SB 9 — Revises provisions relating to Medicaid. (BDR 57-290)

and(b) (2)[Respond Theto] natureNot oflater thethan coverage60 thatdays isafter orreceiving wasany providedinquiry by the society,state including,agency withoutregarding limitation,a theclaim namefor andpayment addressfor the provision of any medical item or service to the insuredperson who is eligible for medical assistance under Medicaid and who the identifyingstate numberagency ofreasonably believes is covered by the certificatesociety forthat healthis benefits,submitted evidencenot later than 3 years after the date of coveragethe provision of the medical item or contract;service [;] , respond to such inquiry;

(b) [Respond to] Not later than 60 days after receiving any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service to the person who is eligible for medical assistance under Medicaid and who the state agency reasonably believes is covered by the society that is - *SB9* – 6 – submitted not later than 3 years after the date of the provision of the medical item or service [;] , respond to such inquiry;

or - 83rd Session (2025) – 6 – (2) The date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:

[(1)] (I) The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service;

and after the date of the provision of the medical item or [(2)] (II) Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.

or (2) It has reimbursed Medicaid in full for the health care providedpro3.dedIf bya Medicaidstate toagency itsis subscriberassigned orany policyholder.rights of a person who is:

3.

If a state agency is assigned any rights of a person who is:

- *SB9* – 7 – (a) Upon request of the state agency, provide to the state agency information regarding the subscriber or policyholder to determine:

and (2)- The83rd natureSession of(2025) the– coverage7 that– is or was provided by the corporation, including, without limitation, the name and address ofofe the subscriber or policyholder and the identifying number of the contract;

or (2) The date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point ofo[(1)] sale(I) thatThe claim is submitted by the basisstate foragency not later than 3 years after the claimdate if:of the provision of the medical item or service;

[(1)] (I) The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service;

(a) Shall treat Medicaid as having a valid and enforceable assignment of benefits due an enrollee or claimant under the enrollee regardless of any exclusion of Medicaid or the absence of a written assignment;

andandany exclusion of Medicaid or the absence of a (b) May, as otherwise allowed by its plan, evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any rights of a recipient of Medicaid to reimbursement against any other liable party if:

- *SB9* – 8 – (1) It is so authorized pursuant to a contract with Medicaid for managed care;

- 83rd Session (2025) – 8 – 3.

and (b) Covered by a health care plan,  the organization responsible for the health care plan shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by the same plan.

(1) Lack of prior authorization if the state agency authorized the medical item or service;

ororthe state agency (2) The date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:

An organization shall not, when considering eligibility for coverage or making payments under any evidence of - *SB9* – 9 – coverage, consider the availability of, or eligibility of a person for, medical assistance under Medicaid.

2.- 83rd Session (2025) – 9 – health care, a prepaid limited health service organization:for (a) Shall treat Medicaid as having a valid and enforceable assignment of benefits due a subscriber or claimant under the subscriber regardless of any exclusion of Medicaid or the absence of a written assignment;

To the extent that payment has been made by Medicaid for health care, a prepaid limited health service organization:

(a) Shall treat Medicaid as having a valid and enforceable assignment of benefits due a subscriber or claimant under the subscriber regardless of any exclusion of Medicaid or the absence of a written assignment;

and (b) Covered by any evidence of coverage,  the prepaid limited health service organization that issued the evidence of coverage shall not impose any requirements upon thethehe state agency except requirements it imposes upon the agents or assignees of other persons covered by any evidence of coverage.

(b) [Respond to] Not later than 60 days after receiving any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service to the person who is eligible for medical assistance under Medicaid and who the state agency reasonably believes is covered by the organization that is submitted not later than 3 years after the date of the provision of the medical item or service [;] , respond to such inquiry;

- *SB9*83rd –Session 10(2025) – (1)10 Lack– of prior authorization if the state agency authorized the medical item or service;

ororthe state agency (2) The date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:

H~~~~~ 25 - *SB9*83rd Session (2025)