Current through 2024-38, September 18, 2024
1.
Review of
Expected Savings. The Superintendent shall commence the implementation
process by evaluating the expected premium savings, if any, resulting from the
implementation of the pooled market and the Association's reinsurance program.
A. The Superintendent shall conduct an
actuarial analysis of the expected premium impact of the pooled market and the
reinsurance program, and shall consider any other analyses that may be provided
by the Association or by members of the public. The Association shall provide
its estimate of the impact of pooling the market on anticipated reinsurance
parameters for the provisional implementation year, including attachment
points, coinsurance percentages, and any reinsurance caps and ceding
premiums.
B. The Superintendent
shall solicit public input on the expected impact of the pooled market and the
reinsurance program, and suggestions for additional or alternate initiatives to
improve the stability and affordability of the small group market.
C. The Superintendent shall hold at least one
forum where the public may provide comments and ask questions. This requirement
may be satisfied by a forum or hearing held in connection with the preliminary
application process for an innovation waiver amendment under subsection 3.
2.
Superintendent's Projection of Expected Savings. After
considering the available information on expected premium savings and the
feedback received pursuant to subsection 1, the Superintendent shall decide
whether to proceed with the scheduled implementation of the pooled market and
the extension of the Association's reinsurance program to small employers. The
Superintendent shall issue a projection comparing expected health insurance
premiums for individuals and small employers, if the pooled market is
implemented and is reinsured by the Association in accordance with section 6,
to a baseline with no pooled market and no subsidized reinsurance program.
A. If the Superintendent finds that the
average premium for individuals in the pooled market scenario is expected to be
the same or lower than the average premium for the individual market in the
baseline scenario, and that the average premium for small employers in the
pooled market scenario is expected to be the same or lower than the average
premium for the small group market in the baseline scenario, the Superintendent
shall proceed with the implementation process as provided in subsections 3 and
4.
B. If the Superintendent does
not find, in accordance with paragraph A, that the pooled market scenario is
expected to avoid adverse premium impacts for both individuals and small
employers in the provisional implementation year, the Superintendent shall
defer implementation as provided in subsection 6.
3.
State-Federal Partnership
Applications. The Superintendent shall initiate planning for an
innovation waiver amendment as part of the review process conducted under
subsection 1.
A. The Superintendent shall
ensure timely compliance with all applicable application
requirements.
B. In addition to the
pooled market and pooled reinsurance program, an innovation waiver application
may also include any other provisions that would improve the stability and
affordability of the small group market or would otherwise benefit the
operation of Maine's health insurance market.
C. Whether or not the pooled market is
implemented, the Superintendent shall consider whether there are any other
opportunities for state-federal partnerships, as defined in
24-A M.R.S.
§2781, or private funding, that would
provide additional resources for the Association or otherwise benefit the
operation of Maine's health insurance market, and initiate or coordinate
applications as the Superintendent considers appropriate.
D. The Superintendent shall ensure that the
Association and all other interested parties have a meaningful opportunity for
input in developing any application submitted under Paragraphs A through
C.
4.
Final
Decision Whether to Implement Pooled Market. The Superintendent shall
issue a final decision on implementation of the pooled market after considering
any actions taken on applications submitted in accordance with subsection 3 and
any new information obtained while such applications are pending. The
provisional implementation year shall be confirmed as the implementation year
unless:
A. The innovation waiver amendment is
denied, or federal authorities have failed to act on the innovation waiver
amendment in time for it to be feasible to implement the pooled the market in
the provisional implementation year;
B. The Superintendent finds that the proposed
terms and conditions of an approved innovation waiver amendment would not be
expected to avoid adverse premium impacts for both individuals and small
employers; or
C. The
Superintendent finds that in light of new and persuasive information about
recent or expected market experience, it is no longer expected that the
implementation of the proposed innovation waiver amendment would avoid adverse
premium impacts for both individuals and small employers.
5.
Reconsideration. If the
Superintendent determines, after issuing a decision to implement or defer
implementation of the pooled market, that the decision might no longer be
appropriate due to extraordinary circumstances that have subsequently arisen,
and that it is still feasible to rescind or modify the decision, the
Superintendent may issue public notice and reopen the evaluation process under
this section. Extraordinary circumstances include, without limitation, the
availability of a new funding source for the Association, the loss of an
existing funding source, or new information that results in a substantial
increase or decrease in expected premium savings for the provisional
implementation year.
6.
Decision to Defer Implementation. If the Superintendent
decides, pursuant to paragraph 2(B) or subsection 4, not to proceed with the
scheduled implementation of the pooled market, the Superintendent shall:
A. Conduct an analysis of alternative
proposals to improve the stability and affordability of the small group
market;
B. Designate a new
provisional implementation year; and
C. Withdraw any pending application that is
dependent on pooling the market, or make any necessary modifications to
postpone the effective date of the proposal.
