Medicaid is generally the “payer of last resort,” meaning that Medicaid only pays claims for covered items and services if there are no other liable third-party payers for the same items and services. When Medicaid beneficiaries have one or more additional sources of coverage for health care services, third-party liability (TPL) rules govern the legal obligation of such third parties. Section 1902(a)(25)(A) of the Social Security Act defines third-party payers as health insurers, managed care organizations, and group health plans, among others. The federal Consolidated Appropriations Act of 2022 (CAA 2022), enacted March 15, 2022, increased state flexibility with respect to TPL. Section 202 of the CAA, 2022 amended section 1902(a)(25)(I) of the Act to require a state plan for medical assistance to provide assurances satisfactory to the Secretary that the state has state laws in place that bar responsible third-party payers (other than Medicare plans) from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer’s rules. Specifically, if the responsible third party requires prior authorization for an item or service furnished to a Medicaid-eligible individual, the responsible third party must accept the authorization provided by the state that the item or service is covered under the state plan (or waiver of such plan) for such individual, as if such authorization was made by the third party for such item or service. Authorization by the state means that the item or service an individual received (and for which third-party reimbursement is being sought) is a covered service or item under the Medicaid state plan (or waiver of such plan) for that individual. The effective date for this new federal provision is January 1, 2024, with an exception for states that first need to pass state legislation to comply with the change in law. This bill is intended to update the provisions of Title 18, § 4003 to make them consistent with federal law contained in the Consolidated Appropriations Act of 2022.
Rep. Kerri Harris
Sponsored bills
This resolution recognizes April 6 through 12, 2024, as “Week of the Young Child” in Delaware.
This resolution recognizes April 25, 2024, as "Take Our Children to Work Day."
This House Concurrent Resolution recognizes the ongoing humanitarian crisis in Gaza and supports a permanent ceasefire, release of all hostages, delivery of immediate and sustained humanitarian aid to Gaza, and diplomatic action to facilitate long-term and mutually respectful peace in the region.
This concurrent resolution recognizes April 29, 2024, as "World Wish Day" in Delaware.
This Concurrent Resolution recognizes April 24, 2024, as Alpha Kappa Alpha Sorority, Incorporated or “AKA Day at the Capitol” in Delaware.
This Act establishes a residential drinking water purification system program to be administered through the Department of Health and Social Services.
This Resolution recognizes April 11 - 17, 2024, as "Black Maternal Health Awareness Week" in Delaware.
This Concurrent Resolution supports Congressional efforts to proclaim the fourth Thursday in March a National Tuskegee Airmen Commemoration Day.
Through this resolution, we recognize the service and sacrifices Veterans have made for the safety of our nation and reaffirm our commitment to supporting and advocating for the needs of our Veteran community, ensuring that they receive the recognition, respect, care, and benefits they rightfully earned.