LD 2627
pg. 2
Page 1 of 4 An Act to Create the Community Health Plan Demonstration Project Page 3 of 4
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LR 4069
Item 1

 
employers, not to exceed 500 covered lives, to be known
as the "target risk pool";

 
(2)__An affordable benefit design;

 
(3)__A premium structure sufficient to cover the
actuarially determined costs of comprehensive health
care services;

 
(4)__Premium subsidies or a sliding premium schedule
for uninsured individuals funded, in part, through a
waiver of the premium tax;

 
(5)__Community preventive care and wellness programs;
and

 
(6)__Reinsurance for catastrophic individual claims and
claims beyond a specified aggregate limit.

 
3.__Project oversight.__The Superintendent of Insurance in
conjunction with the Commissioner of Human Services shall oversee
the implementation of the project by the Mount Desert Island
Community Health Plan or its successor organization.

 
4.__Fund established.__The Community Health Plan Demonstration
Project Guaranty Fund is established for the purpose of covering
potential losses, which may be from reimbursement of claims that
are in excess of income from premiums but not covered by
reinsurance, incurred by the target risk pool during a defined 3-
year benefit period of the project.__The money in the fund may
not lapse but must be carried forward for the purposes identified
in this section.__After final reconciliation of claims at the end
of the 3-year benefit period, any unexpended funds of the fund
must lapse to the General Fund.

 
5.__Exemption.__This project is exempt from the provisions of
other chapters of this Title and Title 22, Title 24-A and Title
36.

 
6.__Assistance.__The Superintendent of Insurance may provide
technical assistance to the Mount Desert Island Community Health
Plan or its successor organization with respect to premium
structure, benefit design, reinsurance and other issues related
to the project.__The Department of Human Services may provide
technical assistance to the Mount Desert Island Community Health
Plan or its successor organization with respect to health quality
and outcome evaluation, community outreach and prevention
strategies and other issues related to the project.

 
7.__Duration.__The project terminates January 1, 2004.


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