PUBLIC Law Chapter 20

commissioner is entitled to recover the ~~amount~~ cost 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, 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.

2-A. Assignment of rights of recovery. The receipt of
benefits under the ~~Medicaid~~ MaineCare program ~~administered by the~~
~~department pursuant to the United States Social Security Act,~~
~~Title XIX or under the elderly low-cost drug program under~~
~~section 254~~ constitutes an assignment by the recipient or any
legally liable relative to the department of the right to recover
from 3rd parties for the medical cost of injury, disease,
disability or similar occurrence for which the recipient receives
medical benefits. The department's assigned right to recover is
limited to the amount of medical benefits received by the
recipient and does not operate as a waiver by the recipient of
any other right of recovery against a 3rd party that a recipient
may have.

The recipient is also deemed to have appointed the commissioner
as the recipient's attorney in fact to perform the specific act
of submitting claims to insurance carriers or endorsing over to
the department any and all drafts, checks, money orders or any
other negotiable instruments connected with the payment of 3rd-
party medical claims.

2-B. Direct reimbursement to health care provider. When an
insured is eligible under the ~~Medicaid~~ MaineCare program
~~administered by the Department of Human Services pursuant to the~~
~~United States Social Security Act, Title XIX or under the elderly~~
~~low-cost drug program under section 254~~ for the medical costs of

Amendments	Public Hearing Schedule	Committee Information
Committee List	Work Session Schedule	Title & Section

	Search Bill Text	Legislative Information
Bill Directory	Search Bill Status	Session Information
119th Legislature Bills	Search Bill Status	Maine Legislature

Office of Legislative Information 100 State House Station Augusta, ME 04333		voice: (207) 287-1692 fax: (207) 287-1580 tty: (207) 287-6826
Word Viewer for Windows		Disclaimer