To amend title XIX of the Social Security Act to strengthen the Medicaid third-party liability requirements.

Summary

Amends title XIX (Medicaid) of the Social Security Act to direct state Medicaid plans to require the state to provide the Secretary of Health and Human Services with satisfactory assurances that it has in effect laws requiring the state to make inquiries to third parties, including health insurers, self-insured plans, group health plans, or other parties operating in any state that are responsible for payment of a claim for a health care item or service. Requires third parties to: (1) provide, upon state request, information about Medicaid-eligible or -receiving individuals to determine during what period the individual (or the spouse or dependents) may be (or may have been) covered by a health insurer, as well as the nature of such coverage; (2) accept the state's right of recovery and the assignment to the state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the state plan; and (3) agree not to deny a claim submitted by the state solely on the basis of its date of submission, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if the claim is submitted by the state within three years after the item or service was furnished, and any action by the state to enforce its rights is commenced within six years of its submission of the claim. Establishes a civil monetary penalty for a third party's failure to reply to inquiries required by this Act.

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3 official files

• Introduced in House (text)

  Introduced in House · EN · 6 December 2007

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• Introduced in House (PDF)

  Introduced in House · EN · 6 December 2007

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• Introduced in House

  summary · EN · 6 December 2007

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