To amend title XIX of the Social Security Act to provide clarification with respect to the liability of third party payers for medical assistance paid under the Medicaid program, and for other purposes.
Health Subcommittee, Energy and Commerce Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
Medicaid Third Party Liability Act This bill alters provisions related to third-party liability for medical assistance paid under the Medicaid program. Specifically, with respect to such liability, the bill: expands the definition of "responsible third party" to include, among other health insurers, the TRICARE program; eliminates special rules with respect to certain services provided to children; requires the inclusion, in a contract between a state Medicaid program and a health insurer, of certain information regarding whether the state is delegating or transferring to the insurer a right of third-party recovery; provides for the treatment as overpayment of reimbursements made by a responsible third party to a health insurer; disallows a responsible third party from denying a state's claim solely on the basis of a failure to obtain a prior authorization; imposes a timeline for a responsible third party to respond to a state's inquiry regarding a claim for payment; provides for reductions to a state Medicaid program's federal matching rate if the state fails to comply with third-party insurance requirements; and modifies other provisions related to third-party liability under the Medicaid program. Third-party liability requirements applicable under Medicaid shall also apply under the Children's Health Insurance Program (CHIP). The Centers for Medicare & Medicaid Services must: publish on its website, and annually update, best practices for assessing third-party liability; monitor and analyze efforts to assess that liability; in consultation with states, develop and make available a model uniform reporting field for identifying information related to responsible third parties; and provide other specified information and guidance to states.
Child healthCivil actions and liabilityGovernment information and archivesHealth care costs and insuranceHealth information and medical recordsIntergovernmental relationsMedicaidMedical tests and diagnostic methodsSeparation, divorce, custody, supportState and local financeState and local government operations
To amend title XIX of the Social Security Act to provide clarification with respect to the liability of third party payers for medical assistance paid under the Medicaid program, and for other purposes.
USA115th CongressHR-938| House
| Updated: 2/10/2017
Medicaid Third Party Liability Act This bill alters provisions related to third-party liability for medical assistance paid under the Medicaid program. Specifically, with respect to such liability, the bill: expands the definition of "responsible third party" to include, among other health insurers, the TRICARE program; eliminates special rules with respect to certain services provided to children; requires the inclusion, in a contract between a state Medicaid program and a health insurer, of certain information regarding whether the state is delegating or transferring to the insurer a right of third-party recovery; provides for the treatment as overpayment of reimbursements made by a responsible third party to a health insurer; disallows a responsible third party from denying a state's claim solely on the basis of a failure to obtain a prior authorization; imposes a timeline for a responsible third party to respond to a state's inquiry regarding a claim for payment; provides for reductions to a state Medicaid program's federal matching rate if the state fails to comply with third-party insurance requirements; and modifies other provisions related to third-party liability under the Medicaid program. Third-party liability requirements applicable under Medicaid shall also apply under the Children's Health Insurance Program (CHIP). The Centers for Medicare & Medicaid Services must: publish on its website, and annually update, best practices for assessing third-party liability; monitor and analyze efforts to assess that liability; in consultation with states, develop and make available a model uniform reporting field for identifying information related to responsible third parties; and provide other specified information and guidance to states.
Child healthCivil actions and liabilityGovernment information and archivesHealth care costs and insuranceHealth information and medical recordsIntergovernmental relationsMedicaidMedical tests and diagnostic methodsSeparation, divorce, custody, supportState and local financeState and local government operations