Sec. D-1. 22 MRSA §42, sub-§7, ¶G is enacted to read:

G.__In administrative appeals of informal review decisions of MaineCare payment, recovery, recoupment and cost report and other audit issues, the department bears the burden of proving a violation of rule or other law by a preponderance of the evidence.__If the department finds records of goods or services to be insufficient but has made no finding that the goods or services affected by the insufficiency were not provided or delivered as claimed, the department may not require total recoupment of MaineCare funds associated with the affected goods or services.__In cases where the department has made such a finding and asserted such a claim, the department must fulfill the burden of proof set forth in this paragraph.

Sec. D-2. 22 MRSA §49 is enacted to read:

§49.__Interpretation of rules

When implementing the law and applying its rules governing the MaineCare program, the department shall make determinations of deviations from acceptable behavior and practices based on standard practices in the relevant service provider industry.

Sec. D-3. Retroactivity; application to pending proceedings. Notwithstanding the Maine Revised Statutes, Title 1, section 302, this Part applies retroactively to proceedings pending before the Commissioner of Human Services on January 1, 2003.

Emergency clause. In view of the emergency cited in the preamble, this Act takes effect when approved.

SUMMARY

Under current law, the Department of Human Services is required to use independent, impartial hearing officers to hear appeals of informal review decisions of MaineCare payment and cost report issues filed by providers of nursing facility services and medical and remedial private nonmedical institution services. Part A of this bill extends the requirements of that appeal process, including the impartial hearing officer requirement, to any other informal review decisions that seek to impose repayment, recovery or recoupment obligations or sanctions or fines on service providers.