S.P. 811 - L.D. 2190
An Act to Implement the Recommendations of the Blue Ribbon Commission to Study the Effects of Government Regulation and Health Insurance Costs on Small Businesses in Maine
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §1951, sub-§2, as enacted by PL 1995, c. 673, Pt. A, §3, is amended to read:
2. Private purchasing alliance. "Private purchasing alliance" or "alliance" means a nonprofit corporation licensed pursuant to this section established under Title 13-A or Title 13-B to provide health insurance to its members through multiple unaffiliated participating carriers.
Sec. 2. 24-A MRSA §1953, first ¶, as enacted by PL 1995, c. 673, Pt. A, §3, is amended to read:
In addition to the powers granted in Title 13-A or Title 13-B, an alliance may do any of the following:
Sec. 3. 24-A MRSA §1955, sub-§§1 and 3, as enacted by PL 1995, c. 673, Pt. A, §3, are amended to read:
1. Restricted activities. An alliance may not purchase health care services, assume risk for the cost or provision of health care services or otherwise contract with health care providers for the provision of health care services to enrollees without the prior approval of the superintendent.
3. Conflict of interest. A person may not be a board member, officer or employee of an alliance if that person is employed as or by, is a member of the board of directors of, is an officer of, or has a material direct or indirect ownership interest in a carrier, or health care provider or insurance agency or brokerage. A person may not be a board member or officer of an alliance if a member of that person's household is a member of the board of directors of, is an officer of or has a material direct or indirect ownership interest in a carrier, or health care provider or insurance agency or brokerage. A board member, officer or An employee of an alliance who is licensed as an agent, broker or consultant may act under that license only on behalf of the alliance and only within the scope of that person's duties as a board member, officer or an employee.
Sec. 4. 24-A MRSA §2752, sub-§2, as enacted by PL 1991, c. 701, §8, is amended to read:
2. Procedures before legislative committees. Whenever a legislative measure containing a mandated health benefit is proposed, the joint standing committee of the Legislature having jurisdiction over the proposal shall hold a public hearing and determine the level of support for the proposal among the members of the committee. If there is substantial support for the proposed mandate among a majority of the members of the committee, the committee may refer the proposal to the Bureau of Insurance for review and evaluation pursuant to subsection 3. Once a review and evaluation has been completed, the committee shall review the findings of the bureau. A proposed mandate may not be enacted into law unless review and evaluation pursuant to subsection 3 has been completed.
Sec. 5. 24-A MRSA §2752, sub-§3, ¶¶A and D, as enacted by PL 1991, c. 701, §8, are amended to read:
A. The social impact of mandating the benefit, including:
(1) The extent to which the treatment or service is utilized by a significant portion of the population;
(2) The extent to which the treatment or service is available to the population;
(3) The extent to which insurance coverage for this treatment or service is already available;
(4) If coverage is not generally available, the extent to which the lack of coverage results in persons being unable to obtain necessary health care treatment;
(5) If the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial hardship on those persons needing treatment;
(6) The level of public demand and the level of demand from providers for the treatment or service;
(7) The level of public demand and the level of demand from the providers for individual or group insurance coverage of the treatment or service;
(8) The level of interest of in and the extent to which collective bargaining organizations in are negotiating privately for inclusion of this coverage in group contracts;
(9) The likelihood of achieving the objectives of meeting a consumer need as evidenced by the experience of other states;
(10) The relevant findings of the state health planning agency or the appropriate health system agency relating to the social impact of the mandated benefit;
(11) The alternatives to meeting the identified need;
(12) Whether the benefit is a medical or a broader social need and whether it is consistent with the role of health insurance and the concept of managed care;
(13) The impact of any social stigma attached to the benefit upon the market;
(14) The impact of this benefit on the availability of other benefits currently being offered; and
(15) The impact of the benefit as it relates to employers shifting to self-insured plans and the extent to which the benefit is currently being offered by employers with self-insured plans; and
(16) The impact of making the benefit applicable to the state employee health insurance program;
D. The effects of balancing the social, economic and medical efficacy considerations, including:
(1) The extent to which the need for coverage outweighs the costs of mandating the benefit for all policyholders; and
(2) The extent to which the problem of coverage may be solved by mandating the availability of the coverage as an option for policyholders.; and
(3) The cumulative impact of mandating this benefit in combination with existing mandates on the costs and availability of coverage.
Effective June 30, 1998, unless otherwise indicated.
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