Sec. B-1. Savings offset payments working group. The Superintendent of Insurance shall convene a working group to advise the Board of Directors of Dirigo Health, referred to in this section as "the board," as provided in this section.
1. Membership. The working group must include 5 members representing the interests of insurers, self-insured entities and 3rd-party administrators and 5 members representing the interests of Dirigo Health.
2. Convening of working group; schedule. The Superintendent of Insurance shall convene the first meeting of the working group. In order to complete its work in a timely fashion, the working group may make its recommendations in accordance with time frames discussed with the Joint Standing Committee on Insurance and Financial Services.
3. Duties. The working group shall make recommendations to advise the board on the following issues:
A. The definition of "subsidy" within the Dirigo Health Program;
B. The definition of "paid claims" for the purpose of using paid claims as the base for savings offset payment assessments on health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers;
C. The process for implementing and invoicing savings offset payment assessments based on the recommended definition of paid claims;
D. The board's proposed methodology for calculating aggregate measurable cost savings. This recommendation must be made no later than September 20, 2005; and
E. A funding strategy to cover Dirigo Health's administrative expenses. This recommendation must be made no later than December 31, 2005.
4. Technical assistance; facilitator. The Department of Professional and Financial Regulation, Bureau of Insurance shall provide technical assistance to the working group upon request. Meetings of the working group must be moderated by an independent facilitator selected by the Superintendent of Insurance.
5. Monthly reports; notice of meetings. The working group shall provide monthly reports to the Joint Standing Committee on Insurance and Financial Services and shall notify committee members of each meeting of the working group. The monthly reports must include any recommendations the working group has made to the board pursuant to subsection 3.
6. Termination of working group. The working group terminates December 31, 2005.
Sec. B-2. Provisions governing first year of savings offset payments.
1. Definition of paid claims; first assessment year. The Board of Directors of Dirigo Health shall adopt rules regarding the definition of paid claims under section 1 of this Part for the calculation of savings offset payments for the first 12-month calendar year period of savings offset payments, referred to in this section as "the first assessment year," due from health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers pursuant to the Maine Revised Statutes, Title 24-A, section 6913. In adopting these rules, the board shall take into account the recommendations of the working group established under section 1 with respect to the definition of paid claims and the methodology for calculating and invoicing savings offset payment assessments based on paid claims. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. For savings offset payments after the first assessment year, the board shall define paid claims through major substantive rulemaking in accordance with Title 24-A, section 6913, subsection 10.
2. Timeline. Notwithstanding any deadlines specified in the Maine Revised Statutes, Title 24-A, section 6913, the Board of Directors of Dirigo Health shall comply with the following deadlines for the first assessment year:
A. No later than the effective date of this Act, the board shall file with the Superintendent of Insurance its determination as to the aggregate measurable cost savings in this State, including any reduction or avoidance of bad debt and charity care cost to health care providers as a result of the operation of Dirigo Health and any increased MaineCare enrollment due to an expansion in MaineCare eligibility occurring after June 30, 2004 as well as the supporting information for that determination. The filing constitutes a public record; and
B. Following a public hearing held in accordance with the Maine Administrative Procedure Act and no later than 6 weeks following the effective date of this Act, the Superintendent of Insurance shall issue an order approving, in whole or in part, or disapproving the filing made under paragraph A. The board is designated a party to the hearing. The superintendent shall approve the filing upon a determination that the aggregate measurable cost savings filed by the board are reasonably supported by the evidence in the record.
Sec. B-3. Funding Dirigo Health administrative expenses. General administrative expenses of Dirigo Health, excluding administrative expenses directly associated with the Maine Quality Forum established in the Maine Revised Statutes, Title 24-A, section 6951, may be covered by the remaining balance of the $53,000,000 in funds transferred from the unappropriated surplus of the General Fund to the Dirigo Health Fund pursuant to Public Law 2003, chapter 469, Part H, section 1 and may not be covered by savings offset payments in accordance with the Maine Revised Statutes, Title 24-A, section 6913, subsection 2. Following receipt and review of the recommendations of the working group, established in section 1, regarding a funding strategy for Dirigo Health's administrative expenses and no later than February 15, 2006, the Board of Directors of Dirigo Health shall submit its recommendations, including any suggested legislation, for funding administrative expenses to the Joint Standing Committee on Insurance and Financial Services. Following receipt and review of the board's recommendation, the committee may report out a bill related to funding Dirigo Health's administrative expenses to the Second Regular Session of the 122nd Legislature.
| Revisor of Statutes Homepage | Subject Index | Search | 122nd Laws of Maine | Maine Legislature |
About the 1st Regular & 1st Special Session Laws Of Maine
