraphs H and I and 
by the research organization pursuant to this section. 
The reports must include the 
amount of savings expected and realized during fiscal years 2014-15 and 2015-16 by 
service area or program, the amount deposited in the MaineCare Stabilization Fund 
pursuant to section 3 of this Part and the amount of savings projected to be achieved 
through fiscal year 2020-21 by service area or program. 
Sec. C-2. Health insurance marketplace report. The Office of Fiscal and 
Program Review shall contract with a nonpartisan research organization to examine the 
financial feasibility of providing health care coverage to newly eligible MaineCare 
members through a health insurance marketplace in a manner similar to that of Medicaid 
expansion coverage in Arkansas or Iowa and the feasibility of establishing a state basic 
health program similar to Washington's basic health plan. The Office of Fiscal and 
Program Review shall report by February 15,2015 to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters regarding the 
feasibility of providing health care coverage to newly eligible MaineCare members 
through a health insurance marketplace in a manner similar to that of Medicaid expansion 
coverage in Arkansas or Iowa and the feasibility of establishing a state basic health 
program similar to Washington's basic health plan. 
Sec. C-3. Calculation and transfer. Notwithstanding any other provision of 
law, the State Budget Officer shall calculate the amount of savings identified in this Part 
that applies against each General Fund account statewide as a result of the expansion of 
MaineCare eligibility authorized in the Maine Revised Statutes, Title 22, section 3I74-G, 
subsection 1, paragraphs H and I and shall transfer the amounts up to the amounts 
specified in section 5 of this Part by financial order upon the approval of the Govemor. 
These transfers are considered adjustments to appropriations in fiscal year 2014-15. The 
State Controller shall transfer any amounts identified under this Part greater than the 
amounts specified in section 5 of this Pali to the MaineCare Stabilization Fund 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" ~"to S.P. 552, L.D. 1487 
established under Title 22, section 3 1 74-KK. The State Budget Officer shall provide a 
report of the transferred amounts to the joint standing committee of the Legislature 
having jurisdiction over appropriations and financial affairs no later than April 30, 2015 
for fiscal year 2014-15 and shall submit adjustments to baseline budget requests totaling 
no less than $11,800,000 per year to reflect the continuation of the identified savings in 
the 2016-2017 biennium. 
Sec. C-4. Review and responsibility. Following receipt of the reports from the 
research organization as required under section 1 of this Part, the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
shall review the information provided in the reports and shall determine if the net cost to 
the General Fund of providing coverage under the MaineCare program to individuals 
pursuant to the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, 
paragraphs H and I exceeds the savings to the General Fund, including any amount 
deposited in the MaineCare Stabilization Fund pursuant to section 3 of this Part, due to 
the expansion of coverage for those individuals. Following its review of the report 
received on February 15, 2016 pursuant to section 2 of this Part the joint standing 
committee may report out a bill to the Second Regular Session of the 127th Legislature 
regarding detenninations and conclusions of the report. 
Sec. C-S. Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Executive Branch Departments and Independent Agencies - Statewide 0017 
Initiative: Deappropriates funds on a statewide basis for initial savings to be identified 
under this Part in existing state programs that result from the expansion of MaineCare 
eligibility. 
GENERAL FUND 
Unallocated 
GENERAL FUND TOTAL 
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
LEGISLATURE 
Legislature 0081 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
($5,900,000) 
($5,900,000) 
2014-15 
($5,900,000) 
($5,900,000) 
COMMITTEE AMENDMENT" B "to S.P. 552, L.D. 1487 
Initiative: Provides one-time funding for the Office of Fiscal and Program Review to 
contract with a nonpartisan research organization to evaluate the impact of the expansion 
of MaineCare eligibility. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
LEGISLATURE 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
SECTION TOTAL - ALL FUNDS 
PARTD 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2014-15 
$100,000 
$100,000 
2014-15 
$100,000 
$100,000 
2014-15 
($5,800,000) 
($5,800,000) 
Sec. D-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds for the costs of MaineCare coverage through December 31, 
2016, for childless adults at or below 133% of the nonfann income official poverty line 
plus 5% for the applicable family size as required by federal law. 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Office of Family Independence - District 0453 
2013-14 
2014-15 
$0 
$327,657,166 
$0 
$327,657,166 
Initiative: Provides funding for 6 Family Independence Unit Supervisor positions, 13 
Office Assistant II positions and 64 Eligibility Specialist positions in the Office of Family 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "15 "to s.P. 552, L.D. 1487 
Independence - District program and for related All Other costs necessary to implement 
and administer the MaineCare eligibility changes. This assumes the Eligibility Specialist 
positions are funded 25% General Fund and 75% Other Special Revenue Funds and the 
other positions are funded 50% General Fund and 50% Other Special Revenue Funds. 
GENERAL FUND 
POSITIONS - LEGISLATNE COUNT 
Personal Services 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2013-14 
0.000 
$0 
$0 
$0 
2013-14 
$0 
$0 
$0 
2014-15 
83.000 
$1,909,557 
$95,105 
$2,004,662 
2014-15 
$4,325,301 
$381,651 
$4,706,952 
Office of MaineCare Services 0129 
Initiative: Provides funding for the one-time costs of changes to the Maine Integrated 
Health Management Solution and the Automated Client Eligibility System as a result of 
expanding MaineCare eligibility. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
$0 
2014-15 
$110,539 
$110,539 
2014-15 
$994,852 
$994,852 
2014-15 
$2,115,201 
$328,652,018 
$4,706,952 
COMMITTEE AMENDMENT 
c.. 
o~~ 
~ 
COMMITTEE AMENDMENT"~ "to S.P. 552, L.D. 1487 
DEPARTMENT TOTAL-ALL FUNDS 
$0 
$335,474,172 
PARTE 
Sec. E-l. Written notices required regarding MaineCare coverage. At the 
time of enrolling in the MaineCare program a member who is eligible under the Maine 
Revised Statutes, Title 22, section 317 4-G, subsection 1, paragraph H or I, the 
Department of Health and Human Services shall provide written notice that is readable at 
the 6th-grade reading level to the member: 
1. Primary care provider. That the member is required to sign up as a patient with 
a primary care provider promptly after enrolling in the MaineCare program; and 
2. Benefit termination. That the member's MaineCare coverage will end no later 
than December 31, 2016 unless a law is passed to extend coverage past that date. 
PARTF 
Sec. F-l. Task Force to Create Opportunities for Stable Employment for 
MaineCare Members. 
The Task Force to Create Opportunities for Stable 
Employment for MaineCare Members, referred to in this Part as "the task force," is 
established. 
1. Task force membership. The task force consists of 8 members appointed as 
follows: 
A. Three members of the Senate appointed by the President of the Senate; 2 must be 
members of the party holding the largest number of seats in the Senate and one must 
be a member of the party holding the 2nd largest number of seats in the Senate; and 
B. Five members of the House of Representatives appointed by the Speaker of the 
House; 3 must be members of the party holding the largest number of seats in the 
House and 2 must be members of the party holding the 2nd largest number of seats in 
the House. 
2. Chairs. The first-named Senate member is the Senate chair and the first-named 
House of Representatives member is the House chair of the task force. 
3. Appointments; convening of task force. All appointments must be made no 
later than 30 days following the effective date of this Part. The appointing authorities 
shall notify the Executive Director of the Legislative Council once all appointments have 
been completed. After appointment of all members, the chairs shall call and convene the 
first meeting of the task force. If 30 days or more after the effective date of this Palt a 
majority of but not all appointments have been made, the chairs may request authority 
and the Legislative Council may grant authority for the task force to meet and conduct its 
business. 
4. Duties. The task force shall meet up to 4 times in order to identify any policies in 
MaineCare that penalize or create a disincentive for members' increasing hours of 
COMMITTEE AMENDMENT 
c., 
0«' ~ 
~ 
lO 
COMMITTEE AMENDMENT" B "to S.P. 552, L.D. 1487 
employment or earnings. The task force shall make recommendations to eliminate any 
such barriers and shall propose new policies that support and promote stable and lasting 
employment. In performing its work, the task force shall examine current mles related to 
MaineCare transitional assistance and any opportunities to further reduce the adverse 
effects on working families that lose eligibility for MaineCare due to increased 
employment. The task force shall consider solutions that provide continuity of care and 
minimize persons' moving on and off the MaineCare program. 
S. Staff assistance. The Legislative Council shall provide necessary staffing services 
to the task force. 
6. Report. 
The task force shall submit a report that includes its findings and 
recommendations for presentation to the joint standing committee of the Legislature 
having jurisdiction over health and human services matters by December 8, 2014. 
PARTG 
Sec. G-l. Implement reforms in programs for adults with intellectual 
disabilities. The Department of Health and Human Services, referred to in this Part as 
"the department," shall implement the reforms identified in this section and shall transfer 
all savings resulting from those refonns and adjust reimbursement rates for providers of 
services as necessary to develop the funds that will reduce waiting lists for services under 
the MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and 
Community Benefits for Members with Intellectual Disabilities or Autistic Disorder and 
Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder 
to less than 6 months by January 15, 2015. 
1. The department shall implement the following refonns specified in Public Law 
2013, chapter 368, Part SS, section 4, including implementing the plan for services called 
for by that law: 
A. Each individual will receive a strength-based standardized assessment of that 
individual's strengths or needs to inform a person-centered plan; 
B. Each individual will be assessed for the natural family and cOlmnunity support 
networks potentially available to that individual; 
C. The State will establish a broad menu option model designed to match the amount 
and kind of paid support services needed by each individual; 
D. Each individual will have a designated community resource assistant whose job it 
is to help individuals at any age navigate the local array of services; 
E. The State will develop a thorough and accessible information repository; 
F. The State will establish early support and planning for steps to transition 
individuals from childhood services to adult services; 
G. The State will undertake educational efforts in each neighborhood to educate and 
foster inclusiveness and awareness of the community; 
H. The State's developmental services will deliver only the paid services needed; and 
I. Formal services will be based on individual and realistic needs. 
COMMITTEE AMENDMENT 
o~s 
~ 
COMMITTEE AMENDMENT "8 "to S.P. 552, L.D. 1487 
2. 
The department shall carry out the directives and proceed to implement the 
directives contained in the following laws: 
A. In Resolve 2013, chapter 24, the directive to the department to add home support 
as a covered service permitting a member to live as independently as possible in the 
member's own home; 
B. In Public Law 2013, chapter 368, Part NN, the directive to the department to 
review rate methodology to reduce costs for those with extraordinarily high medical 
needs; and 
C. 
In Public Law 2013, chapter 368, Part SS, section 1, the directive to the 
department to pursue waivers to use electronic technology to lessen dependence, 
reduce the need for overnight support and eliminate unnecessary staffing costs. 
3. The department shall consider the following reforms: 
A. Decreasing the cost of health care to persons with intellectual disabilities by 
implementing care management for long-tenn support service providers; 
B. Increasing the number of occupants from one or 2 to 3 or 4 in small home support 
residential programs in all cases where it can be done without encountering 
behavioral impediments; 
C. Expediting the filling of residential beds by ensuring that vacancies are prioritized 
for individuals needing residential services; 
D. 
Substituting foster homes for hourly staff care in those situations where 
individuals require long-term or permanent living arrangements for daily support; and 
E. Accelerating the teaching of independent living skills with a focus on populations 
transitioning from school to adult living. 
Sec. G-2. Savings from reforms. 
The savings generated by reforming the 
MaineCare services for adults with intellectual disabilities and autism pursuant to section 
of this Part must be used to serve those on the waiting list for services under the 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and Community 
Benefits for Members with Intellectual Disabilities or Autistic Disorder and Section 29, 
Support Services for Adults with Intellectual Disabilities or Autistic Disorder. 
The 
department shall develop a plan with clear steps and a time line to ensure that waiting lists 
for services under Sections 21 and 29 do not exceed 6 months by January 15,2015, and 
shall present its plan to the Legislature by October 1, 2014. 
Sec. G-3. Emergency rule-making authority. The department is authorized to 
adopt emergency rules under the Maine Revised Statutes, Title 5, sections 8054 and 8073 
to implement the provisions of this Part over which the department has subject matter 
jurisdiction without having to show that immediate adoption is necessary to avoid a threat 
to public health, safety or general welfare. 
PARTH 
Sec. H-l. Fraud investigation. The Department of the Attorney General shall 
undertake an initiative to strengthen fraud investigation in the MaineCare program. The 
Department of the Attorney General shall establish 2 new positions within the Health 
COMMITTEE AMENDMENT 
~s 
~O 
COMMITTEE AMENDMENT" 8 "to S.P. 552, L.D. 1487 
Care Crimes Unit to investigate allegations of misuse of public funds in the MaineCare 
program and to aid the Attorney General in the prosecution of crimes and other legal 
actions related to misuse of public funds. 
Sec. B-2. Appropriations and allocations. The following appropriations and 
allocations are made. 
ATTORNEY GENERAL, DEPARTMENT OF THE 
Administration - Attorney General 0310 
Initiative: Provides funds for 2 Attorney General Detective positions in the Health Care 
Crimes Unit. 
FEDERAL EXPENDITURES FUND 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
SUMMARY 
2013-14 
2014-15 
0.000 
2.000 
$0 
$176,638 
$0 
$30,380 
$0 
$207,018 
This amendment replaces the bill. The amendment contains the following provisions. 
Part A establishes managed care in the MaineCare program. It includes requirements 
for managed care plans and for contracting by the Department of Health and Human 
Services for managed care services. It specifies how MaineCare members enroll in 
managed care plans, provides opportunities for dis enrollment, provides for capitated 
payments to managed care plans, establishes a minimum loss ratio for managed care 
plans, provides a choice of plans and a choice counseling system that ensures the 
consumer has access to accurate information, establishes an ombudsman funded by the 
managed care plans to identify and report on systemic issues and to assist MaineCare 
members and providers with grievances and appeals, sets the minimum benefit package 
and authorizes major substantive rulemaking by the department. It establishes a managed 
care stakeholder group on capitated managed care in the MaineCare program to design 
and plan for implementation and make recommendations for implementation of managed 
care to the department. It requires the department to issue a request for information to 
determine whether there is sufficient interest among managed care companies to provide 
managed care as set forth in the law and in a manner that is consistent with and 
compatible with the goals and structure of the value-based purchasing initiatives being 
undertaken by the department, including but not limited to health homes, patient-centered 
medical homes, accountable communities, peer support organizations and other issues 
that are identified in the responsibilities of the stakeholder group. 
It requires the 
department to report by March 1,2015 to the joint standing committee of the Legislature 
having jurisdiction over health and human services matters on the status of 
implementation of managed care pursuant to the Maine Revised Statutes, Title 22, section 
3174-WW, each of the areas addressed by the managed care stakeholder group, the 
specific recommendations of the stakeholder group and the department's value-based 
COMMITTEE AMENDMENT 
o~s 
~ 
COMMITTEE AMENDMENT" 8 "to S.P. 552, L.D. 1487 
purchasing initiative, including accountable care. The report must also include actual and 
projected cost savings and the structure of the managed care program. Beginning April 1, 
2015, the department is required to provide a report every month to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
on the implementation of managed care. It imposes a schedule of required rulemaking to 
ensure prompt implementation of managed care. It requires the department to apply to 
the federal Department of Health and Human Services, Centers for Medicare and 
Medicaid Services for approval of a state plan amendment under the United States Social 
Security Act, Section 1932(a) to implement the provisions of this amendment and to 
apply for all necessary waivers. It provides a contingent effective date that requires 
notification from the department to the Revisor of Statutes that all necessary approvals 
have been granted. 
Part B expands medical coverage under the MaineCare program to adults who qualify 
under federal law with incomes up to 133% of the nonfann income official poverty line, 
with the 5% federal income adjustment for family size, and qualifies Maine to receive 
federal funding for 100% of the cost of coverage for members who enroll under the 
expansion. Adults eligible are those 21 to 64 years of age, effective July 1, 2014, and, if 
the expansion of MaineCare coverage is not repealed, adults 19 and 20 years of age, 
beginning October 1, 2019. The expansion of Medicaid eligibility contained in this Part is 
repealed the earlier of either December 31, 2016 or 3 circumstances occuring: the 
enhanced Federal Medical Assistance Percentage for calendar years 2014 to 2016 is 
reduced below certain stated levels; the reduced enhanced Federal Medical Assistance 
Percentage has taken effect; and after the occurrence of the reduction of the enhanced 
Federal Medical Assistance Percentage the Legislature has convened and conducted a 
session of at least 30 calendar days. 
Part C requires the Office of Fiscal and Program Review to contract with a 
nonpartisan research organization to evaluate the financial feasibility of providing health 
care coverage to newly eligible MaineCare members through the health insurance 
marketplace, modeled after Medicaid expansion coverage in Arkansas or Iowa, and the 
feasibility of establishing a state basic health program similar to Washington's basic 
health plan and to report the findings of the evaluation to the joint standing committee of 
the Legislature having jurisdiction over health and human services matters by February 
15, 2015. It directs the Office of Fiscal and Program Review to contract for an 
examination of the impact of the MaineCare expansion on programs and services that do 
not currently receive Federal Medical Assistance Percentage matching funds or do not 
qualify for enhanced Federal Medical Assistance Percentage matching funds under the 
federal Patient Protection and Affordable Care Act, 42 United States Code, Section 18001 
et seq., with the goal of identifying and maximizing General Fund savings. It requires that 
the research organization report by February 15, 2015 and February 15,2016 to the joint 
standing committee of the Legislature having jurisdiction over appropriations and 
financial affairs, the joint standing committee of the Legislature having jurisdiction over 
health and human services matters and the joint standing committee of the Legislature 
having jurisdiction over criminal justice and public safety matters on the amount of 
General Fund savings resulting from the MaineCare expansion. The reports must include 
the amount of savings expected and realized during fiscal years 2014-15 and 2015-16 by 
service area or program. It requires the State Budget Officer to calculate the amount of 
savings that applies against each General Fund account for all departments and agencies 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" 8 "to S.P. 552, L.D. 1487 
from savings associated with the MaineCare expansion and to transfer the amounts by 
financial order upon the approval of the Governor. It requires the State Controller to 
transfer any remaining savings to the MaineCare Stabilization Fund. It requires the State 
Budget Officer to provide a report of the transferred amounts to the joint standing 
committee of the Legislature having jurisdiction over appropriations and financial affairs 
no later than April 30, 2015 for fiscal year 2014-15 and to submit adjustments to baseline 
budget requests totaling no less than $11,800,000 per year to reflect the continuation of 
the identified savings in the 2016-2017 biennium. 
Part D provides funding for positions in the Department of Health and Human 
Services, Office of Family Independence - District program. 
Part E requires the department, when enrolling a MaineCare member who is eligible 
under Title 22, section 3174-G, subsection 1, paragraph H or I, to provide written notice 
that is readable at the 6th-grade reading level to the member of the requirement to sign up 
as a patient with a primary care provider promptly after enrolling in the MaineCare 
program and that the member's MaineCare coverage will end no later than December 31, 
2016 unless a law is passed to extend coverage past that date. 
Part F establishes the Task Force to Create Opportunities for Stable Employment for 
MaineCare Members. The task force is directed to meet up to 4 times in order to identify 
any policies in MaineCare that penalize or create a disincentive for members' increasing 
hours of employment or earnings, to make recommendations to eliminate barriers to and 
to propose new policies that support and promote stable and lasting employment, to 
examine rules related to MaineCare transitional assistance and any opportunities to 
further reduce the adverse effects on working families that lose eligibility for MaineCare 
and to consider solutions that provide continuity of care and minimize persons' moving 
on and off the MaineCare program. The task force is directed to submit a report to the 
joint standing cOlmnittee of the Legislature having jurisdiction over health and human 
services matters by December 8, 2014. 
Part G directs the department to implement reforms specified in Public Law 2013, 
chapter 368, Part SS, section 4, to carry out the directives and implement the initiatives 
contained in Resolve 2013, chapter 24 and Public Law 2013, chapter 368, Part NN and 
Part SS, section 1 and to consider 5 reforms. This Part requires that savings resulting 
from accomplishing the required reforms in programs for adults with intellectual 
disabilities and autism be used to serve persons on the waiting lists for benefits under the 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and Community 
Benefits for Members with Intellectual Disabilities or Autistic Disorder and Section 29, 
Support Services for Adults with Intellectual Disabilities or Autistic Disorder. This Part 
directs the department to develop a plan with clear steps and a timeline to ensure that 
waiting lists for services under Sections 21 and 29 do not exceed 6 months by January 15, 
2015, and to present the plan to the Legislature by October 1,2014. This Part authorizes 
the department to adopt emergency rules to accomplish the duties contained in law. 
Part H directs the Department of the Attorney General to undertake an initiative to 
strengthen fraud investigation in the MaineCare program. 
The Department of the 
Attorney General is directed to establish 2 new positions within the Health Care Crimes 
Unit to investigate allegations of misuse of public funds in the MaineCare program and to 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" e "to S.P. 552, L.D. 1487 
aid the Attorney General in the prosecution of crimes and other legal actions related to 
misuse of public funds. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03110114 
;:WaG 
LD 1487 
LR 1044(03) 
An Act To Implement Managed Care in the MaineCare Program 
Fiscal Note for Bill as Amended by Committee Amendment fig' (S-41q) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Other Special Revenue Funds 
Legislative Cost/Study 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
FY2013-14 
$0 
$0 
$0 
$0 
$0 
FY 2014-15 
Projections 
FY 2015-16 
($3,434,799) 
($1,418,768) 
($3,434,799) 
$329,109,036 
$4,706,952 
$4,706,952 
($1,418,768) 
$357,091,833 
$4,836,712 
$4,836,712 
Projections 
FY 2016-17 
$3,542,400 
$3,542,400 
$279,926,385 
$4,970,364 
$4,970,364 
The general operating expenses of the task force in Part F are projected to be $5,250 in fiscal year 2014-15 and $750 
in fiscal year 2015-16. The Legislature's proposed budget includes $10,000 in fiscal year 2014-15 for legislative 
studies. Whether this amount is sufficient to fund all studies will depend on the number of studies authorized by the 
Legislative Council and the Legislature. The additional costs of providing staffing assistance to the study during the 
interim can be absorbed utilizing existing budgeted staff resources. 
Fiscal Detail and Notes 
This bill implements and adjusts funding related to the expansion of MaineCare eligibility and makes other changes to 
the MaineCare program. 
Part A establishes a managed care program for all covered MaineCare services and provides an appropriation of 
$250,000 in fiscal year 2014-15 for the Office of MaineCare Services in the Department of Health and Human 
Services for the initial implementation including: convening and supporting the stakeholder group; preparing and 
issuing a request for information; preparing a report to the Legislature on the status of implementation and for 
required rulemaking. 
LRI044(03) - Fiscal Note - Page 1 of3 
Part C requires an evaluation of current state programs to identify savings that would result from the MaineCare 
expansion, identifies programs and populations that may realize savings and deappropriates funds statewide. The 
specific programs and amount of savings that will be realized and distributed to each program cannot by determined at 
this time. As a benchmark, the implementation of the MaineCare childless adults waiver effective October 2002 
enrolled approximately 15,000 persons by the end of the first year and resulted in savings of$1,800,000 that was 
subsequently deappropriated from the Mental Health Services - Community program in fiscal year 2002-03 (PL 2001 
c.714). Part C includes a de appropriation of $5,900,000 in 2014-15 in the Executive Branch Departments and 
Independent Agencies -Statewide program in the Department of Administrative and Financial Services for the initial 
savings to be identified in existing programs as a result of the expansion of MaineCare eligibility. 
Part C includes an appropriation of $100,000 in fiscal year 2014-15 for the Office of Fiscal and Program Review to 
contract with a nonpartisan research organization to evaluate the impact of the MaineCare expansion on state 
programs and to examine the financial feasibility of providing coverage through a Health Insurance Marketplace 
model. This level of contract funding will likely be insufficient to fund any detailed analysis of both the impact of 
MaineCare expansion and the financial feasibility of a Health Insurance Marketplace model. This level would not be 
sufficient to fund any actuarial analysis. 
Part D of the bill includes General Fund appropriations of $2,004,662 in 2014-15 for the Office of Family 
Independence - District program in the Department of Health and Human Services for the State share of the costs of 
new positions to administer the MaineCare eligibility expansion. Funding for the new positions included in Part D 
reflect a 75% federal match for the 64 Eligibility Specialist positions and a 50% federal match for the other new 
positions. The funding for the Eligibility Specialist positions assumes a 700 person caseload for each new position. 
This is the target caseload the Department of Health and Human Services has identified for the Eligibility Specialist 
positions. 
Part D also includes Federal Expenditures Fund allocations totaling $327,657,166 in 2014-15 as shown below. The 
estimated federal allocations assume 100 percent federal matching funds through December 31, 2016 for childless 
adult waiver population with incomes less than 134% of the federal poverty line. The fiscal note also assumes funding 
for the payment of three months of claims for this popUlation after December 31, 2016 at the 95% enhanced federal 
match rate. 
FY 2013-14 
FY 2014-15 
FY 2015-16 
FY 2016-17 
Childless Adults @ or below 133% ofFPL 
Estimated Population 
55,965 
Est. Annual Cost Per Person 
$5,855 
$0 
$327,657,166 
$343,712,367 
$180,277,137 
Assumed Federal Match 
100.0% 
100.0% 
100.0% 
100.0% 
State Share of Costs 
$0 
$0 
$0 
$0 
Childless Adults - CY 2017 Costs 
Estimated Cost 
$0 
$0 
$0 
$90,138,568 
Assumed Federal Match 
100.0% 
100.0% 
100.0% 
95.0% 
State Share of Costs 
$0 
$0 
$0 
$4,506,928 
LR1044(03) - Fiscal Note - Page 2 of 3 
The bill does not include appropriations for the MaineCare costs of coverage for the parents population from 101 % to 
133% ofthe federal poverty line. Funding for coverage for this population through December 31,2013 and for 
continued transitional MaineCare coverage was included in PL 2013, c. 368, the 2014-2015 Biennial Budget bill (LD 
1509) at a General Fund funding level estimated at the time to be $8,825,036 for fiscal year 2013-14 and $9,319,22: 
for fiscal year 2014-15. PL 2011 c. 657 had originally eliminated coverage for this population effective September 
30,2012 contingent on federal approval of a waiver of federal Patient Protection and Affordable Care Act 
maintenance of effort requirements. Because the federal waiver was not granted, restoring the PL 2011, c. 657 
deappropriation of $5,866,833 ($7,822,444 annualized) for this initiative was included in the adjustments to the 
MaineCare baseline in the 2014-2015 Biennial Budget. 
The Department of Health and Human Services now estimates this population has a General Fund cost of 
approximately $17 million per year, even though there have been no substantive program changes that would 
definitively explain a change in estimate of this magnitude. This fiscal note reflects the difference between the 
baseline adjustment used to prepare the 2014-2015 Biennial Budget and the Department's latest estimate - see table 
below. If there are no subsequent MaineCare appropriations or de appropriations affecting this population during the 
126th Legislature, continued funding for this popUlation will be included in the 2016-2017 MaineCare biennial budget 
baseline. Any biennial 2016-2017 MaineCare budget savings to that baseline will be based on enacted adjustments 
made by the 127th Legislature. 
FY 2013-14 
FY 2014-15 
FY 2015-16 
FY 2016-17 
Parents (Between 101 and 133% of the Federal Poverty Line) 
Estimated Population 
15,000 
2014-2015 Budget Baseline Adjustment 
$0 
$0 
$25,424,935 
$26,670,757 
Assumed Federal Match 
61.8% 
61.6% 
61.6% 
61.6% 
State Share of Costs 
$0 
$0 
$9,775,887 
$10,2S4,9()t= 
Updated DHHS Estimates 
$0 
$0 
$46,411,365 
$48,685,1(, 
Assumed Federal Match 
61.8% 
61.6% 
61.6% 
61.6% 
State Share of Costs 
$0 
$0 
$17,845,170 
$18,719,423 
2016-2017 GF Baseline Adjustment 
$0 
$0 
$8,069,283 
$8,464,517 
The fiscal note assumes any secondary impact on the numbers of persons participating in MaineCare as a result of this 
bill's expansion of MaineCare eligibility would be minimal based on the fact that most of the populations affected by 
the bill have been covered by MaineCare or on a MaineCare waitlist within the last year. The secondary impact on 
MaineCare participation as a result of implementation of the federal Patient Protection and Affordable Care Act 
(ACA) on MaineCare eligibility groups not addressed by the bill is not a result of this bill and therefore not included 
in this fiscal note. Any secondary ACA impact on the childless adult expansion population is assumed to have a 
minimal impact on General Fund costs given the 100% federal match. The secondary ACA impact on the parents 
expansion population could be significant and if it exceeds the growth assumptions for this population may result in 
additional General Fund costs beginning in fiscal year 2014-15. While the bill in aggregate assumes savings that could 
offset these General Fund costs, it does not include a mechanism to return savings to the MaineCare program until 
savings exceed the assumed statewide de appropriation included in this bill. 
Additional costs and/or savings resulting from Part G requirements related to programs for adults with intellectual 
disabilities and autism are assumed to be absorbed within existing resources for existing programs. 
Part H provides a Federal Expenditures Fund allocation of$207,018 in fiscal year 2014-15 for the Department of the 
Attorney General for 2 Attorney General Detective positions in the Healthcare Crimes Unit. 
LR1044(03) - Fiscal Note - Page 3 of3