An Act To Allow the State Timely Opportunity To Participate in Settlement Negotiations for MaineCare Benefits
Maine Legislature, Session 123, LD 1566
Senate Amendment SA_A_S306 (Senate)
Amends: 22 MRSA §14

SENATE AMENDMENT "A " to H.P. 1091, L.D. 1566, Bill, "An Act To Allow 
the State Timely Opportunity To Participate in Settlement Negotiations for MaineCare 
Benefits" 
Amend the bill by striking out all of section 1 and inserting the following: 
'Sec. 1. 22 MRSA §14, suh-§l, as amended by PL 2003, c. 20, Pt. K, §2, is 
further amended to read: 
1. Recovery procedures. When benefits are provided or will be provided to a 
member under the MaineCare program administered by the department pursuant to the 
United States Social Security Act, Title XIX, including any prescription drug programs 
administered under the auspices of MaineCare, referred to collectively in this section as 
MaineCare, for the medical costs of injury, disease, disability or similar occurrence for 
which a 3rd party is, or may be, liable, the commissioner may recover from that party the 
cost of the benefits provided. This right of recovery is separate and independent from any 
rights or causes of action belonging to a member under the MaineCare program. For 
MaineCare recipients who participated in the MaineCare managed care program, "cost" 
means the total value of coverable medical services provided measured by the amount 
that MaineCare would have paid to providers directly for such services, were it not for the 
managed care system. The MaineCare program is the payor of last resort and shall 
provide medical coverage only when there are no other available resources. The Attorney 
General, or counsel appointed by the Attorney General, may, to enforce this right, 
institute and prosecute legal proceedings directly against the 3rd party in the appropriate 
court in the name of the commissioner. 
In addition to the right of recovery set forth in this subsection, the commissioner must 
also be subrogated, to the extent of any benefits provided under the MaineCare program, 
to any cause of action or claim that a member has against a 3rd party who is or may be 
liable for medical costs incurred by or on behalf of the member. The Attorney General, 
or counsel appointed by the Attorney General, to enforce this right may institute and 
prosecute legal proceedings in the name of the injured person, member, guardian, 
personal representative, estate or survivor. If necessary to enforce the commissioner's 
right of recovery, the Attorney General, or counsel appointed by the Attorney General, 
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SENATE AMENDMENT "A " to H.P. 1091, L.n. 1566 
may institute legal proceedings against any member, including the agent, representative 
or attorney of that member, who has received a settlement or award from a 3rd party. 
The commissioner's right to recover the cost of benefits provided constitutes a statutory 
lien on the proceeds of an award or settlement from a 3rd party if recovery for MaineCare 
costs was or could have been included in the recipient's claim for damages from the 3rd 
party to the extent of the recovery for medical expenses. The commissioner is entitled to 
recover the cost of the benefits actually paid out when the commissioner has determined 
that collection will be cost-effective to the extent that there are proceeds available for 
such recovery after the deduction of reasonable attorney's fees and litigation costs from 
the gross award or settlement. In determining whether collection will be cost-effective, 
the commissioner shall consider all factors that diminish potential recovery by the 
department, including but not limited to questions of liability and comparative negligence 
or other legal defenses, exigencies of trial that reduce a settlement or award in order to 
resolve the recipient's claim and limits on the amount of applicable insurance coverage 
that reduce the claim to the amount recoverable by the recipient. The department's 
statutory lien may not be reduced to reflect an assessment of a pro rata share of the 
recipient's attorney's fees or litigation costs. 
The commissioner may, at the 
commissioner's discretion, compromise, or otherwise settle and execute a release of, any 
claim or waive any claim, in whole or in part, if the commissioner determines the 
collection will not be cost-effective or that the best possible outcome requires 
compromise, release or settlement. 
Sec. 2. 22 MRSA §14, sub-§2-D, as amended by PL 2003, c. 20, Pt. K, §2, is 
further amended to read: 
2-D. Notification of claim. A recipient under the MaineCare program, or any agent, 
representative or attorney representing a recipient under the MaineCare program, who 
makes a claim to recover the medical cost of injury, disease, disability or similar 
occurrence for which the party received medical benefits under the MaineCare program 
shall ad¥¥.;e notify the department in writing with prior to settlement negotiations and 
provide information as required by the department of the existence of the claim. If the 
notice is not given and the department's ability to recover for benefits paid is 
compromised, the department may institute legal proceedings against a recipient, 
including the agent, representative or attorney of that recipient, who has received a 
settlement or award from a 3rd party. The department may accept a letter of MaineCare 
claim protection in lieu of this section.' 
Amend the bill by inserting after section 2 the following: 
'Sec.3. 22 MRSA §14, sub-§2-F, as amended by PL 2003, c. 20, Pt. K, §2, is 
further amended to read: 
2-F. Disbursement. Except as otherwise provided in this subsection, a disbursement 
of any award, judgment or settlement may not be made to a recipient without the recipient 
or the recipient's attorney first paying to the department the that amount of the statutory 
lieR from the award, judgment or settlement that constitutes reimbursement for medical 
payments made or obtaining from the department a release of any obligation owed to it 
for medical benefits provided to the recipient. If a dispute arises between the recipient 
and the commissioner as to the settlement of any claim that the commissioner may have 
SENATE AMENDMENT 
SENATE AMENDMENT '',A "to H.P.l091. L.D. 1566 
under this section, the 3rd party or the recipient's attorney shall withhold from 
disbursement to the recipient an amount equal to the commissioner's claim. Either party 
may apply to the Superior Court or the District Court in which an action based upon the 
recipient's claim could have been commenced for an order to determine a reasonable 
amount in satisfaction of the statutory lien, consistent with federal law, eonsidering 
whether an independent aetion by the eommissioner vl'Ould ha¥e been eost effeeti¥e. If 
either party applies under this subseetion to the eourt for an order to determine a 
reasonable amount, the eourt may not order payment in satisfaetion of sueh 8: lien for an 
amount less than 75% of the reeovef)', net of reasonable attorney's fees and litigation 
eosts, unless that amount 6Keeeds the amount of the lien.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment clarifies the obligation to provide notice to the Department of 
Health and Human Services when a MaineCare recipient has received benefits paid for by 
the MaineCare program. 
SENATE AMENDMENT