,i #aac? ,,congress #a/ ,session ,h4 ,r4 #cfei ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,decemb] #e1 #bjac,mr4 ,burgess introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to am5d title ,,xix ( ! ,social ,security ,act to cl>ify policy ) respect to collect+ reimbursem5t f ?ird-p>ty pay]s = m$ical assi/ance paid "u ! ,m$icaid program1 & = o!r purposes4 #a4 ,removal ( special treatm5t ( c]ta9 types ( c>e & paym5ts "u ,m$icaid ?ird-p>ty liability rules ,section #aijb7;a77#be7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77 is am5d$ by /rik+ subp>agraphs 7,e7 & 7,f74 #b4 ,cl>ification ( role ( ,m,c,os ) respect to ?ird-p>ty liability 7a7 ,9 g5]al ,section #aijb7;a77#be7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be771 z am5d$ by section #a1 is fur!r am5d$ by ins]t+1 aft] subp>agraph 7,d71 ! foll[+3 7,e7 t1 if ! ,/ate contracts ) a manag$ c>e entity pursuant to section #aicb = ! purpose ( provid+ items & s]vices "u ?is title-- 7i7 su* contract %all specify :e!r-- 7,i7 ! ,/ate is delegat+ to ! manag$ c>e entity all or "s ( its "r ( recov]y = an item or s]vice = :i* paym5t has be5 made "u ! ,/ate plan2 & 7,,ii7 ! ,/ate is transf]r+ to ! manag$ c>e entity all or "s ( ! assignm5t to ! ,/ate ( any "r ( an individual or o!r entity to paym5t f a heal? insur] 7includ+ self-insur$ plans1 gr\p heal? plans 7z def9$ 9 section #fjg7a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd71 s]vice b5efit plans1 manag$ c>e organizations1 ph>macy b5efit manag]s1 or o!r p>ties t are1 by /atute1 contract1 or agreem5t1 legally responsible = paym5t ( a claim = a heal? c>e item or s]vice7 = an item or s]vice = :i* paym5t has be5 made "u ! ,/ate plan2 & 7ii7 if ! ,/ate delegates its rights "u clause 7i77,i7 or transf]s assignm5t ( rights "u clause 7i77,,ii71 ! ,/ate %all h 9 effect laws requir+ su* heal? insur]s1 z a condition ( do+ bus9ess 9 ! ,/ate-- 7,i7 to provide to su* manag$ c>e entity1 ^u ! reque/ ( su* entity1 ! in=mation describ$ 9 subp>agraph 7,i77i72 7,,ii7 if a "r ( recov]y 0 delegat$ "u clause 7i77,i71 accept ! au?ority ( ! manag$ c>e entity to ex]cise su* "r2 7,,iii7 if an assignm5t ( rights 0 transf]r$ "u clause 7i77,,ii71 accept su* transf] ( assignm5t ( rights2 7,,iv7 respond to an inquiry made by su* entity 9 ! same mann] t ! insur] w\ld respond to an inquiry by a ,/ate "u subp>agraph 7,i77iii72 & 7,v7 agree n to d5y a claim submitt$ by a manag$ c>e entity = :i* ! ,/ate has delegat$ or transf]r$ rights "u clause 7i7 9 ! same mann] t ! insur] may n d5y a claim submitt$ by a ,/ate "u subp>agraph 7,i77iv72 4 7b7 ,treatm5t ( collect$ am\nts ,section #aijc7;d77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7d77#b77;,b77 is am5d$ by add+ at ! end ! foll[+3 ,= purposes ( ?is subp>agraph1 reimbursem5ts made by a ?ird p>ty to manag$ c>e entities pursuant to section #aijb7;a77#be77;,e7 %all be treat$ 9 ! same mann] z reimbursem5ts made to a ,/ate "u ! previ\s s5t5ce44 #c4 ,requir+ coord9ation ( b5efici>y in=mation ) respect to ?ird-p>ty liability ,section #aijb7;a77#be7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be771 z am5d$ by section #b1 is fur!r am5d$ by ins]t+1 aft] subp>agraph 7,e71 ! foll[+3 7,f7 t1 if ! ,/ate contracts ) a heal? insur] 7z def9$ = purposes ( subp>agraph 7,e77 = ! purposes ( provid+ items & s]vices "u ?is title su* contract %all require t-- 7i7 if su* insur] contracts ) a ph>macy b5efit manag] to manage b5efits "u ! heal? plan (f]$ by su* insur]1 su* contract %all require t ! ph>macy b5efit manag] regul>ly report to ! ,/ate 7or1 z applicable1 to an au?oriz$ contractor or ag5t ( ! ,/ate7 any data obta9$ by ! ph>macy b5efit manag] t is relevant1 z det]m9$ by ! ,/ate1 to assi/+ ! ,/ate 9 det]m9+ :e!r su* a heal? insur] is1 by /atute1 contract1 or agreem5t1 legally responsible = paym5t ( a claim = a heal? c>e item or s]vice available "u ! plan2 & 7ii7 su* insur] coop]ates 7includ+ by grant+ reque/s ( ! ,/ate = in=mation1 or = p]mission to utilize in=mation1 t is relevant to det]m9+ :e!r su* a heal? insur] is1 by /atute1 contract1 or agreem5t1 legally responsible = paym5t ( a claim = a heal? c>e item or s]vice available "u ! plan1 reg>dless ( ! ,/ate 9 :i* ! insur] is lic5s$7 ) ! ,/ate ,m$icaid plan 7includ+ any ,/ate ,m$icaid ag5cy or au?oriz$ ag5t or contractor ( su* program or entity7 = ! prop] coord9ation ( b5efits (f]$ ?r\gh ! plan ( su* insur] & m$ical assi/ance "u ! ,/ate plan to effectuate ! pr9ciple ( ! program "u ?is title be+ ! pay] ( la/ resort2 4 #d4 ,developm5t ( model uni=m fields = ,/ates to report ?ird-p>ty in=mation ,n lat] ?an ,janu>y #a1 #bjae1 ! ,secret>y ( ,heal? & ,human ,s]vices %all1 9 consultation ) ! ,/ates1 develop & make available to ! ,/ates a model uni=m report+ field t ,/ates may use = purposes ( report+ to ! ,secret>y )9 ,,cms ,=m #fd 7or any successor =m7 in=mation id5tify+ ?ird-p>ty heal? insur]s 7includ+ self-insur$ plans1 gr\p heal? plans 7z def9$ 9 section #fjg7a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd71 s]vice b5efit plans1 manag$ c>e organizations1 ph>macy b5efit manag]s1 or o!r p>ties t are1 by /atute1 contract1 or agreem5t1 legally responsible = paym5t ( a claim = a heal? c>e item or s]vice7 & o!r relevant in=mation = asc]ta9+ ! legal responsibility ( su* ?ird p>ties to pay = c>e & s]vices available "u ! ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 #e4 ,/ate inc5tive to pursue ?ird-p>ty liability = newly eligibles ,section #aijc7;d77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7d77#b77;,b771 z am5d$ by section #b1 is am5d$ by add+ at ! end ! foll[+3 ,9 ! case ( exp5ditures = m$ical assi/ance provid$ dur+ #bjad & subsequ5t ye>s = newly eligible individuals 7z su* t]m is def9$ 9 section #aije7y77 describ$ 9 subclause 7,,viii7 ( section #aijb7;a77#aj77;,a77i71 9 det]m9+ ! am\nt1 if any1 ( ov]paym5t "u ?is subp>agraph ) respect to su* s]vices1 ! ,secret>y %all apply ! ,f$]al m$ical assi/ance p]c5tage = ! ,/ate "u section #aije7;b71 not)/&+ ! application ( section #aije7y744 #f4 ,p5alty = non-compliance ,subject to section #f7;b71 = any fiscal ye> beg9n+ on or aft] ! date t is #a ye> aft] ! effective date "u section #f1 9 ! case ( a ,/ate t fails to comply ) ! additional requirem5ts = ! ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act t are impos$ by ! am5dm5ts made by ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all r$uce ! ,f$]al m$ical assi/ance p]c5tage 7z def9$ 9 section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 = su* ,/ate by a p]c5tage po9t = su* fiscal ye> dur+ :i* su* requirem5ts are n met4 ,to ! ext5t t a ,/ate fails to comply ) su* additional requirem5ts = consecutive fiscal ye>s1 ! r$uctions "u ! previ\s s5t5ce %all be cumulative = ea* su* subsequ5t fiscal ye>4 #g4 ,effective date 7a7 ,9 g5]al ,except z provid$ 9 subsection 7b71 ?is ,act 7o!r ?an section #d7 & ! am5dm5ts made by ?is ,act %all take effect on ! date ( enactm5t ( ?is ,act & %all apply to m$ical assi/ance provid$ on or aft] su* date4 7b7 ,exception if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5t impos$ by ! am5dm5ts made "u ?is section1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ?is additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( su* session %all be deem$ to be a sep>ate regul> session ( ! ,/ate legislature4