Texas 2015 - 84th Regular

Texas House Bill HB2959 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R8048 SCL-F
2	2	By: Zerwas H.B. No. 2959
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to Medicaid interception of certain insurance payments.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle C, Title 2, Human Resources Code, is
10	10	amended by adding Chapter 37 to read as follows:
11	11	CHAPTER 37. MEDICAID INTERCEPTION OF CERTAIN INSURANCE PAYMENTS
12	12	SUBCHAPTER A. GENERAL PROVISIONS
13	13	Sec. 37.001. SHORT TITLE. This chapter may be cited as the
14	14	Medicaid Interception of Insurance Payments Act.
15	15	Sec. 37.002. PURPOSE. The purpose of this chapter is to
16	16	regulate the recovery of money paid by the Health and Human Services
17	17	Commission under the Medicaid program.
18	18	Sec. 37.003. DEFINITIONS. In this chapter:
19	19	(1) "Claimant" means an insured under an insurance
20	20	policy or self-funded plan or a third-party claimant under a policy
21	21	or plan seeking benefits for injuries received as a result of an
22	22	accident or loss. The term includes an insured's or third party's
23	23	legal representative, family member, or any other individual acting
24	24	on the insured's or third party's behalf.
25	25	(2) "Commission" means the Health and Human Services
26	26	Commission.
27	27	(3) "Insurer" means an insurance company holding a
28	28	certificate of authority to engage in the business of insurance in
29	29	this state.
30	30	(4) "Self-funded plan" means a plan that an entity
31	31	self-insures for the entity's legal responsibility without the
32	32	benefit of primary insurance through the use of a self-insured
33	33	retention.
34	34	(5) "Self-insurer" means an entity insured under a
35	35	self-funded plan. The term includes any entity that is directing
36	36	the handling of self-funded plan claims through a third party or as
37	37	a result of a policy buyback, cost-sharing agreement, or
38	38	coverage-in-place agreement.
39	39	Sec. 37.004. APPLICABILITY OF CHAPTER. (a) This chapter
40	40	applies only to personal injury protection, medical payments
41	41	coverage, and third-party payments for bodily injury from liability
42	42	insurance and self-funded plans that insure similar liabilities.
43	43	This chapter does not apply to:
44	44	(1) a claim under a liability insurance policy that
45	45	does not cover bodily injury;
46	46	(2) a claim for property damage or loss of use of
47	47	property;
48	48	(3) a claim made against an accident and health policy
49	49	regardless of whether the policy is payable on an expense-incurred
50	50	or indemnity basis; and
51	51	(4) a workers' compensation claim.
52	52	(b) This chapter does not apply to a claimant seeking less
53	53	than $2,000 under an insurance policy or self-funded plan or a
54	54	Medicaid recipient with respect to whom this state has incurred
55	55	less than $2,000 of Medicaid costs in connection with an injury
56	56	resulting from an accident or loss.
57	57	Sec. 37.005. EFFECT ON OTHER LAW. This chapter does not
58	58	limit the commission from recovering any other money allowed under
59	59	the laws of this state and federal law.
60	60	Sec. 37.006. RULEMAKING AUTHORITY. The executive
61	61	commissioner of the commission may adopt rules as necessary to
62	62	implement this chapter.
63	63	SUBCHAPTER B. MEDICAID INTERCEPTION
64	64	Sec. 37.051. AUTOMATIC ASSIGNMENT OF RIGHTS. In accordance
65	65	with the laws of this state and applicable rules, when applying for
66	66	Medicaid, an applicant or recipient assigns the applicant's or
67	67	recipient's rights to any payments under applicable insurance
68	68	coverage to the commission.
69	69	Sec. 37.052. MATCH PROCESS. (a) This section applies only
70	70	to an individual or estate making a bodily injury or wrongful death
71	71	claim under an insurance policy or self-funded plan.
72	72	(b) At any time before providing a total payment of at least
73	73	$2,000 on behalf of or to a claimant on a claim under an insurance
74	74	policy or self-funded plan, the insurer or self-insurer shall
75	75	exchange information with the commission in accordance with this
76	76	chapter.
77	77	(c) To facilitate compliance with this chapter, the
78	78	commission shall develop and maintain a data match system to
79	79	compare claimant information held by insurers and self-insurers
80	80	with the commission's database of recipients. The commission shall
81	81	seek the comment of insurers and self-insurers in this state in
82	82	developing the data match system. The data match system must use
83	83	automated data exchanges to the maximum extent possible.
84	84	(d) An insurer or self-insurer shall provide the commission
85	85	with the name and address of an individual or estate determined by
86	86	the commission to be a recipient and may provide the recipient's
87	87	date of birth and last four digits of the recipient's social
88	88	security number.
89	89	(e) An insurer or self-insurer may provide the information
90	90	described by Subsection (d) by:
91	91	(1) authorizing an insurance claim data collection
92	92	organization, to which the insurer or self-insurer subscribes and
93	93	to which the insurer or self-insurer submits the required claim
94	94	data on at least a weekly basis, to:
95	95	(A) receive or access a data file from the
96	96	commission and conduct a data match to identify all recipients who
97	97	are claimants under an insurance policy or self-funded plan and
98	98	submit the required information for each data match to the
99	99	commission; or
100	100	(B) submit a data file to the commission that
101	101	contains the required information for each claim against the
102	102	insurer or self-insurer for the commission to conduct a data match;
103	103	(2) electronically providing the required information
104	104	for each claim against the insurer or self-insurer directly to the
105	105	commission; or
106	106	(3) receiving or accessing a data file from the
107	107	commission and conducting a data match to identify each recipient
108	108	who is a claimant under an insurance policy or self-funded plan and
109	109	submitting the required information for each data match to the
110	110	commission.
111	111	(f) On receiving a data match under this section, the
112	112	commission shall send the insurer or self-insurer a notice of lien
113	113	against the amount payable to the recipient. The notice must
114	114	include the amount of the lien and the name of the recipient who is
115	115	the subject of the lien.
116	116	(g) An insurer or self-insurer may comply with this section
117	117	by making a good faith effort to comply. The commission may only
118	118	demonstrate a violation of this section by proving an intentional
119	119	failure to comply through a pattern and practice of noncompliance.
120	120	The commission may not demonstrate a violation through a single
121	121	instance of noncompliance.
122	122	Sec. 37.053. PAYMENT PROCESS. (a) Subject to this section,
123	123	on receipt of a notice of lien under Section 37.052, an insurer or
124	124	self-insurer shall withhold the lesser of the amount of the payment
125	125	owed to a claimant under an insurance policy or self-funded plan or
126	126	the amount described by the notice of lien and shall remit that
127	127	amount to the commission.
128	128	(b) A lien under this subchapter encumbers the right of the
129	129	claimant to payment under the insurance policy or self-funded plan,
130	130	and the insurer or self-insurer shall disburse to the claimant only
131	131	the portion of the payment remaining after the satisfaction of the
132	132	lien.
133	133	(c) A lien under this subchapter is inferior to any other
134	134	lien or claim for attorney's fees.
135	135	(d) If a recipient believes that the payment of the lien
136	136	exceeds the amount incurred by this state under the Medicaid
137	137	program on behalf of the recipient and notifies the insurer or
138	138	self-insurer that the recipient intends to file an administrative
139	139	appeal, the insurer or self-insurer may issue a single check made
140	140	payable to the recipient and the commission. The insurer or
141	141	self-insurer may notify the commission of its intent to issue
142	142	payment as a single check under this subsection.
143	143	(e) If the notice of lien is received after the insurer or
144	144	self-insurer has issued payment to a claimant, the insurer or
145	145	self-insurer shall notify the commission of the date of payment,
146	146	the amount of payment, and the name and address of the claimant.
147	147	The insurer or self-insurer is not obligated to make a payment to
148	148	the commission.
149	149	(f) An insurer or self-insurer shall pay the commission
150	150	under this section not later than the 30th day after the date of
151	151	notice of lien unless the recipient requests a hearing under
152	152	Section 37.056. If the recipient requests a hearing, the insurer or
153	153	self-insurer shall pay the commission in accordance with the result
154	154	of the hearing not later than the 10th business day after the date a
155	155	decision is rendered.
156	156	(g) The time for prompt payment of a claim under Chapter
157	157	542, Insurance Code, is tolled from the date the insurer receives
158	158	notice of lien under this chapter to the date payment is required to
159	159	be made under Subsection (f).
160	160	Sec. 37.054. DATA CONFIDENTIALITY. (a) The information
161	161	obtained by the commission from an insurer or self-insurer under
162	162	this chapter may only be used for the purposes of this chapter.
163	163	(b) An insurer or self-insurer, including the insurer's or
164	164	self-insurer's directors, agents, or employees, and an insurance
165	165	claim data collection organization, including the organization's
166	166	agents and employees authorized by the insurer or self-insurer to
167	167	act on the insurer's or self-insurer's behalf, shall keep
168	168	information concerning a recipient described by this chapter secure
169	169	and confidential.
170	170	Sec. 37.055. NOTICE OF INTERCEPTION. The commission shall
171	171	provide written notice to the claimant and claimant's attorney, if
172	172	applicable, that includes the date of the notice, the name of the
173	173	recipient, the last four digits of the social security number of the
174	174	recipient, the case number, the intercepted amount, the reason for
175	175	the interception, and notification of an opportunity to request a
176	176	hearing.
177	177	Sec. 37.056. REQUEST FOR HEARING. Not later than the 30th
178	178	day after the date of the notice under Section 37.055, a claimant or
179	179	recipient who has a claim intercepted under this chapter may
180	180	request a hearing from the State Office of Administrative Hearings.
181	181	Sec. 37.057. LIMITATION OF LIABILITY. (a) An insurer or
182	182	self-insurer, including the insurer's or self-insurer's directors,
183	183	agents, or employees, or an insurance claim data collection
184	184	organization, including the organization's agents and employees
185	185	authorized by the insurer or self-insurer to act on the insurer's or
186	186	self-insurer's behalf, that provides or attempts to provide
187	187	information under this chapter is not liable for damages that occur
188	188	as a result of providing or attempting to provide data under this
189	189	chapter. This chapter does not create civil liability for an
190	190	insurer or self-insurer.
191	191	(b) An insurer or self-insurer, including the insurer's or
192	192	self-insurer's directors, agents, or employees, or any insurance
193	193	claim data collection organization, including the organization's
194	194	agents and employees authorized by the insurer or self-insurer to
195	195	act on the insurer's or self-insurer's behalf, is not liable for
196	196	damages that occur as a result of making a payment to the commission
197	197	under this chapter.
198	198	(c) A person against whom any action is brought who is found
199	199	to be immune from liability under this section is entitled to
200	200	recover reasonable attorney's fees and costs from the person who
201	201	brought the action. This section does not abrogate or modify in any
202	202	way any common law or statutory privilege or immunity otherwise
203	203	enjoyed by any person.
204	204	Sec. 37.058. STATUTE OF LIMITATIONS. A person must bring an
205	205	action to pursue the recovery of money paid to the commission under
206	206	this chapter not later than two years after the date of the accident
207	207	or loss causing the injury that is the basis for the payment to the
208	208	commission. This chapter may not be construed to lengthen any
209	209	limitations under an insurance policy or self-funded plan.
210	210	SECTION 2. The change in law made by this Act applies only
211	211	to a claim made under an insurance policy or self-funded plan on or
212	212	after the effective date of this Act. A claim made before the
213	213	effective date of this Act is governed by the law applicable to the
214	214	claim immediately before the effective date of this Act, and that
215	215	law is continued in effect for that purpose.
216	216	SECTION 3. This Act takes effect September 1, 2015.