‘The commissioner's right to recover the cost of benefits provided constitutes a statutory lien on the proceeds of an award or settlement from a 3rd party if recovery for MaineCare costs was or could have been included in the recipient's claim for damages from the 3rd party to the extent of the recovery for medical expenses. The commissioner is entitled to recover the cost of the benefits actually paid out when the commissioner has determined that collection will be cost-effective 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 from that portion of the award or settlement attributable to past medical expenses paid by MaineCare after the pro rata deduction of reasonable attorney's fees and litigation costs. In determining whether collection will be cost-effective, the commissioner shall consider all factors that diminish potential recovery by the department, The portion of the award or settlement attributable to past medical expenses paid by MaineCare must be apportioned taking into consideration the full value of the recipient’s claim and the fraction by which it has been reduced due to factors 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. If an award is established by a court judgment, and the judgment allocates the portion of the award attributable to past medical expenses, that allocation is binding. If the commissioner and a recipient are unable to agree on an allocation of the amount of recovery attributable to past medical expenses paid by MaineCare, either party may submit the matter to a court for a determination of the allocation. 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.’
Amend the bill in section 1 in subsection 1 by striking out all of the last blocked paragraph (page 1, lines 30 to 44 and page 2, lines 1 to 4 in L.D.) and inserting the following:
Amend the bill by adding after section 1 the following:
‘Sec. 2. Appropriations and allocations. The following appropriations and allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Medical Care - Payments to Providers 0147
Initiative: Provides funding to offset the loss of recoveries in MaineCare due to the reduction of statutory liens for attorney's fees or litigation costs.
| GENERAL FUND | 2019-20 | 2020-21 |
|
All Other
|
$0 | $544,200 |
 |
|
|
| GENERAL FUND TOTAL | $0 | $544,200 |
| FEDERAL EXPENDITURES FUND | 2019-20 | 2020-21 |
|
All Other
|
$0 | $955,800 |
|
|
|
| FEDERAL EXPENDITURES FUND TOTAL | $0 | $955,800 |
SUMMARY
This amendment is the majority report. The amendment provides that MaineCare's lien applies to the portion of the award or settlement attributable to past medical expenses paid by MaineCare. If the judgment of the court allocates the portion of the award attributable to past medical expenses, that allocation is binding. Otherwise, if the commissioner and the recipient cannot agree on the allocation, either party may submit the matter to a court for the court to determine the allocation. This amendment also deletes the prohibition on reducing the statutory lien to reflect an assessment of a pro rata share of the recipient's attorney's fees or litigation costs. The amendment adds an appropriations and allocations section.