Section 6035(b) of the Deficit Reduction Act of 2005 (DRA) created a new subparagraph (I) in section 1902(a)(25) of the Social Security Act (the Act), that requires states to establish laws that require the production of the information necessary for each state Medicaid agency to determine third party liability for services rendered to Medicaid beneficiaries. Specifically, section 1902(a) (25) (I) (i) of the Act directs states, as a condition of receiving federal financial participation (FFP) for Medicaid, to have laws in effect that require health insurers doing business in their state to provide the state with the requisite information with respect to individuals who are eligible for, or are provided medical assistance, i.e., Medicaid beneficiaries.
States pass their own laws regarding the submission of health insurance information to implement the provisions of the DRA. As with most federal laws that require some action on the part of the state to implement, states have some latitude in determining how best to comply. Since the information would be provided to the state Medicaid agency as required by that state’s laws, it follows that the submission should conform to what is required under that state law. Such requirements would ensure the state Medicaid agency’s access to the information is necessary and sufficient to determine third party liability for care provided to Medicaid beneficiaries.
(FAQ10534)
