CHAPTER 56-B

MAINE CONSUMER CHOICE HEALTH PLAN

§4346.__Maine Consumer Choice Health Plan

1.__Definitions.__As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.

A.__"Board" means the Board of Directors of the Maine Consumer Choice Health Plan established in Title 5, section 12004-G, subsection 21-B.

B.__"Director" means the Executive Director of the Maine Consumer Choice Health Plan.

C.__"Fund" means the Maine Consumer Choice Health Plan Fund.

D.__"Plan" means the Maine Consumer Choice Health Plan established in this section.

2.__Plan established.__The Maine Consumer Choice Health Plan is established as an independent executive agency to negotiate and contract with carriers to provide a choice of health benefits coverage to eligible enrollees.

3.__Board of Directors.__The plan operates under the supervision of the Board of Directors of the Maine Consumer Choice Health Plan, which consists of 5 voting members.

A.__The Governor shall appoint a member representing large employers, a member representing small employers, a member representing governmental entities, a member representing Medicaid-eligible individuals and a member representing the public.__Appointments by the Governor are subject to review by the joint standing committee of the Legislature having jurisdiction over health insurance matters and to confirmation by the Legislature.

B.__Initial terms of the members of the board are staggered:__ 3 members serve 3-year terms and 2 members serve 2-year terms.__After the initial terms, members serve full 2-year terms and continue to serve until their successors have been appointed.__Board members may serve up to 3 full terms consecutively.

C.__Board members shall elect a chair.__All meetings of the board are public proceedings within the meaning of Title 1, chapter 13, subchapter I.

D.__Board members are entitled to reimbursement for necessary expenses according to the provisions of Title 5, chapter 379.

4.__Executive director.__The Executive Director of the Maine Consumer Choice Health Plan is the administrator of the plan. The director is appointed by the board and serves at the pleasure of the board.

5.__Powers. The board may:

A.__Enter into contracts with qualified 3rd parties for any service necessary to carry out the purposes of this chapter;

B.__Employ necessary staff;

C.__Set reasonable fees for membership in the plan for financing reasonable and necessary costs incurred in administration of the plan;

D.__Approve benefit plan designs offered by participating carriers;

E.__Negotiate with participating carriers the premium rates charged for health benefit plans offered through the plan;

F.__Provide premium collection services for health benefit plans purchased through the plan if the carrier offering the health benefit plan gives express written authorization to the board or any other entity acting on behalf of the board to act as the carrier's agent for that purpose;

G.__Establish procedures for adjusting payments within each risk pool to participating carriers if the board finds that some carriers have a significantly disproportionate share of high-risk or low-risk enrollees;

H.__Establish a financial relationship directly with producers licensed pursuant to chapter 16 to market and service health benefits plans offered through the plan;

I.__Borrow any funds necessary, not to exceed $1,000,000, for initial operating expenses in administering the plan;

J.__Take any legal actions necessary or proper for recovering any penalties for, on behalf of or against the plan;

K. Undertake activities necessary to administer the plan, including marketing and publicizing the plan and ensuring carrier and enrollee compliance with plan requirements; and

L.__Adopt rules as necessary to administer the plan. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.

6.__Participating carriers; contracts.__The board shall develop objective criteria for the selection of participating carriers and provide adequate notice of the application process to permit all carriers a reasonable and fair opportunity to participate.__The selection of participating carriers must be based on the criteria developed by the board.

7.__Selection of carriers; choice of health plans. The board shall contract with a reasonable number of competing carriers to offer multiple health plans to ensure that enrollees have a choice among carriers and types of health benefit plans in accordance with this subsection.

A. The plan must offer, at a minimum, a fee-for-service plan, a managed care plan, a point-of-service plan and a basic plan. These health benefit plans must offer a range of deductibles, including at least one plan with a high deductible.

B.__The basic plan offered pursuant to this subsection may exclude some or all mandated benefits for specific conditions for certain health care services or reimbursement for certain health care providers otherwise required pursuant to Title 24 or this Title as approved by the superintendent to ensure an accessible and affordable option to enrollees.

C. The plan may offer other health benefit plan designs, including medical savings accounts, in accordance with applicable state or federal law.

D.__The plan may offer vision or dental plans or accidental injury, specified disease, hospital indemnity, disability income, Medicare supplement, long-term care or other limited benefit health policies.

E.__The plan must require participating carriers to provide services to enrollees in all geographic areas of the State.

8.__Enrollee eligibility.__The board may establish conditions for enrollment and participation for enrollees in accordance with this subsection.

A.__Enrollees must be residents of this State.

B.__Employers are eligible regardless of the number of their employees. An employer may be a self-employed individual.__ Employers that choose to participate in the plan shall offer enrollment to all employees and their dependents who are not enrolled in another health plan.

C.__Governmental and municipal employers are eligible.

D.__Individuals not enrolled in another health plan may participate.

E.__Individuals eligible for Medicaid may participate on a voluntary basis to the extent permitted under federal and state law or any waiver granted by the Federal Government.

F.__Conditions for eligibility may not be based on health status.

9.__Premiums.__The board shall establish premiums for participation in the plan including any membership fees.__ Enrolled employers shall determine the annual amount, if any, contributed by the employer toward the premium cost of health coverage under the plan for employees and their dependents.__The board shall establish a mechanism to collect premiums from enrolled employers including remittance of the share of any premium paid by an employee.__The board may coordinate with Maine Revenue Services to develop a mechanism for collection of premiums.

10.__Risk pools.__The board shall develop standards for classifying groups of participating enrollees into risk pools. The board may establish one or more risk pools for enrolled employees and their dependents and a risk pool for enrolled individuals and their dependents.

11.__Licensing; regulation.__Notwithstanding any other provision of law, the plan is not subject to licensure as an insurer pursuant to this Title.__Carriers that contract with the plan must be licensed pursuant to Title 24 or this Title. Health plans offered by participating carriers must comply with all applicable requirements of statutes and rules except as provided in subsection 7.

12.__Marketing. The board shall approve and make available to potential enrollees educational and marketing materials, health benefit plan descriptions, enrollee satisfaction survey results and comparison sheets that accurately summarize the requirements for eligibility and the health benefit plans and premiums offered by participating carriers in the plan.__The information provided must enable enrollees and potential enrollees to make informed decisions regarding their enrollment in the plan and their choice of health benefit plan.__Participating carriers may not provide any marketing materials to potential enrollees relating to benefits and premiums for the plan unless authorized by the board.

13.__Coordination with Medicaid. The board shall maximize the use of federal funds available through the Medicaid program to provide health care coverage to all individuals enrolled in the plan who are or could become eligible for Medicaid.

14.__Enrollee satisfaction survey.__On an annual basis, the board shall develop a survey to monitor the satisfaction of enrollees participating in the plan.__The results of the survey must be made available to enrollees and the public.

15.__Fund. The Maine Consumer Choice Health Plan Fund is created as a dedicated fund for the deposit of any funds borrowed for operating expenses and fees paid by enrollees for administration of the plan.__The fund may not lapse, but remains in a continuing carrying account to carry out the purposes of this chapter.

16.__Annual report.__Annually on or before February 1st, the board shall submit a report on the operation of the plan to the joint standing committee of the Legislature having jurisdiction over health insurance matters. The report must include information relating to the carriers participating in the plan; the health benefit plans offered through the plan and their premium rates; the total number of enrollees participating in the plan and sorted as to employer size; and the administrative and operating expenses of the plan.

SUMMARY

This bill establishes the Maine Consumer Choice Health Plan as an independent executive agency to negotiate and provide health care coverage to residents of Maine, including individuals and employers.