Sec. 1. 22 MRSA §13, sub-§6, ¶B, as enacted by PL 2003, c. 419, §1, is amended to read:

B. Notwithstanding paragraph A, the department may terminate or suspend the participation of a provider in the MaineCare program in lieu of recoupment pending final determination regarding an overpayment as long as 30 days' notice is given pursuant to federal and state guidelines.

Sec. 2. 22 MRSA §13, sub-§6, ¶C is enacted to read:

C.__For the purposes of this subsection, "overpayment" does not include an overestimate made as part of a prospective interim payment, 3rd-party liability recovery, departmental administrative error or receivership fees or debt.

Sec. 3. 22 MRSA §42, sub-§7, ¶H, as enacted by PL 2003, c. 419, §2, is amended to read:

H. In an administrative appeal of an informal review decision under this subsection, the department bears the burden of proving a violation of law or rule by a preponderance of the evidence. If the department proves that records of goods or services are defective, the department may impose the a penalty or sanction of, including total recoupment.__Total recoupment is warranted only when the provider has failed to demonstrate by a preponderance of the evidence that the disputed goods or services were actually provided to eligible MaineCare members.

SUMMARY

This bill clarifies that for purposes of recovering overpayments to providers under the MaineCare program, overpayments do not include overestimates made as part of prospective interim payments, 3rd-party liability recovery, departmental administrative error or receivership fees or debt. The bill also clarifies that if the Department of Human Services proves that records of goods or services are defective, it may impose a penalty or sanction, which may include total recoupment.