LD 1356
pg. 3
Page 2 of 5 An Act To Provide Fair Hearing Procedures in the Department of Human Services ... Page 4 of 5
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LR 1441
Item 1

 
§48.__Provider ombudsman

 
The department shall establish a provider ombudsman to
assist providers in addressing and resolving in a cost-
effective and expeditious fashion any controversies,
disagreements or contests between the department and
individual providers or groups of providers.__The provider
ombudsman is authorized to receive and shall investigate
complaints and concerns of providers regarding the
administration of the MaineCare program and payment issues.__
The provider ombudsman has access to the commissioner and may
bring issues to the attention of the commissioner for prompt
resolution.__The provider ombudsman shall inform providers of
their rights, entitlements and obligations under state and
federal laws and shall assist providers in asserting their
legal rights.__In contested proceedings, the provider
ombudsman may advocate for the provider in circumstances where
the provider ombudsman determines this advocacy is necessary
or appropriate.

 
Sec. A-3. Provider ombudsman; funding. The Department of Human
Services shall establish the provider ombudsman pursuant to
the Maine Revised Statutes, Title 22, section 48 using
existing resources by assigning these duties to existing
personnel in an office within the department that does not
have direct enforcement or reimbursement responsibilities with
respect to providers.

 
PART B

 
Sec. B-1. 22 MRSA §13, sub-§6 is enacted to read:

 
6.__Limitation on actions to recover overpayments.__The
department may not impose any sanction or withhold any
payments from a service provider in order to recover
overpayment for services rendered or goods delivered under the
MaineCare program unless, upon petition to the Superior Court,
an order is entered allowing interim sanctions upon a showing
by the department of a substantial likelihood that overpayment
or fraud has occurred and no harm to the public will occur due
to interruption of services.

 
Sec. B-2. 22 MRSA §1714-A, sub-§5, as enacted by PL 1991, c. 568, §4,
is repealed.

 
PART C

 
Sec. C-1. PL 2001, c. 464, §2 is repealed.


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