,,ii  #aaeth ,,congress  #ast ,session  
,s4 #bjbg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,october #bf1  
#bjag,mr4 ,portman introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,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 program1 and for other        
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,medicaid ,third    
,party ,liability ,act4  #b4 ,medicaid  
third party liability  7a7              
,clarification of definitions applicable
 to third party liability  7#a7 ,in     
general ,section #aijb of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is amended by adding at the end the     
following new subsection3  7nn7 ,for    
purposes of subsection 7a77#be7 and     
section #aijc7;d77#b77;,b71 the term    
responsible third party means a health  

insurer 7including a group health plan1 
as defined in section #fjg7a7 of the    
,employee ,retirement ,income ,security 
,act of #aigd1 a self-insured plan1 a   
fully-insured plan1 a service benefit   
plan1 a managed care organization1 a    
pharmacy benefit manager1 and any other 
health plan determined appropriate by   
the ,secretary71 the ,,tricare program  
under chapter #ee of title #aj1 ,united 
,states ,code1 an accountable care      
organization1 or any other party that   
is1 by statute1 contract1 or agreement1 
legally responsible for payment of a    
claim for a health care item or service4
  4  7#b7 ,conforming amendments        
,section #aijb7;a77#be7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77 is amended-- 7,a7 in   
subparagraph 7,a71 in the matter        
preceding clause 7i71 by striking third 
parties and all that follows through    
item or service7 and inserting          
responsible third parties2  7,b7 in     
subparagraph 7,g71 by striking health   

insurer and all that follows through    
item or service7 and inserting          
responsible third party2  7,c7 in       
subparagraph 7,i71 in the matter        
preceding clause 7i71 by striking health
 insurers and all that follows through  
item or service and inserting           
responsible third parties2 and  7,d7 by 
inserting responsible before third each 
place it appears in subparagraphs       
7,a77i71 7,a77ii71 7,c71 7,d71 and 7,h74
  7b7 ,removal of special treatment of  
certain types of care and payments under
 ,medicaid third party liability rules  
,section #aijb7;a77#be7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77 is amended by striking 
subparagraphs 7,e7 and 7,f74  7c7       
,clarification of role of health        
insurers with respect to third party    
liability  7#a7 ,in general ,section    
#aijb7;a77#be7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7a77#be771 as
 amended by subsection 7b71 is further  
amended by inserting after subparagraph 

7,d7 the following new subparagraphs3   
7,e7 that1 in the case of a ,state that 
provides medical assistance under this  
title through a contract with a health  
insurer 7including a group health plan1 
as defined in section #fjg7a7 of the    
,employee ,retirement ,income ,security 
,act of #aigd1 a self-insured plan1 a   
fully-insured plan1 a service benefit   
plan1 a managed care organization1 a    
pharmacy benefit manager1 and any other 
health plan determined appropriate by   
the ,secretary71 such contract shall    
specify whether the ,state is--  7i7    
delegating to such insurer all or some  
of its right of recovery from a         
responsible third party for an item or  
service for which payment has been made 
under the ,state plan 7or under a waiver
 of the plan72 and  7ii7 transferring to
 such insurer all or some of the        
assignment to the ,state of any right of
 an individual or other entity to       
payment from a responsible third party  
for an item or service for which payment

 has been made under the ,state plan 7or
 under a waiver of the plan72  7,f7     
that1 in the case of a ,state that      
elects an option described in clause 7i7
 or 7ii7 of subparagraph 7,e7 with      
respect to a health insurer 7including a
 group health plan1 as defined in       
section #fjg7a7 of the ,employee        
,retirement ,income ,security ,act of   
#aigd1 a self-insured plan1 a           
fully-insured plan1 a service benefit   
plan1 a managed care organization1 a    
pharmacy benefit manager1 and any other 
health plan determined appropriate by   
the ,secretary71 the ,state shall       
provide assurances to the ,secretary    
that the ,state laws referred to in     
subparagraph 7,i7 confer to the health  
insurer the authority of the ,state with
 respect to the requirements specified  
in clauses 7i7 through 7iv7 of such     
subparagraph2  4  7#b7 ,treatment of    
collected amounts ,section              
#aijc7;d77#b77;,b7 of the ,social       
,security ,act 7#db ,u4,s4,c4           

#acif;b7d77#b77;,b77 is amended by      
adding at the end the following3 ,for   
purposes of this subparagraph1          
reimbursements made by a responsible    
third party to health insurers          
7including group health plans1 as       
defined in section #fjg7a7 of the       
,employee ,retirement ,income ,security 
,act of #aigd1 self-insured plans1      
fully-insured plans1 service benefit    
plans1 managed care organizations1      
pharmacy benefit managers1 and any other
 health plan determined appropriate by  
the ,secretary7 pursuant to section     
#aijb7;a77#be77;,e7 shall be treated in 
the same manner as reimbursements made  
to a ,state under the previous          
sentence44  7#c7 ,effective date ,the   
amendments made by this subsection shall
 take effect as if enacted on ,october  
#a1 #bjag4  7d7 ,increasing ,state      
flexibility with respect to third party 
liability ,section #aijb7;a77#be77;,i7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acif;a7a77#be77;,i77 is      

amended--  7#a7 in clause 7i71 by       
striking medical assistance under the   
,state plan and inserting medical       
assistance under a ,state plan 7or under
 a waiver of the plan72  7#b7 by        
striking clause 7ii7 and inserting the  
following new clause3  7ii7 accept--    
7,i7 any ,state's right of recovery and 
the assignment to any ,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 respective ,state's plan 7or 
under a waiver of the plan72 and  7,,ii7
 as a valid authorization of the        
responsible third party for the         
furnishing of an item or service to an  
individual eligible to receive medical  
assistance under this title1 an         
authorization made on behalf of such    
individual under the ,state plan 7or    
under a waiver of such plan7 for the    
furnishing of such item or service to   
such individual2  2  7#c7 in clause     
7iii7-- 7,a7 by striking respond to and 

inserting not later than #fj days after 
receiving2 and  7,b7 by striking 2 and  
at the end and inserting 1 respond to   
such inquiry2 and2 and  7#d7 in clause  
7iv71 by inserting a failure to obtain a
 prior authorization1 after claim form14
  7e7 ,state incentive ,to pursue third 
party liability for newly eligibles     
,section #aijc7;d77#b77;,b7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7d77#b77;,b771 as amended by     
subsection 7c77#b71 is amended by adding
 at the end the following3 ,in the case 
of expenditures for medical assistance  
provided during fiscal year #bjah and   
subsequent fiscal years for individuals 
described in subclause 7,,viii7 of      
section #aijb7;a77#aj77;,a77i71 in      
determining the amount1 if any1 of      
overpayment under this subparagraph with
 respect to such medical assistance1 the
 ,secretary shall apply the ,federal    
medical assistance percentage for the   
,state under section #aije7;b71         
notwithstanding the application of      

section #aije7y744  #c4 ,compliance with
 third party insurance reporting  7a7   
,in general ,section #aijc of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7 is amended by inserting after  
subsection 7m7 the following new        
subsection3  7n7 7#a7 ,for any fiscal   
year beginning after fiscal year #bjbj  
7except as provided in paragraph 7#b771 
unless a ,state complies with the       
requirements of section #aijb7;a77#be7  
with respect to each calendar quarter in
 such fiscal year1 the ,federal medical 
assistance percentage shall be reduced  
by #j4be percentage points for calendar 
quarters in each subsequent fiscal year 
in which the ,state fails to so comply  
7and cumulatively for a failure to so   
comply for a period of consecutive      
fiscal years74  7#b7 ,notwithstanding   
paragraph 7#a71 the reduction in the    
,federal medical assistance percentage  
shall apply--  7,a7 in the case of a    
failure of the ,state to comply with the
 requirements of section #aijb7;a77#be7 

with respect to payment for items and   
services furnished to individuals       
described in subclause 7,,viii7 of      
section #aijb7;a77#aj77;,a77i71 for any 
fiscal year beginning after fiscal year 
#bjah2 and  7,b7 in the case of a       
failure of the ,state to comply with the
 requirements of section #aijb7;a77#be7 
with respect to payment for items and   
services furnished to individuals       
described in subdivision 7i71 7iii71 or 
7iv7 of section #aije7;a71 for any      
fiscal year beginning after fiscal year 
#bjai4  4  7b7 ,verification of         
insurance status required ,section      
#aijb7;a77#be77;,a77i7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77;,a77i77 is amended by  
inserting 1 including the collection of1
 with respect to an individual seeking  
to receive medical assistance under this
 title1 information on whether the      
individual has health insurance coverage
 provided through a health insurer 7as  
described in section #aijb7nn77 and the 

plan of such insurer in which the       
individual is enrolled after sufficient 
information4  #d4 ,application to ,,chip
  7a7 ,in general ,section #bajg7;e77#a7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acig;gg7e77#a77 is amended-- 
7#a7 by redesignating subparagraphs 7,b7
 through 7,r7 as subparagraphs 7,c7     
through 7,s71 respectively2 and  7#b7 by
 inserting after subparagraph 7,a7 the  
following new subparagraph3  7,b7       
,section #aijb7;a77#be7 7relating to    
third party liability74  4  7b7         
,mandatory reporting ,section           
#aijb7;a77#be77;,i77i7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77;,i77i771 as amended by 
section #a7;d71 is further amended--    
7#a7 by striking 7and1 at ,state option1
 child and inserting and child2 and     
7#b7 by striking title ,,xxi7 and       
inserting title ,,xxi4  #e4 ,training on
 third party liability ,section #aicf of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acifu-#f7 is amended-- 7#a7  

in subsection 7b77#d71 by striking and  
quality of care and inserting 1 quality 
of care1 and the liability of           
responsible third parties 7as defined in
 section #aijb7nn772 and  7#b7 by adding
 at the end the following new           
subsection3  7f7 ,third party liability 
training ,with respect to education or  
training activities carried out pursuant
 to subsection 7b77#d7 with respect to  
the liability of responsible third      
parties 7as defined in section #aijb7nn7
 for payment for items and services     
furnished under ,state plans 7or under  
waivers of such plans77 under this      
title1 the ,secretary shall--  7#a7     
publish 7and update on an annual basis7 
on the public ,internet website of the  
,centers for ,medicare  ,medicaid       
,services a dedicated ,internet page    
containing best practices to be used in 
assessing such liability2  7#b7 monitor 
efforts to assess such liability and    
analyze the challenges posed by that    
assessment2  7#c7 distribute to ,state  

agencies administering the ,state plan  
under this title information related to 
such efforts and challenges2 and  7#d7  
provide guidance to such ,state agencies
 with respect to ,state oversight of    
efforts by medicaid managed care        
organizations 7as defined in section    
#aijc7m77#a77 to assess such liability4 
4  #f4 ,development of model uniform    
fields for ,states to report third party
 information ,not later than ,january   
#a1 #bjah1 the ,secretary of ,health and
 ,human ,services shall1 in consultation
 with the ,states1 develop and make     
available to the ,states a model uniform
 reporting field that ,states may use   
for purposes of reporting to the        
,secretary through the ,transformed     
,medicaid ,statistical ,information     
,system 7,t-,,msis7 7or a successor     
system7 information identifying         
responsible third parties 7as defined in
 subsection 7nn7 of section #aijb of the
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;a77 and other relevant information

 for ascertaining the legal             
responsibility of such third parties to 
pay for care and services available     
under the ,state plan 7or under a waiver
 of the plan7 under title ,,xix of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  #g4 ,effective date    
7a7 ,in general ,except as provided in  
subsection 7b7 and section #b7;c77#c71  
this ,act and the amendments made by    
this ,act 7other than as specified in   
the preceding provisions of this ,act7  
shall take effect on the date of        
enactment of this ,act and shall apply  
to medical assistance provided on or    
after such date4  7b7 ,exception if     
,state legislation required ,in the case
 of a ,state plan for medical assistance
 under title ,,xix of the ,social       
,security ,act that the ,secretary of   
,health and ,human ,services determines 
requires ,state legislation 7other than 
legislation appropriating funds7 in     
order for the plan to meet the          
additional requirement imposed by the   

amendments made under this section1 the 
,state plan shall not be regarded as    
failing to comply with the requirements 
of such title solely on the basis of its
 failure to meet this additional        
requirement before the first day of the 
first calendar quarter beginning after  
the close of the first regular session  
of the ,state legislature that begins   
after the date of the enactment of this 
,act4 ,for purposes of the previous     
sentence1 in the case of a ,state that  
has a #b-year legislative session1 each 
year of such session shall be deemed to 
be a separate regular session of the    
,state legislature4