An Act To Improve MaineCare and Promote Employment
Maine Legislature, Session 123, LD 1746
Committee Amendment CA_A_S319 (Senate)
Amends: 19-A MRSA §2001, 19-A MRSA §2012, 19-A MRSA §2202, 22 MRSA §14, 22 MRSA §18, 24-A MRSA §2847-M, 24-A MRSA §4253

COMMITTEE AMENDMENT ".II" to S.P. 613, L.D. 1746, Bill, "An Act To 
Improve MaineCare and Promote Employment" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 19-A MRSA §2001, sub-§5-A is enacted to read: 
5-A. Health plan. "Health plan" means a plan of a nonprofit hospital or medical 
service organization, an insurer, a health maintenance organization or a health insurance 
carrier licensed pursuant to Title 24 or 24-A; a health program administered by the 
department or the State in the capacity of provider of health coverage; or a plan of an 
employer, labor union or other group of persons organized in the State that provides 
health coverage to covered individuals who are employed or reside in the State. "Health 
plan" does not include a health plan that provides coverage only for accidental injury, 
specified disease, hospital indemnity, Medicare supplement, disability income. long-term 
care or other limited benefit health insurance policies and contracts. 
Sec.2. 19-A MRSA §2001, sub-§5-B is enacted to read: 
5-B. Medical care costs. "Medical care costs" means the costs of medical and 
health care for a child, including but not limited to the cost of enrollment or participation 
in or purchase of a health plan and any cash payment required of a parent for premium, 
copayment, deductible, coinsurance and routine and other medical expenses not covered 
by the health plan. Medical care costs reflect the cost of medical care ordinarily spent for 
the care of a child by parents living in the same household. 
Sec.3. 19-A MRSA §2001, sub-§5-C is enacted to read: 
5-C. Medical support. "Medical support" means support for a child's medical care 
costs. 
Sec.4. 19-A MRSA §2012 is enacted to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A " to S.P. 613, L.D. 1746 
§2012. Medical support 
The department, after consultation with the Supreme Judicial Court and interested 
parties, shall adopt rules in accordance with Title 5, chapter 375 establishing medical 
support. Rules adopted pursuant to this section are routine technical rules pursuant to 
Title 5, chapter 375, subchapter 2-A. 
Sec.5. 19-A MRSA §2202, sub-§13, as enacted by PL 2003, c. 20, Pt. K, §1 and 
amended by c. 689, Pt. B, §6, is further amended to read: 
13. Premium from noncustodial parents. The Department of Health and Human 
Services, Division of Support Enforcement and Recovery shall collect a premium from 
noncustodial parents whose children are MaineCare members and who have legally been 
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determined to be responsible for medical care contributions for these children. 
This subsection is repealed upon adoption of the final federal rules to implement the 
premium assistance provisions of the federal Deficit Reduction Act of2005. 
Sec. 6. 19-A MRSA §2202, sub-§13-A is enacted to read: 
13-A. 
Premium from noncustodial parents. The Department of Health and 
Human Services, Division of Support Enforcement and Recovery shall collect a premium 
from noncustodial parents whose children are MaineCare members, including those who 
receive assistance under Title 22, section 3174-T, and from parents who have legally 
been determined to be responsible for medical care contributions for these children but do 
not have access to other health insurance that is at a reasonable cost and that is accessible 
and comprehensive as determined by rules adopted by the department. The department 
shall adopt rules to establish a sliding scale for premiums required under this section in 
accordance with the sliding scale that is applied by the department to custodial parents 
under 42 United States Code. Section 13960-1 (2007) or 42 Code of Federal Regulations. 
Section 457.560 (2006). Rules adopted pursuant to this subsection are routine technical 
rules as described in Title 5. chapter 375. subchapter 2-A. This subsection takes effect 
upon adoption of the final federal rules to implement the premium assistance provisions 
of the federal Deficit Reduction Act of2005. 
Sec. 7. 22 MRSA §14, sub-§2-A, as amended by PL 2003, c. 20, Pt. K, §2, is 
further amended to read: 
2-A. 
Assignment of rights of recovery. 
The receipt of benefits under the 
MaineCare program constitutes an assignment by the recipient or any legally liable 
relative to the department of the right to recover from 3rd parties for the medical cost of 
injUl)', disease, disability or similar occurrence for which the recipient receives medical 
benefits. The department's assigned right to recover is limited to the amount of medical 
benefits received by the recipient and does not operate as a waiver by the recipient of any 
other right of recovery against a 3rd party that a recipient may have. 
The recipient is also deemed to have appointed the commissioner as the recipient's 
attorney in fact to perform the specific act of submitting claims to isstH'ftRee eftffiers or 
endorsisg o¥ef to the departtBest ~r an:d all dfafts, sheeks, mosey orders or aay other 
negotiable isstrHmests eosseeted with the paymest of 3FE1 party medieal slaims, making 
inquiries. requesting information, verifying other previous, current or potential coverage 
for the recipient or the recipient's spouse or dependents or endorsing over to the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A " to S.P. 613, L.D. 1746 
department any and all drafts, checks, money orders or any other negotiable instruments 
connected with the payment of 3rd-party medical claims to 3rd parties, liable parties or 
potentially liable 3rd parties. The appointment includes complete access to medical 
expense records and data, insurance policies and coverage and aU other information 
relating to MaineCare's duty to cost-avoid and seek other coverage or payment response. 
Sec. 8. 22 MRSA §14, suh-§2-H, ~A, as amended by PL 2003, c. 20, Pt. K, §2, 
is further amended to read: 
A. Whenever a participating health eare provider or the department submits claims to 
an a health insurer, as defined in Title 24 A, section 4, or to a health maintenance 
orgaRization included in 42 United States Code, Section I396a(a)(25)(I), including 
self-insured plans, group health plans as defined in the federal Employee Retirement 
Income Security Act of 1974, Section 607(1), service benefit plans, managed care 
organizations, pharmacy benefit managers or other parties that are, by statute, 
contract or agreement, legally responsible for payment of a claim for a health care 
item or service, on behalf of a current or former recipient under the MaineCare 
program for whom an assignment of rights has been received, or whose rights have 
been assigned by the operation of law, the health insurer or health maiRteRaftce 
orgaRization doing business in the State must respond to the department within 60 
days of receipt of a claim by forwardiRg payfHeRt or issuing a notice of deRial directly 
to the submitter of the claim. and: 
(I) Provide information, with respect to individuals who are eligible for or are 
provided medical assistance under MaineCare, upon the request of the State, to 
determine during what period the individual or the individual's spouse or 
dependents may be or may have been covered by a health insurer and the nature 
of the coverage that is or was provided by the health insurer. including the name, 
address and identifying number of the plan, in a manner prescribed by the United 
States Secretary of Health and Human Services; 
(2) Accept the State's right of recovery and the assignment to the State of any 
right of an individual or other entity to payment from the party for an item or 
service for which payment has been made under the state plan; 
(3) Respond to any inquiry by the State regarding a claim for payment for any 
health care item or service that is submitted not later than 3 years after the date of 
the provision of such health care item or service; and 
(4) Agree not to deny a claim submitted by the State solely on the basis of the 
date of submission of the claim, the type or format ofthe claim form or a failure 
to present proper documentation at the point-of-sale that is the basis of the claim, 
if: 
(a) The claim is submitted by the State within the 3-year period beginning on 
the date on which the item or service was furnished; and 
(b) Any action by the State to enforce its rights with respect to such claim is 
commenced within 6 years of the State's submission of such claim. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ':,4 " to S.P. 613, L.D. 1746 
Sec. 9. 22 MRSA §14, sub-§3, as amended by PL 2003, c. 20, Pt. K, §2, is further 
amended to read: 
3. Definitions. 
For purposes of this section, "3rd party" or "liable party" or 
"potentially liable party" means any entity, including, but not limited to, an insaranse 
sarrier any health insurer as included in 42 United States Code, Section 1396a(a)(25)(I) 
and any other parties that are, by statute, contract or agreement, legally responsible for 
payment of a claim for a health care item or service, that may be liable under a contract to 
provide health, automobile, workers' compensation or other insurance coverage that is or 
may be liable to pay all or part of the medical cost of injury, disease, disability or similar 
occurrence of an applicant or recipient of benefits under the MaineCare program. For 
purposes of this section and sections 18 and 19, an "insurance carrier" includes, but is not 
limited to, health insurers, group health plans as defined in 29 United States Code, 
Section 1167(1), service benefit plans and health maintenance organizations, as well as 
any other entity included in 42 United States Code, Section 1396a(a)(25)(1). 
"Liable party," "potentially liable party" or "3rd party" also includes the trustee or trustees 
of any mortuary trust established by the recipient or on the recipient's behalf in which 
there is money remaining after the actual costs of the funeral and burial have been paid in 
accordance with the terms of the trust and in which there is no provision that the excess 
be paid to the decedent's estate. "Liable party," "potentially liable party" or "3rd party" 
may also include the recipient of benefits under the MaineCare program. 
Sec. 10. 22 MRSA §18, sub-§l, as enacted by PL 1997, c. 795, §5, is amended to 
read: 
1. Program. The Private Health Insurance Premium Program is operated by the 
Bareau Office of Medieal MaineCare Services within the department and implements the 
provisions of 42 United States Code, Section 1396a(a}(25)(G) and 1396e. The office 
shall seek to maximize enrollment in the program by establishing procedures to identify 
families or individuals with access to other public or private insurance coverage and 
educating members and employers about the purpose and benefits of the program. 
Sec. 11. 24-A MRSA §2847-M is enacted to read: 
§2847-M. 
Enrollment for individuals or families establishing eligibility for 
MaineCare 
When an individual or family is eligible for MaineCare and is also eligible for health 
insurance coverage provided by an employer, the insurer must permit the individual or 
family to enroll in the health insurance coverage without regard to any enrollment season 
restrictions. 
Sec. 12. 24-A MRSA §4253 is enacted to read: 
§4253. Enrollment for individuals or families establishing eligibility for MaineCare 
When an individual or family is eligible for MaineCare and is also eligible for health 
maintenance organization coverage provided by an employer through a health 
maintenance organization, the health maintenance organization must permit the 
individual or family to enroll in the health maintenance organization coverage without 
regard to any enrollment season restrictions. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT 'A" to S.P. 613, L.D. 1746 
Sec. 13. Notification. The Commissioner of Health and Human Services shall 
notifY the joint standing committee of the Legislature having jurisdiction over health and 
human services matters and the Revisor of Statutes when the final federal rules to 
implement the premium assistance provisions of the federal Deficit Reduction Act of 
2005 have been adopted. 
Sec. 14. Retroactivity. Those sections of this Act that amend or repeal portions of 
the Maine Revised Statutes, Title 22, section 14 apply retroactively to the extent 
authorized by state or federal law. ' 
SUMMARY 
This amendment replaces the bill. 
It enacts provlSlons of child support law 
establishing medical support requirements and expands the option of buying into 
MaineCare coverage for parents and children who lose MaineCare eligibility due to 
increased income. It incorporates the assignment of rights of recovery and honoring of 
assignments applicable to members in the MaineCare program as those provisions were 
enacted in the biennial budget, PL 2007, chapter 240, Part JJJ, sections 1, 2 and 4 and 
applies them retroactively to the extent authorized by law. It maximizes use of the 
Private Health Insurance Premium Program in MaineCare. It allows persons eligible for 
MaineCare and for coverage through an employer to enroll in group health insurance 
plans and health maintenance organization coverage without waiting for the next open 
enrollment period. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 06/13/07 
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LD 1746 
LR370(02) 
An Act To Improve MaineCare and Promote Employment 
Fiscal Note for Bill as Amended by Committee Amendment ''A " 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Potential current biennium savings - General Fund 
Minor cost increase - General Fund 
The bill could result in increased savings to the MaineCare program. The amount of these savings cannot be 
determined at this time and will be affected by similar initiatives included in PL 2007, c. 240, the 2008-2009 biennial 
bUdget. The costs to the Department of Health and Human Services of implementing this bill can be absorbed 
utilizing existing budget resources. 
LR0370(02) - Fiscal Note - Page 1 of 1