An Act to Strengthen Third-party Liability Requirements for the MaineCare Program
Maine Legislature, Session 131, LD 0084
Committee: Health and Human Services
Sponsors: BALDACCI
Amends: 22 MRSA §14

Legislative Document
No. 84
S.P. 51
In Senate, January 4, 2023
An Act to Strengthen Third-party Liability Requirements for the 
MaineCare Program
Submitted by the Department of Health and Human Services pursuant to Joint Rule 204.
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator BALDACCI of Penobscot.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §14, sub-§2-H, as amended by PL 2007, c. 240, Pt. JJJ, §§2 and 
and c. 448, §8 and affected by §14, is further amended to read:
2-H.  Honoring of assignments.  The following provisions apply to claims for 
payment submitted by the department or a health care provider.
A.  Whenever the department submits claims to a health insurer, as included in 42 
United States Code, Section 1396a(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 
doing business in the State or providing coverage to a resident of this State must 
respond to the department within 60 days and:
(1)  Provide information, with respect to individuals who are eligible for or are 
provided medical assistance under the MaineCare program, 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 and, in the case of a responsible 
3rd party that requires prior authorization for an item or service furnished to an 
individual eligible to receive medical assistance under the MaineCare program, 
accept authorization provided by the State that the item or service is covered under 
the MaineCare program for that individual, as if the authorization were the prior 
authorization made by the 3rd party for the item or service;
(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 of the claim form or, a failure to 
present proper documentation at the point-of-sale that is the basis of the claim or, 
in the case of a responsible 3rd party, a failure to obtain a prior authorization for 
the item or service for which the claim is being submitted, 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.
C.  A payment made as part of an assignment by a 3rd party to the MaineCare program 
or a contractor acting on behalf of the MaineCare program is considered final 2 years 
after the date of the payment and when final the payment is not subject to adjustment.
SUMMARY
This bill adds 3rd-party liability requirement provisions for MaineCare claims for 
payment and adds a provision to apply MaineCare assignment provisions to out-of-state 
carriers who provide coverage to residents of this State. The bill also provides that 
payments made under assignment to the MaineCare program by a 3rd party are final after 
years.