J. A health maintenance organization that offers coverage to groups in this State shall offer to groups of all sizes health benefit plans that meet the requirements for standardized health plans specified in Bureau of Insurance Rule Chapter 750.

K. The health maintenance organization provides a spectrum of providers and services that meet patient demand.

L. The health maintenance organization meets the requirements of section 4303, subsection 1.

M. The health maintenance organization demonstrates a plan for providing services for rural and underserved populations and for developing relationships with essential community providers within the area of the proposed certificate. The health maintenance organization must make an annual report to the superintendent regarding the plan.

N. Beginning July 1, 1995, a health maintenance organization that offers coverage to groups in the State shall offer coverage for purchase by individuals.

O. Each health maintenance organization shall provide basic health care services.

The applicant shall furnish, upon request of the superintendent, any information necessary to make any determination required pursuant to this subsection.

Sec. 9. 24-A MRSA §6203, sub-§1, ¶A, as enacted by PL 1987, c. 482, §1, is amended to read:

A. The provider has submitted to the department an application for a certificate of need, if required under Title 22, section 304-A, and the department has submitted a preliminary report of a recommendation for approval of a certificate of need and the provider has applied for any other licenses or permits required prior to operation.

Sec. 10. 24-A MRSA §6203, sub-§1, ¶G, as enacted by PL 1995, c. 452, §11, is amended to read:

G. The department has approved the adequacy of all services proposed under the continuing care agreement not otherwise reviewed under the certificate of need process.

Sec. 11. 24-A MRSA §6203, sub-§2, as amended by PL 1995, c. 452, §§12 to 16, is further amended to read:

2. Final certificate of authority. The superintendent shall issue a final certificate of authority, subject to annual renewal, when:

A. The provider has obtained any required certificate of need or other permits or licenses required prior to construction of the facility;

C. The superintendent is satisfied that the provider has demonstrated that it is financially responsible and shall may reasonably be expected to meet its obligations to subscribers or prospective subscribers;

D. The superintendent has determined that the provider's continuing care agreement meets the requirements of section 6206, subsection 3, and the rules promulgated in this chapter; and

G. The provider certifies to the superintendent either:

(1) That preliminary continuing care agreements have been entered and deposits of not less than 10% of the entrance fee have been received either:

(a) From subscribers with respect to 70% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or

(b) From subscribers with respect to 70% of the total entrance fees due or expected at full occupancy of the community; or

(2) That preliminary continuing care agreements have been entered and deposits of not less than 25% of the entrance fee received from either:

(a) Subscribers with respect to 60% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or

(b) Subscribers with respect to 60% of the total entrance fees due or expected at full occupancy of the community.

Within 120 days after determining that the application to the superintendent and the department is complete, the superintendent shall issue or deny a final certificate of authority to the provider, unless a certificate of need is required, in which case the final certificate of authority shall be issued or denied in accordance with the certificate of need schedule.

Sec. 12. 24-A MRSA §6226, as enacted by PL 1987, c. 563, §7, is repealed.

Sec. 13. 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 Second Regular Session of the 120th 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.

SUMMARY

Under current law, before introducing additional health care services and procedures in a market area, a person must apply for and receive a certificate of need from the Department of Human Services. This bill eliminates that requirement.