An Act To Implement the Recommendations of the Maine Health Exchange Advisory Committee
Maine Legislature, Session 127, LD 1265
Committee: Insurance and Financial Services
Amends: 5 MRSA §12004-I, 24-A MRSA §4320-J

Legislative Document 
No. 1265 
H.P. 865 
House of Representatives, April 7, 2015 
An Act To Implement the Recommendations of the Maine Health 
Exchange Advisory Committee 
(EMERGENCY) 
Reported by Representative BECK of Waterville for the Joint Standing Committee on 
Insurance and Financial Services pursuant to Joint Order 2013, H.P. 1136. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed pursuant to Joint Rule 218. 
ROBERT B. HUNT 
Clerk 
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, this legislation continues on a permanent basis the Maine Health 
Exchange Advisory Committee as recommended by the committee in its final report to 
the Legislature; and 
Whereas, immediate enactment of this legislation is needed to reestablish the Maine 
Health Exchange Advisory Committee as Maine's liaison to the Federal Government in 
the implementation and operation of Maine's federally facilitated marketplace; and 
Whereas, a pending United States Supreme Court decision may have a significant 
impact on the availability and affordability of coverage through the federally facilitated 
marketplace; and 
Whereas, the Maine Health Exchange Advisory Committee may have a role in 
advising the State's policymakers following the Supreme Court's decision; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  5 MRSA §12004-I, sub-§50-B is enacted to read: 
50-B.   
Sec. 2.  24-A MRSA §4320-J is enacted to read: 
§4320-J.  Maine Health Exchange Advisory Committee 
The Maine Health Exchange Advisory Committee, referred to in this section as "the 
advisory committee" and established pursuant to Title 5, section 12004-I, subsection 
50-B, is created to advise the Governor and the Legislature regarding the interests of 
individuals and employers with respect to any health benefit exchange, referred to in this 
section as "an exchange," that may be created for this State pursuant to the federal 
Affordable Care Act. 
Insurance: Health 
Exchange 
Maine Health 
Exchange Advisory 
Committee 
Legislative Per 
Diem and Expenses 
for Legislators and 
Expenses Only for 
Other Members 
upon Demonstration 
of Financial 
Hardship 
24-A MRSA §4320-J 
1.  Appointment; composition.  The advisory committee consists of 21 members as 
follows: 
A.  The following 5 members of the Legislature, of whom 3 members must serve on 
the joint standing committee of the Legislature having jurisdiction over insurance and 
financial services matters and 2 members must serve on the joint standing committee 
of the Legislature having jurisdiction over health and human services matters or the 
joint standing committee of the Legislature having jurisdiction over appropriations 
and financial affairs: 
(1)  Two members of the Senate, appointed by the President of the Senate, 
including one member recommended by the Senate Minority Leader; and 
(2)  Three members of the House of Representatives, appointed by the Speaker of 
the House of Representatives, including one member recommended by the House 
Minority Leader; 
B.  Two persons representing health insurance carriers, one of whom is appointed by 
the President of the Senate and one of whom is appointed by the Speaker of the 
House of Representatives; 
C.  One person representing dental insurance carriers, appointed by the Speaker of the 
House of Representatives; 
D.  One person representing insurance producers, appointed by the President of the 
Senate; 
E.  One person representing Medicaid recipients, appointed by the Speaker of the 
House of Representatives; 
F.  Two persons representing health care providers and health care facilities, 
including one member representing federally qualified health centers, appointed by 
the Speaker of the House of Representatives; 
G.  One person who is an advocate for enrolling hard-to-reach populations in health 
coverage, including individuals with mental health or substance abuse disorders, 
appointed by the President of the Senate; 
H.  One member representing a federally recognized Indian tribe, appointed by the 
President of the Senate; 
I.  One member who has expertise in tax matters, appointed by the President of the 
Senate; 
J.  Four members representing individuals and small businesses, including: 
(1)  One person, appointed by the President of the Senate, who can reasonably be 
expected to purchase individual coverage through an exchange with the 
assistance of a federal premium tax credit and who can reasonably be expected to 
represent the interests of individuals purchasing individual coverage through an 
exchange; 
(2)  One person, appointed by the Speaker of the House of Representatives, who 
represents an employer that can reasonably be expected to purchase group 
coverage through an exchange and who can reasonably be expected to represent 
the interests of such employers; 
(3)  One person, appointed by the President of the Senate, who represents 
navigators or entities likely to be certified as navigators; and 
(4)  One person, appointed by the Speaker of the House of Representatives, who 
is employed by an employer that can reasonably be expected to purchase group 
coverage through an exchange and who can reasonably be expected to represent 
the interests of such employees; 
K.  The superintendent, or the superintendent's designee, who serves as an ex officio, 
nonvoting member; and 
L.  The Commissioner of Health and Human Services, or the commissioner's 
designee, who serves as an ex officio, nonvoting member. 
2.  Term.  Except for members who are Legislators and ex officio members, all 
members are appointed for 3-year terms. A vacancy must be filled by the same 
appointing authority that made the original appointment. An appointed member may not 
serve more than 2 terms. A member may designate an alternate to serve on a temporary 
basis. A member who is a Legislator serves a 2-year term coterminous with the elected 
term.  Except for a member who is a Legislator, a member may continue to serve after 
expiration of the member's term until a successor is appointed. 
3.  Chair.  The first-named member of the Senate is the Senate chair of the advisory 
committee, and the first-named member of the House of Representatives is the House 
chair of the advisory committee. 
4.  Duties.  The advisory committee shall: 
A.  Advise the Governor and Legislature regarding the interests of individuals and 
employers with respect to an exchange; 
B.  Serve as a liaison between an exchange and individuals and small businesses 
enrolled in the exchange; 
C.  Evaluate the implementation and operation of an exchange with respect to the 
following: 
(1)  Whether the State should transition from a federally facilitated exchange 
model to a state-based exchange or partnership model; 
(2)  The essential health benefits benchmark plan designated in this State under 
the federal Affordable Care Act, including whether the State should change its 
designation; 
(3)  The impact of federal and state laws, rules and regulations governing the 
health insurance rating for tobacco use and coverage for wellness programs and 
smoking cessation programs on accessibility and affordability of health 
insurance; 
(4)  The consumer outreach and enrollment conducted by the exchange and 
whether the navigator program is effective and whether navigators or other 
persons providing assistance to consumers are in compliance with any federal or 
state certification and training requirements; 
(5)  The coordination between the state Medicaid program and the exchange; 
(6)  Whether health insurance coverage through the exchange is affordable for 
individuals and small businesses, including whether subsidies for individuals are 
adequate; 
(7)  Whether the exchange is effective in providing access to health insurance 
coverage for small businesses; 
(8)  The implementation of rebates under the federal Affordable Care Act and 
section 4319; 
(9)  The coordination of plan management activities between the bureau and the 
exchange, including the certification of qualified health plans and rate review; 
(10)  The potential for establishing a basic health program or seeking a Medicaid 
state plan amendment or state innovation waiver to provide alternative health 
coverage programs for individuals; 
(11)  Whether changes should be considered in federal law or regulations to 
address dental health coverage available through the marketplace, including, but 
not limited to, premiums and out-of-pocket costs; 
(12)  Whether the State should consider changes to its designated rating areas for 
geographic area to the extent permitted by federal law and regulations; 
(13)  The impact of so-called churn on the effective operation of the marketplace, 
public health programs and the private health insurance market; 
(14)  The impact of federal requirements to provide employer-sponsored health 
coverage; 
(15)  The impact of any change in the definition of "small group" for health 
insurance purposes; 
(16)  The impact of federal transitional risk adjustment programs and whether the 
State should consider ending the suspension of the Maine Guaranteed Access 
Reinsurance Association under section 3953; 
(17)  The impact of health insurance policies continued in the State under the 
transitional relief granted by the federal Department of Health and Human 
Services; and 
(18)  Any issue relating to the implementation of the federal Affordable Care Act 
agreed upon by a majority of the advisory committee; and 
D.  Based on the evaluations conducted by the advisory committee pursuant to this 
subsection, make recommendations for any changes in policy or law that would 
improve the operation of an exchange for individuals and small businesses in the 
State. 
5.  Quorum.  A quorum is a majority of the members of the advisory committee. 
6.  Meetings.  The advisory committee shall meet at least 4 times a year at regular 
intervals and may meet at other times at the call of the chairs. Meetings of the advisory 
committee are public proceedings as provided by Title 1, chapter 13, subchapter 1. 
7.  Records.  Except for information designated as confidential under federal or state 
law, information obtained by the advisory committee is a public record as provided by 
Title 1, chapter 13, subchapter 1. 
8.  Staffing.  The Legislative Council shall provide year-round staff support for the 
operation of the advisory committee. 
9.  Accounting; funding for advisory committee activities.  All funds appropriated, 
allocated or otherwise provided to the advisory committee must be deposited in an 
account separate from all other funds of the Legislature and are nonlapsing. Funds in the 
account may be used only for the purposes of the advisory committee. The advisory 
committee may apply for grants and other nongovernmental funds to provide professional 
support or consultant support to carry out the duties and requirements of this section.  
Prompt notice of solicitation and acceptance of funds must be sent to the Legislative 
Council. All funds accepted must be forwarded to the Executive Director of the 
Legislative Council, along with an accounting that includes the amount received, the date 
that amount was received, from whom that amount was received, the purpose of the 
donation and any limitation on use of the funds. The executive director shall administer 
all funds received in accordance with this section. At the beginning of each fiscal year, 
and at any other time at the request of the chairs of the advisory committee, the executive 
director shall provide to the advisory committee an accounting of all funds available to 
the advisory committee, including funds available for professional support or consultant 
support. 
10.  Reports.  Beginning February 15, 2016 and annually thereafter, the advisory 
committee shall report and make specific recommendations, including any necessary 
legislation, relating to its duties in subsection 4 to the joint standing committee of the 
Legislature having jurisdiction over insurance and financial services matters and the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters and to any appropriate state agency. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
This bill proposes to implement the recommendations of the Maine Health Exchange 
Advisory Committee pursuant to Joint Order 2013, House Paper 1136. The bill 
establishes the Maine Health Exchange Advisory Committee on a permanent basis. 
The Joint Standing Committee on Insurance and Financial Services has not taken a 
position on the substance of the recommendations or the bill, and by reporting out this bill 
the committee is not suggesting and does not intend to suggest that it agrees or disagrees 
with any aspect of the advisory committee's recommendations or this bill. The Joint 
Standing Committee on Insurance and Financial Services is reporting out the bill for the 
sole purpose of turning the advisory committee's proposal into a printed bill that can be 
referred to the Joint Standing Committee on Insurance and Financial Services for an 
appropriate public hearing and subsequent processing in the normal course. The Joint 
Standing Committee on Insurance and Financial Services is taking this action to ensure 
clarity and transparency in the legislative review of the advisory committee's proposal.