LD 1319
pg. 313
Page 312 of 460 PUBLIC Law Chapter 20 Page 314 of 460
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LR 2000
Item 1

 
injury, disease, disability or similar occurrence for which an
insurer is liable, and the insured's claim is payable to a health
care provider as provided or permitted by the terms of a health
insurance policy or pursuant to an assignment of rights by an
insured, the insurer shall directly reimburse the health care
provider to the extent that the claim is honored.

 
2-C. Direct reimbursement to department. 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 injury,
disease, disability or similar occurrence for which an insurer is
liable, and the claim is not payable to a health care provider
under the terms of the health insurance policy, the insurer shall
directly reimburse the Department of Human Services, upon
request, for any medical services paid by the department on
behalf of a recipient under Medicaid or the elderly low-cost drug
program under section 254 the MaineCare program to the extent
that those medical services are payable under the terms of the
health insurance policy. If the insurer knows or has information
upon which to reasonably conclude that the insured is a recipient
of MaineCare services, the insurer shall advise the department in
writing as to the existence of the claim prior to any other
payment.

 
2-D. Notification of claim. A recipient under Medicaid or
the elderly low-cost drug program under section 254 the MaineCare
program, or any attorney representing a recipient under Medicaid
or the elderly low-cost drug program under section 254 the
MaineCare program, who makes a claim to recover the medical cost
of injury, disease, disability or similar occurrence for which
the party received medical benefits under the Medicaid MaineCare
program pursuant to the United States Social Security Act, Title
XIX or the elderly low-cost drug program under section 254 shall
advise the department in writing with information as required by
the department of the existence of the claim.

 
2-E. Notification of pleading. In any action to recover the
medical cost of injury, disease, disability or similar occurrence
for which the party received medical benefits under the Medicaid
MaineCare program or the elderly low-cost drug program under
section 254, the party bringing the action shall notify the
department of that action at least 10 days prior to filing the
pleadings. Department records indicating medical benefits paid
by the department on behalf of the recipient are prima facie
evidence of the medical expenses incurred by the recipient for
the related medical services.


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