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PUBLIC LAWS OF MAINE
First Regular Session of the 121st

CHAPTER 419
S.P. 444 - L.D. 1356

An Act To Improve Complaint Resolution and Hearing Procedures in the Department of Human Services

Be it enacted by the People of the State of Maine as follows:

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

     6. Limitation on actions to recover overpayments. The department may impose a sanction or withhold payment from a MaineCare provider in order to recover or impose penalties for an overpayment for services rendered or goods delivered under the MaineCare program as provided in this subsection.

     Sec. 2. 22 MRSA §42, sub-§7, as enacted by PL 2001, c. 666, Pt. C, §1, is amended to read:

     7. Appeal process. The department shall amend the rules governing appeals of informal review decisions of Medicaid MaineCare payment and cost report audit and review issues filed by MaineCare providers of nursing facility services and medical and remedial private nonmedical institution services of goods and services or initiated by the department and any other informal review decisions that seek to impose repayment, recovery or recoupment obligations or sanctions or fines on providers as provided in this subsection.

The department shall provide funding for contractual services under this subsection from within existing resources.

     Sec. 3. 22 MRSA §48 is enacted to read:

§48. Provider relations

     Department personnel assigned to MaineCare provider relations shall assist MaineCare providers in addressing and resolving in a cost-effective and expeditious manner any disagreements between the department and providers or groups of providers. Provider relations personnel shall receive and investigate complaints and concerns from providers regarding the MaineCare program and the MaineCare reimbursement prior to informal review or administrative hearing. In performing their duties under this subsection, the provider relations personnel must have access to the Director of the Bureau of Medical Services. The department shall implement the provisions of this section within existing resources.

     Sec. 4. 22 MRSA §1714-A, sub-§2, as amended by PL 2001, c. 596, Pt. B, §4 and affected by §25, is further amended to read:

     2. Establishment of debt. A debt is established by the department when it notifies a provider of debt that the provider owes the department pursuant to a final reconciliation decision and order that constitutes final agency action. A debt is collectible by the department 31 days after exhaustion of all administrative appeals and any judicial review available under Title 5, chapter 375.

     Sec. 5. 22 MRSA §1714-A, sub-§5, as enacted by PL 1991, c. 568, §4, is amended to read:

     5. Department may offset. The department may offset against current reimbursement owed to a provider or any entity related by ownership or control to that provider any debt it is owed by that provider after the debt becomes collectible. The department shall adopt rules that implement this subsection and define the ownership or control relationships that are subject to an offset under this subsection. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

     Sec. 6. Complaint resolution and informal hearing process recommendations. By January 5, 2004, the Department of Human Services and the Department of Behavioral and Developmental Services, in conjunction with their duties with regard to merger of the 2 departments under Public Law 2003, chapter 20, Part K, section 18, shall report to the Joint Standing Committee on Health and Human Services recommendations to improve the MaineCare complaint resolution and informal hearing process that ensure that MaineCare providers receive fair and impartial complaint resolution procedures and informal hearings.

Effective September 13, 2003, unless otherwise indicated.

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