An Act To Enact the Made for Maine Health Coverage Act and Improve Health Choices in Maine
Sec. A-1. 22 MRSA c. 1479 is enacted to read:
MADE FOR MAINE HEALTH COVERAGE ACT
§ 5401. Short title
This Act may be known and cited as "the Made for Maine Health Coverage Act."
§ 5402. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
§ 5403. Maine Health Insurance Marketplace established
The Maine Health Insurance Marketplace is established to conduct the functions defined in 42 United States Code, Section 18031(d)(4). The purpose of the marketplace is to benefit the State's health insurance market and persons enrolling in health insurance policies, facilitate the purchase of qualified health plans, reduce the number of uninsured individuals, improve transparency and conduct consumer education and outreach.
§ 5404. Powers and duties of the commissioner
(1) Educated health care consumers who are enrollees in qualified health plans;
(2) Individuals and entities with experience in facilitating enrollment in qualified health plans;
(3) Representatives of small businesses and self-employed individuals;
(4) Representatives and members of the MaineCare program;
(5) Advocates for enrolling hard-to-reach populations;
(6) Representatives of the Passamaquoddy Tribe, the Penobscot Nation, the Houlton Band of Maliseet Indians and the Aroostook Band of Micmacs, appointed by the tribes' respective chiefs in consultation with their tribal councils;
(7) Representatives of health care providers;
(8) Representatives of insurance carriers;
(9) Representatives of insurance producers; and
(10) Any other groups or representatives required by the federal Affordable Care Act and recommended by the commissioner;
§ 5405. Maine Health Insurance Marketplace Trust Fund
§ 5406. User fees
The commissioner shall charge a user fee to all carriers that offer qualified health plans in the marketplace. The user fee must be paid monthly by the carrier and deposited into the marketplace trust fund and may be used only for marketplace functions. The user fee must be applied at a rate that is a percentage of the total monthly premium charged by a carrier for each qualified health plan sold in the marketplace and may not exceed the total user fee rate charged by the Federal Government for use of the federally facilitated exchange during plan year 2020. The rate is 0.5% during any period that the State is using the federal platform as described in 45 Code of Federal Regulations, Section 155.200(f) and 3% during any period that the State is performing all the functions of a state-based marketplace as described in 45 Code of Federal Regulations, Section 155.200.
§ 5407. Rulemaking
The commissioner may adopt rules as necessary for the proper administration and enforcement of this chapter. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. Rules adopted pursuant to this section must be consistent with the federal Affordable Care Act and state law.
§ 5408. Technical assistance from other state agencies
State agencies, including but not limited to the Department of Professional and Financial Regulation, Bureau of Insurance, the Department of Administrative and Financial Services, Bureau of Revenue Services and the Maine Health Data Organization, shall provide technical assistance and expertise to the marketplace upon request.
§ 5409. Records
Except as provided in this section or by other provision of law, information obtained by the marketplace under this chapter is a public record within the meaning of Title 1, chapter 13, subchapter 1.
§ 5410. Relation to other laws
Nothing in this chapter and no action taken by the marketplace pursuant to this chapter may be construed to preempt or supersede the authority of the superintendent to regulate the business of insurance within this State.
§ 5411. Reporting
Beginning in 2021 and annually thereafter, the marketplace shall submit a report to the Governor and the Legislature summarizing enrollment, the affordability of health insurance for consumers using the marketplace, marketing activity and operations. This report must be submitted no later than 45 days after the end of the open enrollment period.
Sec. B-1. 24-A MRSA c. 34-A is enacted to read:
STATE-FEDERAL HEALTH COVERAGE PARTNERSHIPS
§ 2781. State-federal health coverage partnerships
Sec. B-2. 24-A MRSA c. 34-B is enacted to read:
POOLED MARKET AND CLEAR CHOICE DESIGN
§ 2791. Affordable health coverage for individuals, families and small businesses
§ 2792. Clear choice designs
The superintendent shall develop clear choice designs for the individual and small group health insurance markets in order to reduce consumer confusion and provide meaningful choices for consumers by promoting a level playing field on which carriers compete on the basis of price and quality.
Sec. B-3. 24-A MRSA §2808-B, sub-§2, ¶E, as amended by PL 2019, c. 96, §1, is repealed and the following enacted in its place:
(1) Association group membership or eligibility for participation in the trustee group may not be conditioned on health status, claims experience or other risk selection criteria.
(2) All health plans offered by the carrier through that association or trustee group must be made available on a guaranteed issue basis to all eligible employers that are members of the association or are eligible to participate in the trustee group except that a professional association may require that a minimum percentage of the eligible professionals employed by a subgroup be members of the association in order for the subgroup to be eligible for issuance or renewal of coverage through the association. The minimum percentage must not exceed 90%. For purposes of this subparagraph, "professional association" means an association that:
(a) Serves a single profession that requires a significant amount of education, training or experience or a license or certificate from a state authority to practice that profession;
(b) Has been actively in existence for 5 years;
(c) Has a constitution and bylaws or other analogous governing documents;
(d) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(e) Is not owned or controlled by a carrier or affiliated with a carrier;
(f) Has at least 1,000 members if it is a national association; 200 members if it is a state or local association;
(g) All members and dependents of members are eligible for coverage regardless of health status or claims experience; and
(h) Is governed by a board of directors and sponsors annual meetings of its members.
(3) The aggregate rate charged by the carrier to the association or trustee group is considered a large group rate, and the terms of coverage are considered a large group health plan. Rates for participating employers within the group may vary only as permitted by paragraphs B to D-2.
(4) Producers may only market association memberships, accept applications for membership or sign up members in a professional association in which the individuals are actively engaged in or directly related to the profession represented by the professional association.
(5) Carriers may not be reinsured under section 3958 for coverage issued under this paragraph.
(6) Except for employers with plans that have grandfathered status under the federal Affordable Care Act, this paragraph does not apply to policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2014 until December 31, 2019. To the extent permitted under the federal Affordable Care Act, this paragraph applies to policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2020.
Sec. B-4. 24-A MRSA §2808-B, sub-§2-A, as amended by PL 2009, c. 244, Pt. C, §7 and c. 439, Pt. D, §1, is further amended to read:
Sec. B-5. 24-A MRSA §2808-B, sub-§2-B, as amended by PL 2011, c. 364, §15, is further amended to read:
Sec. B-6. 24-A MRSA §2808-B, sub-§2-C, as amended by PL 2011, c. 364, §16, is further amended to read:
Sec. B-7. 24-A MRSA §3952, sub-§4-A is enacted to read:
Sec. B-8. 24-A MRSA §3952, sub-§5-A is enacted to read:
Sec. B-9. 24-A MRSA §3952, sub-§6, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:
Sec. B-10. 24-A MRSA §3952, sub-§9, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:
Sec. B-11. 24-A MRSA §3953, sub-§1, as amended by PL 2017, c. 124, §1, is further amended to read:
(1) An innovation waiver under Section 1332 of the federal Affordable Care Act as contemplated by paragraphs B and C is granted; or
(2) The federal Affordable Care Act is repealed or amended in a manner that makes the granting of an innovation waiver unnecessary or inapplicable.
Sec. B-12. 24-A MRSA §3955, sub-§1, ¶D, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:
Sec. B-13. 24-A MRSA §3955, sub-§1, ¶E, as amended by PL 2011, c. 621, §2, is repealed.
Sec. B-14. 24-A MRSA §3955, sub-§2, ¶H, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:
Sec. B-15. 24-A MRSA §3956, sub-§3, ¶C, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:
Sec. B-16. 24-A MRSA §3957, sub-§9, as enacted by PL 2011, c. 90, Pt. B, §8, is repealed.
Sec. B-17. 24-A MRSA §3958, as amended by PL 2011, c. 621, §§4 and 5, is further amended to read:
§ 3958. Reinsurance; premium rates
(1) The association shall reimburse member insurers based on the total eligible claims paid during a calendar year for a single individual in excess of the attachment point specified by the board. The board may establish multiple layers of coverage with different attachment points and different percentages of claims payments to be reimbursed by the association.
(2) Eligible claims by all individuals enrolled in individual or small group health plans in this State may not be disqualified for reimbursement on the basis of health conditions, predesignation by the member insurer or any other differentiating factor.
(3) The board shall annually review the attachment points and coinsurance percentages and make any adjustments that are necessary to ensure that the retrospective reinsurance program operates on an actuarially sound basis.
(4) The board shall ensure that any surplus in the retrospective reinsurance program at the conclusion of a plan year is used to lower attachment points, increase coinsurance rates or both for that plan year, consistent with its responsibility to ensure that the program operates on an actuarially sound basis.
Sec. B-18. 24-A MRSA §3959, sub-§1, ¶A, as enacted by PL 2011, c. 621, §6, is amended to read:
Sec. B-19. 24-A MRSA §3959, sub-§5 is enacted to read:
Sec. B-20. 24-A MRSA §3961, as amended by PL 2011, c. 621, §§7 and 8, is repealed.
Sec. B-21. 24-A MRSA §3962, as amended by PL 2015, c. 404, §§2 and 3, is repealed.
Sec. B-22. 24-A MRSA §3963 is enacted to read:
§ 3963. State-federal health coverage partnerships involving the association
Sec. C-1. 24-A MRSA §4320-A, as amended by PL 2017, c. 343, §1, is further amended to read:
§ 4320-A. Coverage of preventive and primary health services
Notwithstanding any other requirements of this Title, a carrier offering a health plan in this State shall, at a minimum, provide coverage for and may not impose cost-sharing requirements for preventive and primary health services as required by this section.
Sec. C-2. Notification regarding fulfillment of contingency. Upon adoption of routine technical rules and notification from the Federal Government of its approval of a state innovation waiver amendment in accordance with the Maine Revised Statutes, Title 24-A, section 2791, subsection 5, the Superintendent of Insurance shall notify the Secretary of State, the Secretary of the Senate, the Clerk of the House of Representatives and the Revisor of Statutes that the contingencies set forth in section 2791, subsection 5 have been met.
Sec. C-3. Revisor's review; cross-references. The Revisor of Statutes shall review the Maine Revised Statutes and include in the errors and inconsistencies bill submitted to the First Regular Session of the 130th Legislature pursuant to Title 1, section 94 any sections necessary to correct and update any cross-references in the statutes to provisions of law repealed in this Act.
1. Establishes the Made for Maine Health Coverage Act;
2. Establishes the Maine Health Insurance Marketplace Trust Fund;
3. Authorizes the State to enter into state-federal health coverage partnerships that support the availability of affordable health coverage;
4. Establishes a pooled market for individual health plans and small group health plans and changes reinsurance to be retrospective and applied to the pooled market; and
5. Creates clear choice design for cost sharing and requires coverage of certain primary care and behavioral health visits without the application of any deductible.