An Act To Enact the Made for Maine Health Coverage Act and Improve Health Choices in Maine
Maine Legislature, Session 129, LD 2007
Committee Amendment CA_A_H765 (House)
Amends: 24-A MRSA §2808-B, 24-A MRSA §3953, 24-A MRSA §3958

COMMITTEE AMENDMENT "A " 
to H.P. 1425, L.D. 2007, Bill, "An Act To 
Enact the Made for Maine Health Coverage Act and Improve Health Choices in Maine" 
Amend the bill in Part A in section 1 in §5404 in subsection 2 in paragraph Din the 
first line (page 2, line 37 in L.D.) by striking out the following: 
"Legislature" and 
inserting the following: 'joint standing committee of the Legislature having jurisdiction 
over health insurance coverage matters' 
Amend the bill in Part A in section 1 in §5411 in the first paragraph in the 2nd line 
(page 4, line 26 in L.D.) by striking out the following: "Legislature" and inserting the 
following: 'joint standing committee of the Legislature having jurisdiction over health 
insurance coverage matters' 
Amend the bill in Part B in section 2 by inserting after the chapter headnote and 
before §2791 the following: 
'§2791. Definitions 
As used in this chapter. unless the context otherwise indicates. the following terms 
have the following meanings. 
1. Individual health plan. "Individual health plan" has the same meaning as in 
section 2736-C. subsection 1, paragraph C. 
2. Small group health plan. "Small group health plan" has the same meaning as in 
section 2808-B. subsection 1. paragraph G.' 
Amend the bill in Part B in section 2 in §2791 by striking out all of subsection 1 
(page 5, lines 34 to 40 and page 6, lines 1 and 2 in L.D.) and inserting the following: 
'1. Pooled market established. Subject to the requirements of subsection 5. all 
individual and small group health plans offered in this State with effective dates of 
coverage on or after January 1. 2022 must be offered through a pooled market. A health 
insurance carrier offering an individual health plan subject to this section shall make the 
plan available to all eligible small employers within the plan's approved service area. and 
a health insurance carrier offering a small group health plan subject to this section shall 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "Ir" to H.P. 1425, L.D. 2007 
make the plan available to all eligible individuals residing within the plan's approved 
service area. This subsection does not require the Maine Health Insurance Marketplace 
established in Title 22, chapter 1479 to offer identical choices of health plans to 
individuals and to small employers under Title 22, chapter 1479.' 
Amend the bill in Part B in section 2 in §2791 by striking out all of subsection 3 
(page 6, lines 11 to 16 in L.D.) and inserting the following: 
'3. Harmonization of mandated benefit laws. In addition to the requirements of 
chapter 56-A, a health plan subject to this section must comply with the applicable 
mandated benefit provisions in chapter 33 or the corresponding provisions of chapter 35. 
A health maintenance organization or a nonprofit hospital and medical service 
organization may offer any health plan approved by the superintendent for sale in the 
pooled market established pursuant to this section. notwithstanding any provision of 
chapter 56 or Title 24 to the contrary.' 
Amend the bill in Part B in section 2 in §2791 by striking out all of subsection 5 
(page 6, lines 20 to 25 in L.D.) and inserting the following: 
'5. Preconditions for pooled market. This section may not be implemented unless 
routine technical rules as defined in Title 5, chapter 375. subchapter 2-A are adopted to 
implement this section and the Federal Government approves a state innovation waiver 
amendment that extends reinsurance under section 3953 to the pooled market established 
pursuant to this section based on projections by the superintendent that both average 
individual premium rates and average small group premium rates would be the same or 
lower than they would have been absent the provisions of this section. If this section is 
not implemented. the superintendent shall conduct an analysis of alternative proposals to 
improve the stability and affordability of the small group market.' 
Amend the bill in Part B in section 2 in §2792 in subsection 1 in the 4th line (page 6, 
line 34 in L.D.) by striking out the following: "2791" and inserting the following: '2792' 
Amend the bill in Part B in section 2 in §2792 in subsection 2 by striking out all of 
the 3rd sentence (page 6, line 41 and page 7, lines 1 and 2 in L.D.) and inserting the 
following: 'The superintendent shall develop at least one clear choice design for each tier 
of health insurance plan designated as bronze. silver. gold and platinum in accordance 
with the federal Affordable Care Act.' 
Amend the bill in Part B in section 2 in §2792 by striking out all of subsection 4 
(page 7, lines 11 to 17 in L.D.) and inserting the following: 
'4. Alternative plan designs. In addition to one or more health plans that include 
cost-sharing parameters consistent with a clear choice design developed pursuant to this 
section, a carrier may offer up to 3 health plans that modify one or more specific cost-
sharing parameters in a clear choice design if the carrier submits an actuarial certification 
to the satisfaction of the superintendent that the alternative plan design offers significant 
consumer benefits and does not result in adverse selection. An alternative plan design 
may be offered only in a service area where the carrier offers at least one clear choice 
design plan at the same tier.' 
Amend the bill in Part B in section 2 in chapter 34-B by renumbering the sections to 
read consecutively. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1425, L.D. 2007 
Amend the bill in Part B by striking out all of sections 4 to 6 and inserting the 
following: 
'Sec. B-4. 24-A MRSA §2808-B, sub-§2-A, ,rB, as amended by PL 2009, c. 
439, Pt. D, §1, is further amended to read: 
B. A filing and all supporting information, except for protected health information 
required to be kept confidential by state or federal statute and except for descriptions 
of the amount and terms or conditions or reimbursement in a contract between an 
insurer and a 3rd party, are public records notwithstanding Title 1, section 402, 
subsection 3, paragraph B and become part of the official record of any hearing held 
pursuant to subsection 2-B, paragraph B or I"'. section 2792. subsection 2. 
Sec. B-5. 24-A MRSA §2808-B, sub-§2-A, 1C, as amended by PL 2007, c. 
629, Pt. M, §6, is further amended to read: 
C. Rates for small group health plans must be filed in accordance with this section 
and subsections 2-B and 2-C or section 2792, as applicable, for premium rates 
effective on or after July 1, 2004, except that the filiB.g of rates for small group health 
plans are not required to account for any payment or any recovery of that payment 
pursuant to subsection 2-B, paragraph D and former section 6913 for rates effective 
before July 1, 2005. 
Sec. B-6. 24-A MRSA §2808-B, sub-§2-B, as amended by PL 2011, c. 364, 
§ 15, is further amended to read: 
2-B. Rate review and hearings. Except as provided in subsection 2-C and section 
2792, rate filings are subject to this subsection. 
A. Rates subject to this subsection must be filed for approval by the superintendent. 
The superintendent shall disapprove any premium rates filed by any carrier, whether 
initial or revised, for a small group health plan unless it is anticipated that the 
aggregate benefits estimated to be paid under all the small group health plans 
maintained in force by the carrier for the period for which coverage is to be provided 
will return to policyholders at least 75% of the aggregate premiums collected for 
those policies, as determined in accordance with accepted actuarial principles and 
practices and on the basis of incurred claims experience and earned premiums. For 
the purposes of this calculation, any payments paid pursuant to former section 6913 
must be treated as incurred claims. 
B. If at any time the superintendent has reason to believe that a filing does not meet 
the requirements that rates not be excessive, inadequate or unfairly discriminatory or 
that the filing violates any of the provisions of chapter 23, the superintendent shall 
cause a hearing to be held. Hearings held under this subsection must conform to the 
procedural requirements set forth in Title 5, chapter 375, subchapter 4. 
The 
superintendent shall issue an order or decision within 30 days after the close oft.he 
hearing or of any rehearing or reargument or within such other period as the 
superintendent for good cause may require, but not to exceed an additional 30 days. 
In the order or decision, the superintendent shall either approve or disapprove the rate 
filing. If the superintendent disapproves the rate filing, the superintendent shall 
establish the date on which the filing is no longer effective, specify the filing the 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT •A" to H.P. 1425, L.D. 2007 
superintendent would approve and authorize the insurer to submit a new filing in 
accordance with the terms of the order or decision. 
C. When a filing is not accompanied by the information upon which the carrier 
supports the filing or the superintendent does not have sufficient information to 
determine whether the filing meets the requirements that rates not be excessive, 
inadequate or unfairly discriminatory, the superintendent shall require the carrier to 
furnish the information upon which it supports the filing. 
D. A carrier that adjusts its rate shall account for the savings offset payment or any 
recovery of that savings offset payment in its experience consistent with this section 
and former section 6913. 
Sec. B-7. 24-A MRSA §2808-B, sub-§2-C, as amended by PL 2011, c. 364, 
§16, is further amended to read: 
2-C. Guaranteed loss ratio. Notwithstanding subsection 2-B, rate filings for a 
credible block of small group health plans may be filed in accordance with this subsection 
instead of subsection 2-B, except as otherwise provided in section 2792. Rates filed in 
accordance with this subsection are filed for informational purposes. 
A. A block of small group health plans is considered credible if the anticipated 
average number of members during the period for which the rates will be in effect 
meets standards for full or partial credibility pursuant to the federal Affordable Care 
Act. The rate filing must state the anticipated average number of members during the 
period for which the rates will be in effect and the basis for the estimate. If the 
superintendent determines that the number of members is likely to be less than 
needed to meet the credibility standard, the filing is subject to subsection 2-B.' 
Amend the bill in Part B by striking out all of section 11 and inserting the following: 
'Sec. B-11. 24-A MRSA §3953, sub-§1, as amended by PL 2017, c. 124, §1, is 
further amended to read: 
1. 
Guaranteed access reinsurance mechanism established. 
The Maine 
Guaranteed Access Reinsurance Association is established as a nonprofit legal entity. As 
a condition of doing business in the State, an insurer that has issued or administered 
medical insurance within the previous 12 months or is actively marketing a medical 
insurance policy or medical insurance administrative services in this State must 
participate in the association. The Dirigo Health Program established in ehapter 87 and 
any other state sponsored health benefit program shall also partieipate in the assoeiation. 
Unless an earlier resumption of operations is ordered by the superintendent in aooordanee 
with paragraph A, operations of the assoeiation are suspended until Deoember 31, 2023 
exoept to the extent provided in seotion 3962 and the assooiation may not oolleot 
assessments as provided in seetion 3957, pro:vide reinsra:anoe for member insurers under 
seotion 3958 or provide reimbursement for member insra:ers under seotion 3961 as of the 
date on whioh a transitional reinsuranoe program esta-blished under the Effithority of 
Seotion 13 41 of the federal }.iforda-ble Care A.et eommenees operations in this State. The 
association may operate a reinsurance program contingent on the approval of. or 
continued approval of, a state innovation waiver under Section 1332 of the federal 
Affordable Care Act submitted by the superintendent as provided for in section 2781. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1425, L.D. 2007 
A. If the board proposes a revised plan of operation that calls for the resumption of 
operations earlier than December 31, 2023 and the superintendent determines that the 
re:vised plan is likely to provide sigaificant benefit to the State's health insUl"anee 
market, the superintendent may order the association to resmne operations in 
accordance ,vith the r07,rised plan. This paragraph applies only if. 
(1) ,A,n innovation waiver under Section 1332 of the federal Affordable Care Act 
as contemplated b-y paragraphs B and C is granted; or 
(2) The federal Affordable Care f .. ct is repealed or amended in a maaner that 
makes the granting of an innovation waiver l.Hlnccessary or inapplicable. 
B. After consulting ·.vith the board and receiving public comment, the superintendent 
may develop a proposal for an inno·1ation waiver under Section 1332 of the federal 
Affordable Care f.,ct that facilitates the resumption of operations of the association in 
a manner that pre:i;.rents or minimizes the loss of federal funding to support the 
affordability of health insurance in the State. 
C. With the approval of the Go11ernor, the superintendent may submit an application 
on behalf of the State in aeeordance with the proposal developed under paragraph B 
for the purposes of resuming operations of the association to the United States 
Department of Health and Human Services and to the United States Secretary of the 
Treasury to waive certain provisions of the federal Affordable Care f ... et as provided 
in Section 1332. The superiRtendent may implement any federally approved ·.vaiver.' 
Amend the bill in Part B by striking out all of section 17 and inserting the following: 
'Sec. B-17. 24-A MRSA §3958, as amended by PL 2011, c. 621, §§4 and 5, is 
further amended to read: 
§3958. Reinsurance; premium rates 
1. Reinsurance amount. A member insurer offering an individual health plan under 
section 2736-C must be reinsured by the association to the level of coverage provided in 
this subsection and is liable to the association for the any applicable reinsurance premium 
at the rate established in accordance with subsection 2. For calendar year 2022 and 
subsequent calendar years. the association shall also reinsure member insurers for small 
group health plans issued under section 2808-B, unless otherwise provided in rules 
adopted by the superintendent pursuant to section 2792, subsection 5. 
A. 
Beginning July 1, 2012, except as otherwise provided in paragraph A-1. the 
association shall reimburse a member insurer for claims incurred with respect to a 
person designated for reinsurance by the member insurer pursuant to section 3959 er 
3-96± after the insurer has incurred an initial level of claims for that person of $7,500 
for covered benefits in a calendar year. In addition, the insurer is responsible for 10% 
of the next $25,000 of claims paid during a calendar year. 
The amount of 
reimbursement is 90% of the amount incurred between $7,500 and $32,500 and 
100% of the amount incurred in excess of $32,500 for claims incurred in that 
calendar year with respect to that person. For calendar year 2012, only claims 
incurred on or after July 1st are considered in determining the member insurer's 
reimbursement. The With the approval of the superintendent, the association may 
annually adjust the initial level of claims and the maximum limit to be retained by the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A "to H.P. 1425, L.D. 2007 
insurer to reflect increases changes in costs aad,. utilization within the stan.dard 
market for individual health plans within the State. The adjustments may not be less 
than. the annual change in the Consumer Price Index for meclieal care services unless 
the superintencient a}'lproves a lmver adjustment factor as requested b=y. available 
funding and any other factors affecting the sustainable operation of the association. 
A-1. In any plan year in which a pooled market is operating in accordance with 
section 2792. the association shall operate a retrospective reinsurance program 
providing coverage to member insurers for all individual and small group health 
plans issued in this State in that plan year. For plan years beginning in 2022, if the 
pooled market has not been unplemented pursuant to section 2792. subsection 5, the 
association may operate a retrospective reinsurance program for individual health 
plans. subject to the approval of the superintendent. 
(1) The association shall reimburse member insurers based on the total eligible 
claims paid during a calendar year for a single individual in excess of the 
attachment point specified by the board. The board may establish multiple layers 
of coverage with different attachment points and different percentages of claims 
payments to be reimbursed by the association. 
(2) Eligible claims by all individuals enrolled in individual or small group health 
plans in this State may not be disqualified for reimbursement on the basis of 
health conditions, predesignation by the member insurer or any other 
differentiating factor. 
(3) The board shall annually review the attachment points and coinsurance 
percentages and make any adjustments that are necessary to ensure that the 
retrospective reinsurance program operates on an actuarially sound basis. 
(4) The board shall ensure that any surplus in the retrospective reinsurance 
program at the conclusion of a plan year is used to lower attachment points. 
increase coinsurance rates or both for that plan year, consistent with its 
responsibility to ensure that the program operates on an actuarially sound basis. 
B. Aa A member insurer shall apply all managed care, utilization review, case 
management, preferred provider arrangements, claims processing and other methods 
of operation without regard to whether claims paid for coverage are reinsured under 
this subsection. A member insurer shall report for each plan year the name of each 
high-priced item or service for which its payment exceeded the amount allowed for 
eligible claims and the name of the provider that received this payment. 
The 
association shall annually compile and publish a list of all reported names. 
2. Premium rates. The association, as part of the plan of operation under section 
3953, subsection 3, shall establish a methodology for determining premium rates to be 
charged member insurers to reinsure persons eligible for coverage under this chapter. 
The methodology must include a system for classification of persons eligible for coverage 
that reflects the types of case characteristics used by insurers for individual health plans 
pursuant to section 2736-C, together with any additional rating factors the association 
determines to be appropriate. The methodology must provide for the development of 
base reinsurance premium rates, subject to approval of the superintendent, set at levels 
that, together with other funds available to the association, will be sufficient to meet the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1425, L.D. 2007 
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anticipated costs of the association. 
The association shall periodically review the 
methodology established under this subsection and may make changes to the 
methodology as needed with the approval of the superintendent. The association may 
consider adjustments to the premium rates charged for reinsurance to reflect the use of 
effective cost containment and managed care arrangements by an insurer. 
This 
subsection does not apply to reinsurance with respect to any calendar year for which the 
association operates a retrospective reinsurance program under subsection 1, paragraph 
A-1. With the approval of the superintendent. the association's plan of operation for a 
retrospective reinsurance program may include a provision for charging premium on an 
equitable basis to all member insurers.' 
Amend the bill in Part C in section 1 in §4320-A by striking out all of subsection 3 
(page 15, lines 25 to 32 in L.D.) and inserting the following: 
'3. Primary health services. An individual or small group health plan with an 
effective date on or after January 1, 2021 must provide coverage without cost sharing for 
the first primary care office visit and first behavioral health office visit in each plan year 
and may not apply a deductible or coinsurance to the 2nd or 3rd primary care and 2nd or 
3rd behavioral health office visits in a plan year. Any copays for the 2nd or 3rd primary 
care and 2nd or 3rd behavioral health office visits in a plan year count toward the 
deductible. This subsection does not apply to a plan offered for use with a health savings 
account unless the federal Internal Revenue Service determines that the benefits required 
by this section are permissible benefits in a high deductible health plan as defined in the 
federal Internal Revenue Code. Section 223(c)(2). The superintendent shall conduct a 
study analyzing the effects of this subsection on premiums based on experience in plan 
years 2020 and 2021. The superintendent may adopt rules as necessary to address the 
coordination of the requirements of this subsection for coverage without cost sharing for 
the first primary care visit and the requirements of this section with respect to coverage of 
an annual well visit. Rules adopted pursuant to this subsection are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A.' 
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Amend the bill in Part C in section 2 in the 4th line (page 15, line 36 in L.D.) by 
striking out the following: "2791" and inserting the following: '2792' 
Amend the bill in Part C in section 2 in the next to the last line (page 15, line 38 in 
L.D.) by striking out the following: "2791 '' and inserting the following: '2792' 
Amend the bill by inserting after Part C the following: 
'PARTD 
Sec. D-1. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides allocation for one Executive Director position, beginning July 1, 
2020. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1425, L.D. 2007 
l 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATNE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Maine Health Insurance Marketplace Trust Fund N343 
2019-20 
2020-21 
0.000 
1.000 
$0 
$186,547 
$0 
$10,804 
$0 
$197,351 
Initiative: Provides allocation for one Public Service Executive II position to serve as 
chief technology officer, beginning January 1, 2021. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Maine Health Insurance Marketplace Trust Fund N343 
2019-20 
0.000 
$0 
$0 
$0 
2020-21 
1.000 
$69,306 
$5,402 
$74,708 
Initiative: Provides allocation for one Public Service Manager III position to handle 
communications and outreach duties, beginning January 1, 2021. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Maine Health Insurance Marketplace Trust Fund N343 
2019-20 
0.000 
$0 
$0 
$0 
2020-21 
1.000 
$64,455 
$5,402 
$69,857 
Initiative: Provides allocation for one Public Service Coordinator II position to handle 
finance and compliance duties, beginning January 1, 2021. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Maine Health Insurance Marketplace Trust Fund N343 
2019-20 
0.000 
$0 
$0 
$0 
2020-21 
1.000 
$56,316 
$5,402 
$61,718 
Initiative: Provides allocation for one Comprehensive Health Planner II position to serve 
as a project manager and policy analyst, beginning June 1, 2021. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT •A" to H.P. 1425, L.D. 2007 
~ 
OTHER SPECIAL REVENUE FUNDS 
2019-20 
2020-21 
POSmONS - LEGISLATIVE COUNT 
0.000 
1.000 
Personal Services 
$0 
$7,556 
All Other 
$0 
$901 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$8,457 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides allocation for one Secretary Specialist position to serve as 
administrative assistant, beginning January 1, 2021. 
OTHER SPECIAL REVENUE FUNDS 
2019-20 
2020-21 
POSITIONS - LEGISLATIVE COUNT 
0.000 
1.000 
Personal Services 
$0 
$40,878 
All Other 
$0 
$5,402 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$46,280 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides a one-time allocation for a website development contract. 
OTHER SPECIAL REVENUE FUNDS 
2019-20 
2020-21 
All Other 
$0 
$15,000 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$15,000 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides allocation for an annual contract for navigator grants. 
OTHER SPECIAL REVENUE FUNDS 
2019-20 
2020-21 
All Other 
$0 
$150,000 
OTHERSPECIALREVENUEFUNDSTOTAL 
$0 
$150,000 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides allocation for a contract for an annual audit. 
OTHER SPECIAL REVENUE FUNDS 
2019-20 
2020-21 
All Other 
$0 
$65,000 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$65,000 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'A "to H.P. 1425, L.D. 2007 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides a one-time allocation for an independent verification and validation 
vendor contract. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOT AL 
Maine Health Insurance Marketplace Trust Fund N343 
Initiative: Provides allocation for the STA-CAP plan. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
HEAL TH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
2019-20 
$0 
$0 
2019-20 
$0 
$0 
2019-20 
$0 
$0 
2020-21 
$200,000 
$200,000 
2020-21 
$19,751 
$19,751 
2020-21 
$908,122 
$908,122 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
Administrative Services - Professional and Financial Regulation 0094 
Initiative: Provides allocation to establish one part-time Insurance Actuarial Assistant 
position and All Other costs. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Insurance - Bureau of 0092 
2019-20 
$0 
$0 
2020-21 
$2,340 
$2,340 
Initiative: Provides allocation to establish one part-time Insurance Actuarial Assistant 
position and All Other costs. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" ff" to H.P. 1425, L.D. 2007 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
PROFESSIONAL AND FINANCIAL 
REGULATION, DEPARTMENT OF 
DEPARTMENT TOTALS 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
SECTION TOTALS 
OTHER SPECIAL REVENUE FUNDS 
SECTION TOTAL -ALL FUNDS 
2019-20 
2020-21 
0.000 
0.500 
$0 
$39,605 
$0 
$7,691 
$0 
$47,296 
2019-20 
2020-21 
$0 
$49,636 
$0 
$49,636 
2019-20 
2020-21 
$0 
$957,758 
$0 
$957,758 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment makes the following changes to the bill. 
1. It specifies that the reporting to the Legislature on the operations of the Maine 
Health Insurance Marketplace is to the joint standing committee of the Legislature having 
jurisdiction over health coverage, insurance and financial services matters. 
2. It adds cross-references to the definitions of "individual health plan" and "small 
group health plan" to clarify that the requirements for the pooled market do not extend to 
certain limited benefit insurance plans. 
3. It clarifies the intent that a health plan in the pooled market must comply with the 
requirements of the Maine Revised Statutes, Title 24-A, chapter 56-A. 
4. It clarifies that the pooled market does not change current law allowing carriers to 
limit their operations to a designated service area or to offer different plans within 
different service areas. 
5. It clarifies that the 
11average premium" trigger is not intended to allow the pooled 
market to go forward merely on a finding that average premiums for the pooled group 
will be lower, if savings for nongroup policyholders come at the expense of increased 
costs for small business. It also adds language requiring the Superintendent of Insurance 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1425, L.D. 2007 
to conduct an analysis of alternative proposals to stabilize the small group market, should 
the pooled market not be implemented. 
6. It clarifies that the Superintendent of Insurance is required to develop at least one 
clear choice design plan for each tier and allows carriers to offer up to 3 alternative plans 
subject to submission of a satisfactory actuarial certification to the Superintendent of 
Insurance. 
7. It allows the Maine Guaranteed Access Reinsurance Association the option to 
continue to charge a ceding premium even after converting to a retrospective program. 
8. It clarifies that the Maine Guaranteed Access Reinsurance Association is not 
required to transition to a retrospective reinsurance model in 2022 if the pooled market is 
not in effect. It does provide the option that the association may elect to move to a 
retrospective model regardless of the pooled market, subject to approval by the 
Superintendent of Insurance. 
9. It affirms that the reinsurance program is contingent on federal approval, which is 
an important technical distinction, in order for the program to generate pass-through 
funding. 
10. It limits the scope of the primary care and behavioral health benefit to the 
individual, small group and future pooled markets and corrects an error that inadvertently 
made it applicable to large group plans. It clarifies the intent of the bill to apply the 
primary health services requirement to a total of 6 visits, 3 primary care visits and 3 
behavioral health visits, and further requires that copays for the 2nd and 3rd primary care 
and behavioral health visits must count toward the enrollee's deductible. It adds the word 
"office" after "behavioral health" for clarity. It requires the Superintendent of Insurance 
to analyze the effects of the primary health services requirement on premiums following 
implementation and authorizes the superintendent to adopt rules to address the 
coordination of the requirements for coverage without cost sharing for the first primary 
care visit and the requirements with respect to coverage of an annual well visit. 
11. It adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 03/14/20 frar:.. 
LD 2007 
LR 3131(02) 
An Act To Enact the Made for Maine Health Coverage Act and Improve Health Choices in Maine 
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Fiscal Note Required: Yes 
Fiscal Note 
FY 2019-20 
FY 2020-21 
Projections 
FY 2021-22 
Projections 
FY 2022-23 
Appropriations/ Allocations 
Other Special Revenue Funds 
$0 
$957,758 
$6,290,574 
$11,151,125 
.evenue 
Other Special Revenue Funds 
$0 
$933,585 
$6,535,096 
$11,203,021 
Transfers 
Other Special Revenue Funds 
$0 
$0 
$0 
$0 
Fiscal Detail and Notes 
The bill establishes the Maine Health Insurance Marketplace and creates the Maine Health Insurance Marketplace 
Trust Fund for the deposit of any funds generated for the marketplace. The bill includes Other Special Revenue Funds 
allocations to the Department of Health and Human Services of $908,122 in fiscal year 2020-21 for multiple contracts 
and to ·establish 6 positions to create and handle the on-going operations of the Maine Health Insurance Marketplace. 
The revenue generated for the new Maine Health Insurance Marketplace Trust Fund comes from user fees paid 
monthly by the carriers on the marketplace. 
The bill also includes an Other Special Revenue Funds allocation to the Department of Professional and Financial 
Regulation, Bureau of Insurance, of $49,636 in fiscal year 2020-21 to establish one part-time Insurance Actuarial 
Assistant position and all other costs to handle the new requirements in this bill. 
Any additional costs to the Legislature, the Treasurer's Office, the Department of Administrative and Financial 
Services and the Maine Health Data Organization are expected to be minor and can be absorbed within existing 
budgeted resources. 
LR3 l 31 (02) - Fiscal Note - Page 1 of 1