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6. Funds obtained through the recovery of bad debt and charity care. 370 This idea is basedon the premise that bad debt and charity care is shifted to higher provider rates andpremiums. By providing affordable access to health insurance, Maine is anticipating thatsavings in the health care system will be obtained though reducing the amount of charitycare. If health system savings can be documented, the state will recoup some of thecosts of bad debt and charity care through levying up to 4 percent of insurers’ revenue tohelp fund the Dirigo Health Plan (though this is not mandatory). 3717. Maine is also relying on the successful implementation of several other cost containmentstrategies to keep the program affordable. These efforts include:a) Certificate of Need (CON) changes: 372• Expanded to include ambulatory surgery centers and doctors’ offices.• Requirement for review predicated on function and cost as opposed to site ofcare.• Capital Investment Fund to establish a statewide budget for capitalexpenditures and “to ensure a wise and appropriate allocation of resources”(expenditures must not exceed the limitations of the fund).• Reviews investments in new technologies costing more than $1.2 million andcapital expenditures over $2.4 million.b) Insurance Overview: expands individual coverage rate review to small groupproducts. Carriers will also be required to report administrative costs andunderwriting gain. 373c) Voluntary Limits on Growth of Insurance Premiums and Health Care Costs:Hospitals and other providers are asked to voluntarily limit their cost growth to 3percent and their operating margins to 3.5 percent. Insurers are also being asked tolimit their operating margin to 3.5 percent. 374d) Hospital Planning: The Commission to Study Maine’s Hospitals will conductanalysis of Maine’s hospitals, including an analysis of hospital finances, structures,roles, reimbursement, capital, technology, staffing needs, other pertinent areas ofstudy. 375Dirigo Health BenefitsThe benefits offered by Dirigo Health are:• Traditional services including inpatient and outpatient hospital care, 376 physician andspecialist visits, emergency services and prescription drugs.• Disease management, and health promotion and wellness initiatives.• Preventive services such as routine physicals, blood tests, Pap test, flu shots,mammograms and well-baby care.• Routine diagnostic tests, X-rays and surgery.• Occupational, speech and physical therapy.• Chiropractic services.• Skilled nursing care facility.• Ambulance services.• Cardiac rehabilitation.• Durable Medical Equipment.C-28