LD 1687, Page 2 - 119th Legislature, FIRST REGULAR Session

party. The commissioner is entitled to recover the ~~full~~ amount of

the benefits actually paid out or, with regard to Medicaid

recipients who participated in the managed care program when the

commissioner has determined that collection will be cost-effective,

the reasonable value of benefits provided 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 compromise, or 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-F, as amended by PL 1997, c. 795, §2, is
further amended to read:

2-F. Disbursement. 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
amount of the statutory lien from the award, judgment or
settlement 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 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 considering whether an
independent action by the commissioner would have been cost-
effective.

SUMMARY

This bill allows the compromise, release or settlement of
Medicaid-related claims when the commissioner determines that the
best possible outcome requires compromise, release or settlement.

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