,,ii  #aae? ,,congress  #a/ ,session    
,s4 #bjbg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #bf1 #bjag,mr4 
,portman introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to provide  
cl>ification ) respect to ! liability ( 
?ird p>ty pay]s = m$ical assi/ance paid 
"u ! ,m$icaid program1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,m$icaid ,?ird ,p>ty ,liability     
,act4  #b4 ,m$icaid ?ird p>ty liability 
7a7 ,cl>ification ( def9itions          
applicable to ?ird p>ty liability  7#a7 
,9 g5]al ,section #aijb ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7nn7 ,= purposes (         
subsection 7a77#be7 & section           
#aijc7;d77#b77;,b71 ! t]m responsible   
?ird p>ty means a heal? insur] 7includ+ 
a gr\p heal? plan1 z def9$ 9 section    
#fjg7a7 ( ! ,employee ,retirem5t ,income
 ,security ,act ( #aigd1 a self-insur$  

plan1 a fully-insur$ plan1 a s]vice     
b5efit plan1 a manag$ c>e organization1 
a ph>macy b5efit manag]1 & any o!r heal?
 plan det]m9$ appropriate by !          
,secret>y71 ! ,,tric>e program "u *apt] 
#ee ( title #aj1 ,unit$ ,/ates ,code1 an
 acc\ntable c>e organization1 or any o!r
 p>ty t is1 by /atute1 contract1 or     
agreem5t1 legally responsible = paym5t (
 a claim = a heal? c>e item or s]vice4  
4  7#b7 ,con=m+ am5dm5ts ,section       
#aijb7;a77#be7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#be77 is 
am5d$-- 7,a7 9 subp>agraph 7,a71 9 !    
matt] prec$+ clause 7i71 by /rik+ ?ird  
p>ties & all t foll[s ?r\gh item or     
s]vice7 & ins]t+ responsible ?ird       
p>ties2  7,b7 9 subp>agraph 7,g71 by    
/rik+ heal? insur] & all t foll[s ?r\gh 
item or s]vice7 & ins]t+ responsible    
?ird p>ty2  7,c7 9 subp>agraph 7,i71 9 !
 matt] prec$+ clause 7i71 by /rik+ heal?
 insur]s & all t foll[s ?r\gh item or   
s]vice & ins]t+ responsible ?ird p>ties2
 &  7,d7 by ins]t+ responsible be=e ?ird

 ea* place x appe>s 9 subp>agraphs      
7,a77i71 7,a77ii71 7,c71 7,d71 & 7,h74  
7b7 ,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
  7c7 ,cl>ification ( role ( heal?      
insur]s ) respect to ?ird p>ty liability
  7#a7 ,9 g5]al ,section #aijb7;a77#be7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a7a77#be771 z am5d$ by  
subsection 7b71 is fur!r am5d$ by ins]t+
 aft] subp>agraph 7,d7 ! foll[+ new     
subp>agraphs3  7,e7 t1 9 ! case ( a     
,/ate t provides m$ical assi/ance "u ?is
 title ?r\gh a contract ) a heal? insur]
 7includ+ a gr\p heal? plan1 z def9$ 9  
section #fjg7a7 ( ! ,employee ,retirem5t
 ,income ,security ,act ( #aigd1 a      
self-insur$ plan1 a fully-insur$ plan1 a
 s]vice b5efit plan1 a manag$ c>e       
organization1 a ph>macy b5efit manag]1 &
 any o!r heal? plan det]m9$ appropriate 

by ! ,secret>y71 su* contract %all      
specify :e!r ! ,/ate is--  7i7 delegat+ 
to su* insur] all or "s ( its "r (      
recov]y f a responsible ?ird p>ty = an  
item or s]vice = :i* paym5t has be5 made
 "u ! ,/ate plan 7or "u a waiv] ( !     
plan72 &  7ii7 transf]r+ to su* insur]  
all or "s ( ! assignm5t to ! ,/ate ( any
 "r ( an individual or o!r entity to    
paym5t f a responsible ?ird p>ty = an   
item or s]vice = :i* paym5t has be5 made
 "u ! ,/ate plan 7or "u a waiv] ( !     
plan72  7,f7 t1 9 ! case ( a ,/ate t    
elects an option describ$ 9 clause 7i7  
or 7ii7 ( subp>agraph 7,e7 ) respect to 
a heal? insur] 7includ+ a gr\p heal?    
plan1 z def9$ 9 section #fjg7a7 ( !     
,employee ,retirem5t ,income ,security  
,act ( #aigd1 a self-insur$ plan1 a     
fully-insur$ plan1 a s]vice b5efit plan1
 a manag$ c>e organization1 a ph>macy   
b5efit manag]1 & any o!r heal? plan     
det]m9$ appropriate by ! ,secret>y71 !  
,/ate %all provide assurances to !      
,secret>y t ! ,/ate laws ref]r$ to 9    

subp>agraph 7,i7 conf] to ! heal? insur]
 ! au?ority ( ! ,/ate ) respect to !    
requirem5ts specifi$ 9 clauses 7i7 ?r\gh
 7iv7 ( su* subp>agraph2  4  7#b7       
,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    
responsible ?ird p>ty to heal? insur]s  
7includ+ gr\p heal? plans1 z def9$ 9    
section #fjg7a7 ( ! ,employee ,retirem5t
 ,income ,security ,act ( #aigd1        
self-insur$ plans1 fully-insur$ plans1  
s]vice b5efit plans1 manag$ c>e         
organizations1 ph>macy b5efit manag]s1 &
 any o!r heal? plan det]m9$ appropriate 
by ! ,secret>y7 pursuant to section     
#aijb7;a77#be77;,e7 %all be treat$ 9 !  
same mann] z reimbursem5ts made to a    
,/ate "u ! previ\s s5t5ce44  7#c7       
,effective date ,! am5dm5ts made by ?is 
subsection %all take effect z if enact$ 
on ,octob] #a1 #bjag4  7d7 ,increas+    

,/ate flexibility ) respect to ?ird p>ty
 liability ,section #aijb7;a77#be77;,i7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a7a77#be77;,i77 is      
am5d$--  7#a7 9 clause 7i71 by /rik+    
m$ical assi/ance "u ! ,/ate plan &      
ins]t+ m$ical assi/ance "u a ,/ate plan 
7or "u a waiv] ( ! plan72  7#b7 by /rik+
 clause 7ii7 & ins]t+ ! foll[+ new      
clause3  7ii7 accept-- 7,i7 any ,/ate's 
"r ( recov]y & ! assignm5t to any ,/ate 
( any "r ( an individual or o!r entity  
to paym5t f ! p>ty = an item or s]vice =
 :i* paym5t has be5 made "u ! respective
 ,/ate's plan 7or "u a waiv] ( ! plan72 
&  7,,ii7 z a valid au?orization ( !    
responsible ?ird p>ty = ! furni%+ ( an  
item or s]vice to an individual eligible
 to receive m$ical assi/ance "u ?is     
title1 an au?orization made on behalf ( 
su* individual "u ! ,/ate plan 7or "u a 
waiv] ( su* plan7 = ! furni%+ ( su* item
 or s]vice to su* individual2  2  7#c7 9
 clause 7iii7-- 7,a7 by /rik+ respond to
 & ins]t+ n lat] ?an #fj days aft]      

receiv+2 &  7,b7 by /rik+ 2 & at ! end &
 ins]t+ 1 respond to su* inquiry2 &2 &  
7#d7 9 clause 7iv71 by ins]t+ a failure 
to obta9 a prior au?orization1 aft]     
claim =m14  7e7 ,/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        
subsection 7c77#b71 is am5d$ by add+ at 
! end ! foll[+3 ,9 ! case ( exp5ditures 
= m$ical assi/ance provid$ dur+ fiscal  
ye> #bjah & subsequ5t fiscal ye>s =     
individuals 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* m$ical     
assi/ance1 ! ,secret>y %all apply !     
,f$]al m$ical assi/ance p]c5tage = !    
,/ate "u section #aije7;b71 not)/&+ !   
application ( section #aije7y744  #c4   
,compliance ) ?ird p>ty insurance       
report+  7a7 ,9 g5]al ,section #aijc ( !
 ,social ,security ,act 7#db ,u4,s4,c4  

#acif;b7 is am5d$ by ins]t+ aft]        
subsection 7m7 ! foll[+ new subsection3 
7n7 7#a7 ,= any fiscal ye> beg9n+ aft]  
fiscal ye> #bjbj 7except z provid$ 9    
p>agraph 7#b771 unless a ,/ate complies 
) ! requirem5ts ( section #aijb7;a77#be7
 ) respect to ea* cal5d> qu>t] 9 su*    
fiscal ye>1 ! ,f$]al m$ical assi/ance   
p]c5tage %all be r$uc$ by #j4be p]c5tage
 po9ts = cal5d> qu>t]s 9 ea* subsequ5t  
fiscal ye> 9 :i* ! ,/ate fails to s     
comply 7& cumulatively = a failure to s 
comply = a p]iod ( consecutive fiscal   
ye>s74  7#b7 ,not)/&+ p>agraph 7#a71 !  
r$uction 9 ! ,f$]al m$ical assi/ance    
p]c5tage %all apply--  7,a7 9 ! case ( a
 failure ( ! ,/ate to comply ) !        
requirem5ts ( section #aijb7;a77#be7 )  
respect to paym5t = items & s]vices     
furni%$ to individuals describ$ 9       
subclause 7,,viii7 ( section            
#aijb7;a77#aj77;,a77i71 = any fiscal ye>
 beg9n+ aft] fiscal ye> #bjah2 &  7,b7 9
 ! case ( a failure ( ! ,/ate to comply 
) ! requirem5ts ( section #aijb7;a77#be7

 ) respect to paym5t = items & s]vices  
furni%$ to individuals describ$ 9       
subdivision 7i71 7iii71 or 7iv7 (       
section #aije7;a71 = any fiscal ye>     
beg9n+ aft] fiscal ye> #bjai4  4  7b7   
,v]ification ( insurance /atus requir$  
,section #aijb7;a77#be77;,a77i7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#be77;,a77i77 is am5d$ by    
ins]t+ 1 includ+ ! collection (1 )      
respect to an individual seek+ to       
receive m$ical assi/ance "u ?is title1  
in=mation on :e!r ! individual has heal?
 insurance cov]age provid$ ?r\gh a heal?
 insur] 7z describ$ 9 section #aijb7nn77
 & ! plan ( su* insur] 9 :i* !          
individual is enroll$ aft] suffici5t    
in=mation4  #d4 ,application to ,,*ip   
7a7 ,9 g5]al ,section #bajg7;e77#a7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acig;gg7e77#a77 is am5d$-- 7#a7 by     
r$esignat+ subp>agraphs 7,b7 ?r\gh 7,r7 
z subp>agraphs 7,c7 ?r\gh 7,s71         
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,a7 ! foll[+ new           

subp>agraph3  7,b7 ,section             
#aijb7;a77#be7 7relat+ to ?ird p>ty     
liability74  4  7b7 ,m&atory report+    
,section #aijb7;a77#be77;,i77i7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#be77;,i77i771 z am5d$ by    
section #a7;d71 is fur!r am5d$--  7#a7  
by /rik+ 7&1 at ,/ate option1 *ild &    
ins]t+ & *ild2 &  7#b7 by /rik+ title   
,,xxi7 & ins]t+ title ,,xxi4  #e4 ,tra9+
 on ?ird p>ty liability ,section #aicf (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acifu-#f7 is am5d$-- 7#a7 9 subsection
 7b77#d71 by /rik+ & quality ( c>e &    
ins]t+ 1 quality ( c>e1 & ! liability ( 
responsible ?ird p>ties 7z def9$ 9      
section #aijb7nn772 &  7#b7 by add+ at !
 end ! foll[+ new subsection3  7f7 ,?ird
 p>ty liability tra9+ ,) respect to     
education or tra9+ activities c>ri$ out 
pursuant to subsection 7b77#d7 ) respect
 to ! liability ( responsible ?ird      
p>ties 7z def9$ 9 section #aijb7nn7 =   
paym5t = items & s]vices furni%$ "u     
,/ate plans 7or "u waiv]s ( su* plans77 

"u ?is title1 ! ,secret>y %all--  7#a7  
publi% 7& update on an annual basis7 on 
! public ,int]net website ( ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices a d$icat$    
,int]net page conta9+ be/ practices to  
be us$ 9 assess+ su* liability2  7#b7   
monitor ef=ts to assess su* liability & 
analyze ! *all5ges pos$ by t assessm5t2 
7#c7 di/ribute to ,/ate ag5cies adm9i/]+
 ! ,/ate plan "u ?is title in=mation    
relat$ to su* ef=ts & *all5ges2 &  7#d7 
provide guidance to su* ,/ate ag5cies ) 
respect to ,/ate ov]sight ( ef=ts by    
m$icaid manag$ c>e organizations 7z     
def9$ 9 section #aijc7m77#a77 to assess 
su* liability4  4  #f4 ,developm5t (    
model uni=m fields = ,/ates to report   
?ird p>ty in=mation ,n lat] ?an ,janu>y 
#a1 #bjah1 ! ,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 ?r\gh ! ,trans=m$ ,m$icaid   
,/ati/ical ,in=mation ,sy/em 7,t-,,msis7

 7or a successor sy/em7 in=mation       
id5tify+ responsible ?ird p>ties 7z     
def9$ 9 subsection 7nn7 ( section #aijb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a77 & o!r relevant      
in=mation = asc]ta9+ ! legal            
responsibility ( su* ?ird p>ties to pay 
= c>e & s]vices available "u ! ,/ate    
plan 7or "u a waiv] ( ! plan7 "u title  
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq474  #g4          
,effective date  7a7 ,9 g5]al ,except z 
provid$ 9 subsection 7b7 & section      
#b7;c77#c71 ?is ,act & ! am5dm5ts made  
by ?is ,act 7o!r ?an z specifi$ 9 !     
prec$+ provisions ( ?is ,act7 %all take 
effect on ! date ( enactm5t ( ?is ,act &
 %all apply to m$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