Medicaid Third Party Liability Act This bill modifies requirements relating to Medicaid third-party liability. Current law generally requires legally liable third parties (e.g., health insurers) to pay claims before Medicaid. However, Medicaid must pay first (and seek reimbursement from liable third parties) for claims for (1) preventive pediatric care, and (2) services for an individual for whom child support enforcement is being conducted by the state. The bill repeals these exceptions. Current law also requires state Medicaid programs to take all reasonable measures to identify legally liable third parties. The bill specifically prohibits federal Medicaid payment for services to individuals for whom third-party insurance information was not obtained and verified by the state.
Impact
If passed, HB 497 would specifically alter the legal framework surrounding Medicaid reimbursements and third-party liabilities. Insurers would be required to take on more clearly defined roles regarding their liabilities while receiving medical assistance payments. One crucial update is the clarification that states can delegate their right to recover costs from third parties to health insurers, fostering collaboration between state agencies and private insurers.
Summary
House Bill 497, known as the Medicaid Third Party Liability Act, aims to amend Title XIX of the Social Security Act, clarifying the responsibilities of third-party payers related to medical assistance under the Medicaid program. The bill revises the rules governing how state agencies can recover costs from third-party insurers when Medicaid pays for medical services. This change is intended to enhance the efficiency of state Medicaid programs by ensuring that they can effectively recover funds from private insurers, which could lead to decreased state expenditures for Medicaid.
Contention
The bill could lead to differences in opinion among stakeholders. Proponents argue that streamlining recovery processes will benefit the overall efficiency of Medicaid funding, providing essential services to more people without increasing state costs. However, detractors might raise concerns about the implications for individual rights regarding insurance claims and the financial burden on insurers that may arise from expanded responsibilities under HB 497. Legislative debates may focus on protecting the interests of Medicaid recipients while balancing the financial responsibilities of insurers.
This bill requires the Centers for Medicare & Medicaid Services to revise regulations so as to specifically require Medicare skilled nursing facilities and Medicaid nursing facilities to report the identity of medical directors and related information.
Freedom for Health Care Workers Act This bill nullifies the rule titled Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination, which was issued by the Centers for Medicare & Medicaid Services on November 5, 2021, and prohibits the issuance of any substantially similar rule. The rule requires health care providers, as a condition of Medicare and Medicaid participation, to ensure that staff are fully vaccinated against COVID-19.
Cover Outstanding Vulnerable Expansion-eligible Residents Now Act or the COVER Now Act This bill establishes a demonstration program to allow local governments to provide health benefits to the Medicaid expansion population in states that have not expanded Medicaid. Under the program, local governments may provide coverage for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (i.e., the Medicaid expansion population) for a maximum of 10 years, or until their respective states expand Medicaid. The bill provides a 100% federal matching rate for the first three years of program participation. The bill prohibits states from taking certain actions against participating localities, such as withholding funding, increasing taxes, or restricting provider participation. States that violate these requirements are subject to certain funding penalties.
To prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services.
Stop the Nosy Obsession with Online Payments Act of 2023 or the SNOOP Act of 2023 This bill modifies requirements for third party settlement organizations to eliminate their reporting requirement with respect to the transactions of their participating payees unless they have earned more than $20,000 on more than 200 separate transactions in an applicable tax period. A third party settlement organization is the central organization that has the contractual obligation to make payments to participating payees (generally, a merchant or business) in a third party payment network. This reverses a provision in the American Rescue Plan Act of 2021 that lowered the reporting threshold to $600 with no minimum on the number of transactions.
Saving Gig Economy Taxpayers Act This bill modifies requirements for third party settlement organizations to eliminate their reporting requirement with respect to the transactions of their participating payees unless they have earned more than $20,000 on more than 200 separate transactions in an applicable tax period. A third party settlement organization is the central organization that has the contractual obligation to make payments to participating payees (generally, a merchant or business) in a third party payment network. This reverses a provision in the American Rescue Plan Act of 2021 that lowered the reporting threshold to $600 with no minimum on the number of transactions.
To amend title XIX of the Social Security Act to expand the application of Medicaid State programs to monitor antipsychotic medications to all Medicaid beneficiaries.