Bill Summary – FastDemocracy

APPROVED                 CHAPTER
                                                                  JULY 26, 2023                 432
                                                                 BY GOVERNOR              PUBLIC LAW
                                  STATE OF MAINE
                                          _____
                          IN THE YEAR OF OUR LORD
                      TWO THOUSAND TWENTY-THREE
                                          _____
                                  H.P. 265 - L.D. 432
  An Act to Clarify MaineCare Program Requirements Regarding Certain
                     High-risk Health Care Providers
Be it enacted by the People of the State of Maine as follows:
    Sec. 1. 22 MRSA §5307, sub-§1, as enacted by PL 2021, c. 400, §1, is repealed
and the following enacted in its place:
    1. Definitions. As used in this section, unless the context otherwise indicates, the
following terms have the following meanings.
    A. "Final adverse action" has the same meaning as in 42 Code of Federal Regulations,
    Section 424.502 (2008) in effect on November 19, 2008.
    B. "High-risk provider" means a provider the department has determined is high risk
    in accordance with subsection 2-A.
    C. "Person with ownership interest" means a person who has at least a 5% direct or
    indirect ownership interest in a high-risk provider or a provider in a high-risk provider
    category.
    D. "Provider" has the same meaning as "provider" or "supplier" in 42 Code of Federal
    Regulations, Section 400.202 (1983) in effect on January 1, 2022.
    E. "Provider in a high-risk provider category" has the same meaning as "high
    categorical risk: Provider and supplier categories" in 42 Code of Federal Regulations,
    Section 424.518(c)(1) (2020) in effect on December 28, 2020.
    F. "State Police" means the Department of Public Safety, Bureau of State Police.
    Sec. 2. 22 MRSA §5307, sub-§2, as enacted by PL 2021, c. 400, §1, is amended to
read:
    2. Background check. The department shall request a background check for a
MaineCare provider applicants applicant who are is a high-risk providers or provider, a
provider in a high-risk provider categories as those terms are defined by department rule
category or a person with ownership interest. The applicant subject to the background
check is responsible for the fees associated with the background check. The background
                                   Page 1 - 131LR0164(07)
check must include criminal history record information obtained from the Maine Criminal
Justice Information System and the Federal Bureau of Investigation.
    A. The criminal history record information obtained from the Maine Criminal Justice
    Information System must include a record of public criminal history record information
    as defined in Title 16, section 703, subsection 8.
    B. The criminal history record information obtained from the Federal Bureau of
    Investigation must include other state and national criminal history record information.
    C. A provider applicant shall submit to having fingerprints taken. The State Police,
    upon payment by the provider applicant, shall take or cause to be taken the applicant's
    fingerprints and shall forward the fingerprints to the State Bureau of Identification so
    that bureau can conduct state and national criminal history record checks. Except for
    the portion of the payment, if any, that constitutes the processing fee charged by the
    Federal Bureau of Investigation, all money received by the State Police for purposes
    of this paragraph must be paid over to the Treasurer of State. The money must be
    applied to the expenses of administration incurred by the Department of Public Safety.
    D. The subject of a Federal Bureau of Investigation criminal history record check may
    obtain a copy of the criminal history record check by following the procedures outlined
    in 28 Code of Federal Regulations, Sections 16.32 and 16.33. The subject of a state
    criminal history record check may inspect and review the criminal history record
    information pursuant to Title 16, section 709.
    E. State and national criminal history record information of a provider applicant must
    be used by the department for the purpose of screening that provider applicant.
    F. Information obtained pursuant to this subsection is confidential. The results of
    background checks received by the department are for official use only and may not be
    disseminated to any other person or entity.
    G. An individual whose enrollment as a MaineCare provider has expired and who has
    not applied for renewal may request in writing that the State Bureau of Identification
    remove the individual's fingerprints from the bureau's fingerprint file. In response to a
    written request, the bureau shall remove the individual's fingerprints from the
    fingerprint file and provide written confirmation of that removal.
    Sec. 3. 22 MRSA §5307, sub-§2-A is enacted to read:
    2-A. High-risk provider adjustments by the department. The department shall
adjust the categorical risk for a provider to high if any of the following conditions exist:
    A. Within the previous 10-year period:
        (1) The MaineCare program has imposed a payment suspension on the provider
        based on credible allegations of fraud, waste or abuse;
        (2) The United States Department of Health and Human Services, Office of
        Inspector General or another state's Medicaid program has excluded the provider
        from Medicaid;
        (3) A Medicare contractor revoked the provider's billing privileges and the provider
        is attempting to:
            (a) Enroll as a new provider; or
                                   Page 2 - 131LR0164(07)
            (b) Establish billing privileges for a new service location; or
        (4) The provider was subject to a final adverse action;
    B. Within the previous 6-month period, the United States Department of Health and
    Human Services, Centers for Medicare and Medicaid Services lifted a temporary
    moratorium for a particular provider type that prevented the provider from enrolling as
    a MaineCare provider and that provider is now a MaineCare provider applicant;
    C. The United States Department of Health and Human Services, Office of Inspector
    General excluded the provider from Medicare; or
    D. The provider:
        (1) Owes $1,000 or more to the department as a result of a Medicaid overpayment
        that is not currently under appeal or in a payment plan;
        (2) Has been terminated or is otherwise precluded from billing Medicaid; or
        (3) Has been excluded from any federal health care program.
    Sec. 4. Appropriations and allocations. The following appropriations and
allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Office of MaineCare Services 0129
Initiative: Provides one-time funding for technology changes.
GENERAL FUND                                                      2023-24        2024-25
 All Other                                                             $0          $9,250
                                                               __________     __________
GENERAL FUND TOTAL                                                     $0          $9,250
FEDERAL EXPENDITURES FUND                                         2023-24        2024-25
 All Other                                                             $0        $27,750
                                                               __________     __________
FEDERAL EXPENDITURES FUND TOTAL                                        $0        $27,750
                                   Page 3 - 131LR0164(07)
Statutes affected: 
Bill Text LD 432, HP 265: 22.5307
Bill Text ACTPUB , Chapter 432: 22.5307