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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XVII PUBLIC WELFARE
  • CHAPTER 118E DIVISION OF MEDICAL ASSISTANCE
  • Section 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions

Section 51. The division, in cooperation with the department of public health and in accordance with the regulations of the secretary, shall establish processes of utilization review for care or services for which medical assistance is available under this chapter.

The division shall establish data processing and collection procedures which will: (1) monitor eligibility of recipients; (2) assure that providers are neither paid twice for the same care or service nor paid in amounts in excess of fee schedules or other applicable limits; and (3) provide the statistical data necessary for effective utilization review.

A medical professional employee of the division, or person providing medical professional counsel or services to the division on a voluntary or paid basis or an employee of a division subcontractor, shall not be liable in a civil action for damages arising out of any act, omission, proceeding or undertaking in the performance, in good-faith, of duties or responsibilities relative to any utilization related activities authorized or established by this chapter or by regulations promulgated by the secretary.