Section 031-856-4 - Establishment of Pooled Market1.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.02-031 C.M.R. ch. 856, § 4