| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to third-party health insurers. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. 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 have been covered by the health insurer; |
|
|
(2) the nature of the coverage, if any; and |
|
|
(3) the name, address, and identifying number of the |
|
|
health plan under which the person was covered. |
|
|
(b) A third-party health insurer shall accept the state's |
|
|
right of recovery and the assignment to the state of any right of an |
|
|
individual or other entity to payment for an item or service for |
|
|
which payment was made under the medical assistance plan. |
|
|
(c) A third-party health insurer shall respond to any |
|
|
inquiry by the state regarding a claim for payment for any health |
|
|
care item or service submitted by the state 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 state 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 sale that is the basis |
|
|
of the claim, if: |
|
|
(1) the claim is submitted by the state not later than |
|
|
the third anniversary of the date the item or service was provided; |
|
|
and |
|
|
(2) any action by the state to enforce the state's |
|
|
rights with respect to the claim is commenced not later than the |
|
|
sixth anniversary of the date the state submits the claim. |
|
|
SECTION 2. This Act takes effect September 1, 2009. |