Sec. 1. 22 MRSA §3174-GG is enacted to read:

§3174-GG.__MaineCare health care savings accounts and health

care management

The department shall establish health care savings accounts and a health care management program within the MaineCare program.__The terms of the health care management program, referred to in this section as "the program," and of the health care savings accounts are subject to approval of a waiver application by the federal Centers for Medicare and Medicaid Services and rules adopted by the department to implement the program.__The requirements for health care savings accounts and the program are as follows.

1.__Member election.__Upon initial MaineCare enrollment or continuing eligibility review, a member must discuss enrollment options with an enrollment counselor to be assigned to a health care manager to administer the member's benefits.

2.__Program operation.__A member receives health coverage that includes benefits for preventive, routine and catastrophic illness or injury__care, using networks and payment structures negotiated by the health care manager.__Routine care program benefits are determined by the member, with participation by the health care manager for accounting assistance only, up to the amount contained in the member's health care savings account.__ Preventive and catastrophic program benefits are determined by the member, paid for under contract by the health care manager, with administrative services provided by the health care manager.

3.__Member account.__Each member, with the participation of the health care manager for accounting assistance only, shall establish an individual or family health care savings account to which contributions must be paid by the department based on average MaineCare costs in the prior year, adjusted by age, gender and other factors determined by the department to be actuarially applicable.__Account balances unpaid at the end of each calendar year carry forward to the next year for use during that year or may be transferred as provided in subsection 6.

4.__Capitation.__Health care managers contract with the department to provide coverage and benefits under the program and are paid a capitated rate per enrolled member for routine preventive and catastrophic care.__Rates must be set based on average MaineCare costs in the prior year, adjusted by age, gender and other factors determined by the department to be actuarially applicable.