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Amend SB 531 (House committee printing) by adding the
following appropriately numbered SECTION to the bill and
renumbering subsequent SECTIONS of the bill accordingly:
SECTION ____. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0424 to read as follows:
Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
(a) A third-party health insurer is required to provide to the
department, on the department's request, information in a form
prescribed by the department necessary to determine:
(1) the period during which an individual entitled to
medical assistance, the individual's spouse, or the individual's
dependents may be, or may have been, covered by coverage issued by
the health insurer;
(2) the nature of the coverage; and
(3) the name, address, and identifying number of the
health plan under which the person may be, or may have been,
covered.
(b) A third-party health insurer shall accept the state's
right of recovery and the assignment under Section 32.033 to the
state of any right of an individual or other entity to payment from
the third-party health insurer for an item or service for which
payment was made under the medical assistance program.
(c) A third-party health insurer shall respond to any
inquiry by the department regarding a claim for payment for any
health care item or service reimbursed by the department under the
medical assistance program not later than the third anniversary of
the date the health care item or service was provided.
(d) A third-party health insurer may not deny a claim
submitted by the department or the department's designee for which
payment was made under the medical assistance program solely on the
basis of the date of submission of the claim, the type or format of
the claim form, or a failure to present proper documentation at the
point of service that is the basis of the claim, if:
(1) the claim is submitted by the department or the
department's designee not later than the third anniversary of the
date the item or service was provided; and
(2) any action by the department or the department's
designee to enforce the state's rights with respect to the claim is
commenced not later than the sixth anniversary of the date the
department or the department's designee submits the claim.
(e) This section does not limit the scope or amount of
information required by Section 32.042.