Summary: H.R.938 — 115th Congress (2017-2018)All Information (Except Text)

There is one summary for H.R.938. Bill summaries are authored by CRS.

Shown Here:
Introduced in House (02/07/2017)

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.