LD 1611
pg. 17
Page 16 of 73 PUBLIC Law Chapter 469 Page 18 of 73
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LR 2137
Item 1

 
Health insurance carriers that seek to qualify to provide
Dirigo Health Insurance must also qualify as health plans in
Medicaid.

 
4.__Contracting authority.__Dirigo Health has contracting
authority and powers to administer Dirigo Health Insurance as set
out in this subsection.

 
A.__Dirigo Health may contract with health insurance
carriers licensed to sell health insurance in this State or
other private or public third-party administrators to
provide Dirigo Health Insurance.__In addition:

 
(1)__Dirigo Health shall issue requests for proposals
from health insurance carriers;

 
(2)__Dirigo Health may include quality improvement,
disease prevention, disease management and cost-
containment provisions in the contracts with
participating health insurance carriers or may arrange
for the provision of such services through contracts
with other entities;

 
(3)__Dirigo Health shall require participating health
insurance carriers to offer a benefit plan identical to
Dirigo Health Insurance, for which no Dirigo Health
subsidies are available, in the general small group
market;

 
(4)__Dirigo Health shall make payments to participating
health insurance carriers under a Dirigo Health
Insurance contract to provide Dirigo Health Insurance
benefits to plan enrollees not enrolled in MaineCare;

 
(5)__Dirigo Health may set allowable rates for
administration and underwriting gains for Dirigo Health
Insurance;

 
(6)__Dirigo Health may administer continuation benefits
for eligible individuals from employers with 20 or more
employees who have purchased health insurance coverage
through Dirigo Health for the duration of their
eligibility periods for continuation benefits pursuant
to the federal Consolidated Omnibus Budget
Reconciliation Act, Public Law 99-272, Title X, Private
Health Insurance Coverage, Sections 10001 to 10003; and

 
(7)__Dirigo Health may administer or contract to administer the
United States Internal Revenue Code of 1986, Section 125 plans
for employers and employees


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