Maine LD 1498: An Act To Clarify Medicaid Managed Care Ombudsman Services

LD 1498 (subjects: MEDICAID , MANAGED CARE PLAN )

Official bill page at mainelegislature.org: http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=1498&PID=1456&snum=127


Sponsors | Actions | Bill Text | Patterns of Support | In The News


Sponsors

Principal Sponsor: Rep. Karen Vachon of Scarborough: (R – District 29) — e-mail | Twitter | Facebook

19 Cosponsors:

Actions

Chamber

Action
12/23/2015 House Received by the Clerk of the House on December 21, 2015.
The Bill was REFERRED to the Committee on HEALTH AND HUMAN SERVICES pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint Rule 401.
3/31/2016 House Reports READ.
On motion of Representative GATTINE of Westbrook, the Majority Ought to Pass as Amended Report was ACCEPTED.
ROLL CALL NO. 542
(Yeas 114 – Nays 32 – Absent 5 – Excused 0)
The Bill was READ ONCE.
Committee Amendment “A” (H-620) was READ and ADOPTED.
Under suspension of the rules, the Bill was given its SECOND READING without REFERENCE to the Committee on Bills in the Second Reading.
The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment “A” (H-620).
Sent for concurrence. ORDERED SENT FORTHWITH.
4/1/2016 Senate Reports READ
On motion by Senator BRAKEY of Androscoggin Tabled until Later in Today’s Session, pending ACCEPTANCE OF EITHER REPORT
Unfinished Business
4/4/2016 Senate Unfinished Business
4/5/2016 Senate Unfinished Business
4/6/2016 Senate Unfinished Business
4/7/2016 Senate Unfinished Business
4/11/2016 Senate Unfinished Business
4/12/2016 Senate Taken from the table by the President
Motion by Senator BRAKEY of Androscoggin to ACCEPT The Minority Ought Not To Pass Report FAILED
Roll Call Ordered Roll Call Number 654 Yeas 5 – Nays 30 – Excused 0 – Absent 0
The Majority Ought to Pass As Amended Report ACCEPTED in concurrence
Committee Amendment “A” (H-620) READ and ADOPTED
Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED by Committee Amendment “A” (H-620) in concurrence
4/12/2016 House PASSED TO BE ENACTED.
Sent for concurrence. ORDERED SENT FORTHWITH.
4/12/2016 Senate PASSED TO BE ENACTED, in concurrence.
4/29/2016 House This Bill, having been returned by the Governor, together with objections to the same pursuant to Article IV, Part Third, Section 2 of the Constitution of the State of Maine, after reconsideration, the House proceeded to vote on the question: “Shall this Bill become a law notwithstanding the objections of the Governor?”
ROLL CALL NO. 657V
118 having voted in the affirmative and 28 in the negative, with 5 being absent, and accordingly it was the vote of the House that the Bill become a law notwithstanding the objections of the Governor, since two-thirds of the members of the House so voted.
Sent for concurrence. ORDERED SENT FORTHWITH.
4/29/2016 Senate LD 1498 In Senate, April 29, 2016, this Bill, having been returned by the Governor, together with objections to the same pursuant to the provisions of the Constitution of the State of Maine, after reconsideration, the Senate proceeded to vote on the question: “Shall this Bill become a law notwithstanding the objections of the Governor?” 29 In Favor and 5 Against, accordingly it was the vote of the Senate that the Bill become law and the VETO was OVERRIDDEN.

Bill Text

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An Act To Clarify Medicaid Managed Care Ombudsman Services

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA 3174-X, as enacted by PL 1999, c. 681, 1, is repealed and the following enacted in its place:

3174-X. Contracted ombudsman services

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. “Children’s health insurance program” means the state children’s health insurance program under Title XXI of the Social Security Act.
B. “Eligible member” means a person who is eligible to participate as a member or beneficiary of the MaineCare program or the children’s health insurance program.
C. “Medicaid managed care” means all Medicaid and children’s health insurance program programs and services that are determined by the United States Department of Health and Human Services to be managed care programs. Such managed care programs include but are not limited to primary care case management and health homes or other patient-centered medical homes that include MaineCare or children’s health insurance program members, including behavioral health homes.
D. “Ombudsman” means the director of the program and persons employed or volunteering to perform the work of the program.
E. “Outreach and education” includes, but is not limited to, work site and community-based training and workshops; outreach at events such as town fairs, expositions and health fairs; development of mailings about coverage options, open enrollment periods and other important updates; information hotline response, including providing information and referrals to members and eligible members who call; and screening for eligibility for coverage programs, including programs other than Medicaid programs.
F. “Program” means the ombudsman program established under this section.

2. Program established. The ombudsman program is established as an independent program to provide ombudsman services to the Medicaid managed care population regarding Medicaid services provided by the department and the department’s office for family independence and office of MaineCare services. The program shall consider and promote the best interests of the Medicaid and children’s health insurance program populations, answer inquiries and investigate, advise and work toward resolution of complaints of infringement of the rights of a member or eligible member. The program shall include outreach and education to eligible members and those who serve eligible members, including health care providers, social service providers and health insurance navigators and other enrollment professionals. The program shall function through the staff of the program, subcontractors and any volunteers recruited and trained to assist in the duties of the program.
3. Contracted services; political activity prohibited. The program shall operate by contract with a nonprofit organization that is best able to provide services on a statewide basis. The ombudsman may not be actively involved in state-level political party activities or publicly endorse, solicit funds for or make contributions to political parties on the state level or candidates for statewide elective office. The ombudsman may not be a candidate for or hold any statewide elective or appointive public office.
4. Program services. The first priority in the work of the program and the contract for ombudsman services under subsection 3 must be case-specific advocacy and enrollment services. In performing services under this section, the program, as it determines to be appropriate, may create and maintain records and case-specific reports. The program may:

A. Provide information to the public about the services of the program through a comprehensive outreach program. The program shall provide information through a toll-free telephone number or numbers;
B. Answer inquiries, investigate and work toward resolution of complaints regarding the performance and services of the department and participate in conferences, meetings and studies that may improve the performance of the department;
C. Provide services to members and eligible members to assist them in protecting their rights;
D. Inform members and eligible members of the means of obtaining services from the department;
E. Provide information and referral services;
F. Analyze and provide opinions and recommendations to agencies, the Governor and the Legislature on state programs, rules, policies and laws;
G. Determine what types of complaints and inquiries will be accepted for action by the program and adopt policies and procedures regarding communication with members and eligible members making inquiries or complaints and the department;
H. Apply for and use grants, gifts and funds for the purpose of performing the duties of the program; and
I. Collect and analyze records and data relevant to the duties and activities of the program and make reports as required by law or as the department considers appropriate.

5. Information for members and eligible members; eligibility. The program, in consultation with appropriate interested parties, shall provide information about eligibility requirements and procedures for enrolling in MaineCare to members and eligible members, including their dependents. The providing of the information under this subsection does not constitute representation of members and eligible members. Members and eligible members may seek and receive information regardless of whether they are represented by legal counsel. The information must be provided free of charge to members and eligible members.

This subsection does not create new rights or obligations concerning the provision of legal advice or representation of members and eligible members.

6. Confidentiality of records. Information held by or records or case-specific reports maintained by the program are confidential. Disclosure may be made only if the ombudsman determines such disclosure is lawful and in the best interest of the member or eligible member.
7. Liability. Any person who in good faith submits a complaint or inquiry to the program pursuant to this section is immune from any civil or criminal liability arising from that complaint or inquiry. For the purpose of any civil or criminal proceedings, there is a rebuttable presumption that any person acting pursuant to this section did so in good faith. The ombudsman and employees and volunteers of the program are employees of the State for the purposes of the Maine Tort Claims Act.
8. Information. Information about the services of the program must be given to all members and eligible members who receive or are eligible to receive services from the department and from persons and entities contracting with the department for the provision of Medicaid services.
9. Report. The program shall report to the department according to the requirements of the program contract under subsection 3.
10. Funding. The department shall contract for ombudsman services under this section as long as nonstate funding is available for use as the state seed money for such a contract and General Fund money is not required.

SUMMARY

Current law requires the Department of Health and Human Services to contract for ombudsman services for the Medicaid managed care population as long as nonstate funding is available. This bill retains that provision and establishes the ombudsman program in statute, describes the Medicaid managed care population and specifies the duties of the ombudsman program, which include providing services and outreach for members and eligible members of the Medicaid program and the state children’s health insurance program under Title XXI of the Social Security Act.

Patterns of Support

Pattern of Cosponsorship by Region:

Pattern of Cosponsorship by Gender:

Pattern of Cosponsorship by Party:

Pattern of Cosponsorship by Campaign Finance Classification:

Note: Maine Clean Elections Act (MCEA) Qualified candidates only accept a small dollar value of initial contributions early in their campaigns, pledge not to accept further campaign contributions from private sources, and receive public funding for their campaigns. MCEA Non-Qualified candidates choose not to obtain public funding and instead are free to accept campaign contributions from individuals, party committees, political action committees and business sources.


In The News…

Recent news stories featuring LD 1498:


This information about LD 1498 was last updated on 2016-05-12.
The Open Maine Politics website is in a beta release and results should not be taken as definitive. Please visit the official website of the Maine State Legislature for entirely verifiable information.

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