AGO 2009-03.
Case Date | April 23, 2009 |
Court | Maine |
Maine Attorney General Opinions
2009.
AGO 2009-03.
2009-03April 23, 2009The Honorable Kevin L. RayeSenate
Minority Leader 3 State House Station Augusta, ME
04333-0003 Dear Senator Raye:
You have asked whether a General Fund bond issue to provide funds
to pay outstanding MaineCare settlements owed to hospitals would be
constitutional. Your question specifically refers to article V, part 3, §
5 of the Maine Constitution ("Section 5"), which provides (in pertinent part)
that "the Legislature shall enact general law prohibiting the use of proceeds
from the sale ofbonds to fund current expenditures..."
For the reasons that follow, we believe that MaineCare hospital
settlements are current expenditures and that Section 5 prohibits the use of
bond proceeds to make those payment.
Facts
We begin by setting out our understanding of the hospital
settlements that are the focus of your inquiry. The Department of Human
Services ("DHHS"), through the joint federal-state Medicaid program known as
"MaineCare," pays hospitals and other providers for medical services to
individuals of limited income. 22 M.R.S.A. §§ 10, 12, 3173 (2007). If
a State elects to participate, as Maine has, it mustadopt a Medicaid State Plan
and comply with certain requirements and restrictions imposed by federal
Medicaid statutes and regulations. 42 U.S.C.S. §§ 1396, 1396a, 1396k
(2007). The State Plan must include a method for reimbursing health care
providers for the medical services they provide to MaineCare members. 42
U.S.C.S. §1396a(a)(13)(A). Each State establishes a methodology for
Medicaid hospital reimbursement, which is set forth in its State Plan. 42
U.S.C.S. § 1396(a)(13)(A).
Pursuant to 22 M.R.S. §§ 3172-3193 (2007), Maine
adopted a State Plan that establishes a three-step process for reimbursing
hospitals. First, prior to a particular fiscal year, DHHS estimates the total
amount of Medicaid reimbursement a hospital will be owed for the fiscal year
and makes weekly interim payments over the course of the year. Second, at the
close of the hospital's fiscal year, DHHS issues an Interim Settlement based on
cost data in the hospital's as filed (but un-audited) Medicare cost report.
Third, DHHS issues a MaineCare Final Settlement after it receives both the
Notice of Program Reimbursement and the audited Medicare cost repmi from
Medicare.
We take your use or the term "hospital settlements" to encompass
both the Interim and Final...
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