ENROLLED
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ACT No. 824
Regular Session, 2014
HOUSE BILL NO. 814
BY REPRESENTATIVE JAMES
AN ACT1
To amend and reenact R.S. 46:446, relative to recovery of medical assistance payments2
made by medical assistance programs; to provide for definitions; to confer upon3
Medicaid managed care organizations certain rights of recovery; to provide relative4
to notice, pleadings, compromise, and prescription in cases of third party liability for5
injury, illness, or death; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 46:446 is hereby amended and reenacted to read as follows:8
ยง446. Recovery of assistance and medical payments medical assistance payments;9
notice; pleadings; compromise; prescription; privilege for reimbursement of10
Medicaid payments11
A. As used in this Section, the following terms have the meaning ascribed12
in this Subsection:13
(1) "Department" means the Department of Health and Hospitals.14
(2) "Medicaid" means the medical assistance program provided for in Title15
XIX of the Social Security Act.16
(3) "Medicaid managed care organization" means any private entity that17
contracts with the department to provide Medicaid benefits and services to enrollees18
of the Medicaid program.19
A.B. When an injury has been sustained or an illness or death incurred by20
any person under circumstances creating in some third person or legal entity a legal21
liability or obligation to pay damages or compensation to that person or to his22
spouse, representative, or dependent, the Department of Health and Hospitals23
department shall have a cause of action against such third party and/or to recover the24
medical assistance payments the department has paid or is obligated to pay on behalf25 ENROLLEDHB NO. 814
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of the injured, ill, or deceased person in connection with the injury, illness, or death.1
The department, a Medicaid managed care organization, or both, may intervene in2
a suit filed by or on behalf of the injured, ill, or deceased person or his spouse,3
representative, or dependent against such third party to recover the assistance4
payments and medical expenses medical assistance payments the Department of5
Health and Hospitals department, Medicaid managed care organization, or each, has6
paid or is obligated to pay on behalf of the injured, ill, or deceased person in7
connection with said injury, illness, or death.8
B.C. Any person or his spouse, representative, or dependent who files suit9
for the recovery of damages or compensation as the result of an injury, illness, or10
death for which assistance payments of medical expenses medical assistance11
payments in whole or in part have been paid by the Department of Health and12
Hospitals department, a Medicaid managed care organization, or both, for which the13
department, Medicaid managed care organization, or each, has an obligation to pay14
therefor, shall at the time suit is filed cause a copy of the petition to be served on the15
department, Medicaid managed care organization, or both, in the manner prescribed16
by Article 1313 of the Louisiana Code of Civil Procedure. Such person filing suit17
shall be responsible to the department, Medicaid managed care organization, or both,18
to the extent of the medical payments or assistance medical assistance payments19
received, interest, and attorney fees if he fails to have service made upon the20
department, Medicaid managed care organization, or both. Such person shall also21
be responsible to the department, Medicaid managed care organization, or both, if22
he compromises his claim without giving the department, Medicaid managed care23
organization, or both, written notice at least thirty days before the compromise is24
affected. This written notice shall include the name and date of birth of all injured25
or ill recipients and the name and address of the party or parties potentially liable for26
damages or compensation.27
C.D. Pleadings filed on behalf of the Department of Health and Hospitals28
department or Medicaid managed care organization shall be accompanied by an29
itemized statement of its monetary claim, and when accompanied by an affidavit to30 ENROLLEDHB NO. 814
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the correctness thereof to the best of the affiant's knowledge and belief, such1
itemized statement shall be accepted as prima facie proof of the amount, purpose,2
and necessity of such payments.3
D.E. No compromise of any claim referred to in Subsections A and B B and4
C of this Section shall be binding upon or affect the rights of the Department of5
Health and Hospitals department or a Medicaid managed care organization against6
a third party if the department or Medicaid managed care organization has notified7
such third party in writing of the amount of its claim prior to the date the8
compromise settlement is made. The notice provided for herein may be directed to9
either the third party or his agent.10
E.F. An intervention filed by the Department of Health and Hospitals11
department or a Medicaid managed care organization as provided by Subsection A12
B of this Section is not barred by prescription if it was not barred at the time the13
main demand was filed, provided such intervention is filed within ninety days of the14
date of service of the main demand upon the department.15
F.G. The Department of Health and Hospitals department and a Medicaid16
managed care organization shall have a privilege for the medical assistance payments17
made by the department or Medicaid managed care organization on behalf of an18
injured or ill Medicaid recipient on the amount payable to the injured recipient, his19
heirs, or legal representatives out of the total amount of any recovery or sum had,20
collected, or to be collected, whether by judgment or by settlement judgment,21
settlement, or compromise, from another person on account of such injuries, and on22
the amount payable by any insurance company under any contract providing for23
indemnity or compensation to the injured person. The privilege of an attorney shall24
have precedence over the privilege created under this Section.25
G.H. The privilege created herein in Subsection G of this Section shall26
become effective if, prior to the payment of insurance proceeds, or to the payment27
of any judgment, settlement, or compromise on account of injuries, a written notice28
containing the name and address of the injured person, and if known, the name of the29
person alleged to be liable to the injured person on account of the injuries received,30 ENROLLEDHB NO. 814
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is mailed by the Department of Health and Hospitals department, a Medicaid1
managed care organization, or its an attorney or agent of either, by certified mail,2
return receipt requested, to the injured person, to his attorney, to the person alleged3
to be liable to the injured person on account of the injuries sustained, to any4
insurance carrier which has insured such person against liability, and to any5
insurance company obligated by contract to pay indemnity or compensation to the6
injured person. This privilege shall be effective against the persons given notice7
according to the provisions hereof, and shall not be defeated nor rendered ineffective8
as against the persons who have been given such notice, because of failure to give9
such notice to other persons named herein.10
H.I. Any insurer, potentially liable third party, or other person who, having11
received notice in accordance with the provisions hereof of this Section, pays over12
any monies subject to the privilege created herein to any injured person, or to the13
attorney, heirs, or legal representatives of any injured person, and any injured person,14
his legal representative, or attorney who receives monies subject to the privilege15
herein created in Subsection G of this Section shall be liable to the Department of16
Health and Hospitals department, Medicaid managed care organization, or both, for17
the amount of the privilege not to exceed the amount paid by the insurer, potentially18
liable third party, or other person.19
I.J. Nothing in this Section shall be construed to create any statutory lien or20
privilege on any life insurance proceeds or trust proceeds in favor of any third21
person.22
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: