LD 585
pg. 3
Page 2 of 5 An Act to Establish a Statewide Primary and Preventive Health Care Program ... Page 4 of 5
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LR 50
Item 1

 
period if the commissioner has lowered the maximum
eligibility level under paragraph B.

 
E.__A person whose family income meets the eligibility
requirements at the time of enrollment and increases to
disqualify the person at the end of the 12-month
enrollment period may purchase coverage under the program
for a period of up to 18 months at a premium level that is
revenue neutral and that covers the cost of the benefit
and a contribution toward administrative costs no greater
than the maximum level allowable under COBRA.__The
department shall adopt rules to implement this paragraph.

 
3.__Program administration; benefit design.__With the
exception of premium payments under subsection 5 and any other
requirements imposed under this section, the program must be
coordinated and integrated with the MaineCare program and
administered with it in one administrative structure within
the department, with the same enrollment and eligibility
processes and outreach.__The department shall adopt and
promote a simplified eligibility form and eligibility process.__
In order to maximize the use of federal and other nonstate
funds, the delivery of primary and preventive health care
services must be coordinated with the delivery of those
services in other health care programs and settings in this
State, including without limitation rural health clinics,
federally qualified health centers, federally qualified look-
alikes and Indian health services.__The program must use, but
is not limited to, the same benefit delivery system as the
MaineCare program and provide benefits through the same health
plans, contracting process and providers.

 
4.__Advisory committee.__The department shall convene an
advisory committee, as established in Title 5, section 12004-
I, subsection 36-E, to provide advice regarding benefit design
and primary and preventive health care services to be covered
by the program.__The advisory committee, which may not exceed
10 members, must include consumers, providers of health care
services, carriers licensed under Title 24 and Title 24-A, and
representatives of Indian health care services.__Members of
the advisory committee not otherwise reimbursed for expenses
may be reimbursed for expenses by the department.

 
5.__Consumer copayments and premium payments.__In
consultation with the advisory committee formed pursuant to
subsection 4, the department may charge reasonable consumer
copayments and premiums for primary and preventive health care
services under the program.__If the department adopts rules
establishing premiums for the program, the department shall
include a provision waiving premiums for good cause.


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