An Act To Allow for a Contingency Fee Agreement with a MaineCare Recovery Audit Contractor
Maine Legislature, Session 125, LD 1629
Committee Amendment CA_A_S470 (Senate)

COMMITTEE AMENDMENT" A. " to S.P. 539, L.D. 1629, Bill, "An Act To 
Allow for a Contingency Fee Agreement with a MaineCare Recovery Audit Contractor" 
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, 
Be it enacted by the People of the State of Maine as follows: 
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 
COMMITTEE AMENDMENT 
o"<~ 
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COMMITTEE AMENDMENT" A" to S.P. 539, L.D. 1629 
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. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
" 
Approved: 03/16112 
~ac.. 
LD 1629 
LR 2491(02) 
An Act To Allow for a Contingency Fee Agreement with a MaineCare Recovery Audit Contractor 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment "A" SLf'l 0 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Potential CUlTent biennium savings - General Fund 
PL 2011, c. 380 (the 2012-2013 Biennial Budget) assumed $1.3 million in 2012-13 General Fund savings "as a result 
of recoveries from Maine's' recently approved state plan amendment to use a recovery audit contractor to address 
overpayments to providers". This bill authorizes the Department of Health and Human Services to enter into an 
agreement with a MaineCare recovery audit contractor on a contingency basis consistent with the assumed savings 
proposal in the biennial budget. While there is the potential for MaineCare savings in addition to those assumed in the 
biennial budget, these are not quantifiable at the present time and will depend on actual experience with the 
contractor. 
LR2491 (02) - Fiscal Note - Page 1 of 1