Bill > SB1687

This bill modifies provisions related to MO HealthNet, Missouri's Medicaid program, and its ability to recover costs from third parties who are liable for a participant's medical expenses. MO HealthNet is generally the payer of last resort, meaning it pays for medical care only after other sources, like private health insurance, have been exhausted. The bill clarifies that MO HealthNet has a right to recover payments made on behalf of a participant from any person, corporation, or entity that is liable for the participant's injury, disease, or disability, or from benefits the participant is entitled to from a health insurance plan. It outlines procedures for health benefit plans, third-party administrators, and pharmacy benefits managers to process and pay MO HealthNet's subrogation claims, including timeframes for responding to inquiries and specific conditions under which claims cannot be denied. The bill also details requirements for participants to cooperate with MO HealthNet in identifying and pursuing liable third parties, and establishes that failure to cooperate can result in ineligibility for benefits. It further clarifies the state's lien rights on any recoveries a participant may receive from a liable third party, including provisions for court adjudication of these rights and the apportionment of recovery costs. The bill also addresses TEFRA (Tax Equity and Fiscal Responsibility Act) liens on the property of institutionalized individuals, with specific exceptions for surviving spouses, dependent children, or siblings residing in the home. Finally, it allows the MO HealthNet division to waive recovery efforts if the cost of recovery is expected to exceed the amount recovered or if recovery is not cost-effective.

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=5552591