Enrolled Bill Summary

Senate Bill 1342	Senate Author:  Perry
Effective:  9-1-23	House Sponsor:  Smithee

            Senate Bill 1342 amends the Government Code and Human Resources Code to revise provisions regarding the liability of third‑party health insurers in relation to Medicaid to reflect changes in federal regulations.  Among other provisions, the bill does the following:

·        requires a third‑party health insurer that is responsible for payment for an item or service provided to a Medicaid-eligible individual that was previously paid for by the state to accept authorization that the item or service is covered under the state Medicaid program as if that authorization is a prior authorization made by the insurer, with certain exceptions;

·        prohibits a responsible third‑party health insurer from denying a claim submitted by the state for which payment was made under Medicaid solely on the basis of a failure to obtain prior authorization for the item or service for which the claim is being submitted; and

·        establishes a deadline for a third‑party health insurer to respond to any inquiry from the state regarding a claim for payment for a health care item or service.

The bill repeals certain requirements for health insurers and the state's Medicaid third-party recovery division relating to the identification of Medicaid recipients who have third‑party health coverage or insurance.