119-hr497

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 497 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 497

To amend title XIX of the Social Security Act to provide clarification 
 with respect to the liability of third party payers for medical 
 assistance paid under the Medicaid program, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 January 16, 2025

 Mr. Crenshaw introduced the following bill; which was referred to the 
 Committee on Energy and Commerce

_______________________________________________________________________

 A BILL

To amend title XIX of the Social Security Act to provide clarification 
 with respect to the liability of third party payers for medical 
 assistance paid under the Medicaid program, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Medicaid Third Party Liability 
Act''.

SEC. 2. MEDICAID THIRD PARTY LIABILITY.

    (a) Removal of Special Treatment of Certain Types of Care and 
Payments Under Medicaid Third Party Liability Rules.--

Section 1902

    (a)

    (25) of the Social Security Act (42 U.S.C. 1396a

    (a)

    (25) ) is 
amended by striking subparagraphs
        (E) and
        (F) and redesignating the 
subsequent subparagraphs accordingly.

    (b) Clarification of Role of Health Insurers With Respect to Third 
Party Liability.--

Section 1902

    (a)

    (25) of the Social Security Act (42 
U.S.C. 1396a

    (a)

    (25) ), as amended by subsection

    (a) , is further 
amended--

    (1) in subparagraph
        (F) (as so redesignated), by striking 
 at the end ``and'';

    (2) in subparagraph
        (G) (as so redesignated), by striking 
 the period at the end and inserting ``; and''; and

    (3) by adding at the end the following new subparagraph:
 ``
        (H) that, in the case of a State after January 1, 
 2026, that provides medical assistance under this title 
 through a contract with a health insurer (including a 
 group health plan (as defined in 

section 607

    (1) of the 
 Employee Retirement Income Security Act of 1974), a 
 self-insured plan, a fully insured plan, a service 
 benefit plan, a managed care organization, a pharmacy 
 benefit manager, or any other health plan determined 
 appropriate by the Secretary)--
 ``
            (i) such contract shall specify--
 ``
            (I) whether the State is 
 delegating to such insurer all or some 
 of its right of recovery from a 
 responsible third party for an item or 
 service for which payment has been made 
 under the State plan (or under a waiver 
 of the plan); and
 ``
            (II) whether the State is 
 transferring to such insurer all or 
 some of the assignment to the State of 
 any right of an individual or other 
 entity to payment from a responsible 
 third party for an item or service for 
 which payment has been made under the 
 State plan (or under a waiver of the 
 plan); and
 ``
            (ii) in the case of a State that elects 
 an option described in subclause
            (I) or
            (I) of 
 clause
            (i) with respect to a health insurer 
 (including a group health plan (as defined in 
 

section 607

    (1) of the Employee Retirement 
 Income Security Act of 1974), self-insured 
 plan, a fully insured plan, a service benefit 
 plan, a managed care organization, a pharmacy 
 benefit manager, and any other health plan 
 determined appropriate by the Secretary), the 
 State shall provide assurances to the Secretary 
 that the State laws referred to in subparagraph
        (G) confer to the health insurer the authority 
 of the State with respect to the requirements 
 specified in clauses
            (i) through
            (iv) of such 
 subparagraph.''.
            (c) Increasing State Flexibility With Respect to Third Party 
Liability.--

Section 1902

    (a)

    (25)
        (G)
            (ii) of the Social Security Act (42 
U.S.C. 1396a

    (a)

    (25)
        (G)
            (ii) ), as so redesignated by subsection

    (a) , is 
amended to read as follows:
 ``
            (ii) accept--
 ``
            (I) the State's right of recovery 
 and the assignment to the State of any 
 right of an individual or other entity 
 to payment from the party for an item 
 or service for which payment has been 
 made under the respective State's plan 
 (or under a waiver of the plan); and
 ``
            (II) after January 1, 2026, as a 
 valid authorization of the responsible 
 third party for the furnishing of an 
 item or service to an individual 
 eligible to receive medical assistance 
 under this title, an authorization made 
 on behalf of such individual under the 
 State plan (or under a waiver of such 
 plan) for the furnishing of such item 
 or service to such individual;''.
            (d) Verification of Insurance Status Required.--

    (1) In general.--

Section 1902

    (a)

    (25)
        (A)
            (i) of the Social 
 Security Act (42 U.S.C. 1396a

    (a)

    (25)
        (A)
            (i) ) is amended by 
 inserting ``, including the collection of, with respect to an 
 individual seeking to receive medical assistance under this 
 title, information on whether the individual has health 
 insurance coverage provided through a third party (as described 
 in such paragraph) and the plan of such insurer in which the 
 individual is enrolled,'' after ``in regulations)''.

    (2) FFP unavailable without insurance status 
 verification.--

Section 1903
            (i) of the Social Security Act (42 
 U.S.C. 1396b
            (i) ) is amended--
        (A) in paragraph

    (26) , by striking ``; or'' and 
 inserting ``;'';
        (B) in paragraph

    (27) , by striking ``of the 
 State.'' and inserting ``of the State; or''; and
            (C) by inserting after paragraph

    (27) the 
 following:
 ``

    (28) with respect to any amounts after January 1, 2026, 
 expended for medical assistance for individuals for whom the 
 State has not obtained and verified, in accordance with 

section 1902

    (a)

    (25)
        (A)
            (i) , information on whether such an individual 
 has coverage provided through a third party (as described in 
 such paragraph) and the plan of such coverage in which the 
 individual is enrolled.''.

SEC. 3. EFFECTIVE DATE.

 In the case of a State plan for medical assistance under title XIX 
of the Social Security Act that the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirement imposed by the amendments made under this section, the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
this additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of enactment of this Act. 
For purposes of the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session shall be deemed 
to be a separate regular session of the State legislature.
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