‘An Act To Allow for a Contingency Fee Agreement with a MaineCare Program Integrity Recovery Audit Contractor’
| SP0539 LD 1629 |
Second Regular Session - 125th Maine Legislature C "A", Filing Number S-470, Sponsored by
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LR 2491 Item 2 |
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| Bill Tracking, Additional Documents | Chamber Status | ||
Amend the bill by striking out the title and substituting the following:
‘An Act To Allow for a Contingency Fee Agreement with a MaineCare Program Integrity Recovery Audit Contractor’
Amend the bill by striking out everything after the title and before the summary and inserting the following:
‘Emergency preamble. Whereas, acts and resolves of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, the detection of errors in reimbursement and the collection of overpayments and correction of underpayments for services in the MaineCare program within the Department of Health and Human Services are critical to the integrity of the program and to compliance with the requirements of federal law; and
Whereas, initiating the services of a recovery audit contractor for the MaineCare program in a timely manner is important to the fiscal integrity of the program and to compliance with federal law; and
Whereas, in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore,
Sec. 1. 22 MRSA §13-A is enacted to read:
§ 13-A. MaineCare program integrity recovery audit contractor agreement
Notwithstanding any other provision of law to the contrary, the provisions of this section apply to MaineCare program integrity recovery audit contracting. The department may enter into an agreement with a recovery audit contractor for the purpose of ensuring MaineCare program integrity, specifically to identify and reimburse to correct underpayments and to identify and recoup overpayments under the Medicaid state plan and under any waiver of the state plan. An agreement entered into under this section must provide that payment to the contractor may be made only from amounts recovered and that payments for identifying underpayments and collecting overpayments must be made on a contingent fee basis. After payments to correct underpayments and payment of any contingent fees due to the contractor, the proceeds of collections from overpayments must be deposited into the Medical Care - Payments to Providers program, Other Special Revenue Funds account in the Department of Health and Human Services for the purpose of providing state match under the federal Medicaid program.
Emergency clause. In view of the emergency cited in the preamble, this legislation takes effect when approved.’
SUMMARY
This amendment is the majority report of the committee. This amendment adds an emergency preamble and emergency clause to the bill. It changes the title of the bill. It retains the provisions of the bill that authorize the Department of Health and Human Services to enter into agreements for the purpose of ensuring Maine Care program integrity with a recovery audit contractor as required under Section 6411 of the federal Patient Protection and Affordable Care Act, Public Law 111-148. It clarifies that the audits are intended to identify and correct underpayments and identify and recoup overpayments. It requires an agreement to provide that the contractor may be paid only from amounts recovered and that payments for identifying underpayments and collecting overpayments must be made on a contingent fee basis. It adds a requirement that the overpayments collected, less the contingent fees paid to the contractor, are paid into the Medical Care - Payments to Providers program, Other Special Revenue Funds account in the Department of Health and Human Services.