SB 312  - AS INTRODUCED

 

 

2024 SESSION

24-2924

05/10

 

SENATE BILL 312

 

AN ACT relative to third party liability in Medicaid.

 

SPONSORS: Sen. Birdsell, Dist 19

 

COMMITTEE: Health and Human Services

 

-----------------------------------------------------------------

 

ANALYSIS

 

This bill provides for health carrier acceptance of liability to third parties under state Medicaid procedures.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

24-2924

05/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty Four

 

AN ACT relative to third party liability in Medicaid.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1 Health Carrier Disclosure of Third Party Liability. Amend RSA 167:4-b, V to read as follows:

V. Each health carrier shall:

(a) Accept the state's, or its designated managed care organizations, and or contractor or its assigned designee, right of recovery and assignment to the state or its designated managed care organizations 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.

(b) Respond to any inquiry by the state, or its designated managed care organizations, and or contractor or its assigned designee, within 60 calendar days from the date the inquiry is sent, regarding a claim for payment for any health care item or service that is submitted not later than 3 years after the date of the provision of such health care item or service and action taken on the claim commenced within 6 years of the submission of the claim for payment.

(c) [Not deny a claim submitted by the state solely on the basis of the date of submission of the claim, 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:

(1)  The claim is submitted by the state within the 3-year period beginning on the date on which the item or service was furnished; and

(2)  Any action by the state to enforce its rights with respect to such claim is commenced within 6 years of the state's submission of such claim.] Not deny a claim submitted by the state, or its designated managed care organizations, and or contractor or its assigned designee:

(1)  Solely on the basis of the date of submission of the claim;

(2)  For specific type of format of the claim form, including that the responsible third party cannot require claims to be submitted on national claim forms or electronically;

(3)  For unknown or unavailable policyholder information or coordination of benefits authorization from the policyholder;

(4)  For failure to present proper documentation at the point-of-sale that is the basis of the claim;

(5)  For the state or its designated managed care organizations not having a National Provider Identifier (NPI) on the submitted claim; or

(6)  For not obtaining the responsible third party’s prior authorization for items or services paid by the state or its designated manage care organizations.  The responsible third party shall deem the state or its designated managed care organizations’ payment of a claim for a medical item or service to be the equivalent of the medical assistance recipient having obtained prior authorization for the item or service from the third party.

2  Effective Date.  This act shall take effect July 1, 2024.