House Bill 25-1033 Reengrossed

A Bill for an Act

• Page 1, Line 101Concerning medical assistance third-party liability

• Page 1, Line 102payments.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

The bill requires third-party payers to reimburse the department of health care policy and financing (state department) for health-care items and services rendered to a medicaid member regardless of whether prior authorization was obtained.

The bill requires third-party payers to respond to the state department's inquiry regarding a claim for payment no later than 60 days after receiving the state department's inquiry. The third party must respond either by paying the claim or issuing a written denial of the claim to the state department.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, 25.5-4-209, amend

• Page 2, Line 3(2)(b)(III), (2)(b)(IV) introductory portion, and (2)(b)(IV)(B); and add (2)(b)(V) as follows:

• Page 2, Line 425.5-4-209.  Payments by third parties - copayments by

• Page 2, Line 5members - review - appeal - children's waiting list reduction fund -

• Page 2, Line 6rules. (2) (b)  A third party, as a condition of doing business in the state, shall:

• Page 2, Line 7(III)  Respond to any inquiry by the state No later than sixty

• Page 2, Line 8days following the receipt of an inquiry by the state department

• Page 2, Line 9regarding a claim for payment for any health-care item or service that is

• Page 2, Line 10submitted not no later than three years after the date of the provision of

• Page 2, Line 11the health-care item or service; and service, respond by either paying the claim or issuing a written denial to the state department;

• Page 2, Line 12(IV)  Agree not to deny a claim submitted by the state

• Page 2, Line 13department solely on the basis of the date of submission of the claim,

• Page 2, Line 14the type or format of the claim form, or a failure to present proper documentation at the point of sale that is the basis of the claim, if:

• Page 2, Line 15(B)  Any action by the state department to enforce its rights with

• Page 2, Line 16respect to the claim is commenced within six years after the state's state department's submission of the claim; and

• Page 2, Line 17(V)  Accept the state department's payment of a claim for

• Page 2, Line 18a health-care item or service to be the equivalent of the

• Page 2, Line 19health-care provider or the member having obtained prior authorization for the item or service from the third party.

• Page 3, Line 1SECTION 2.  Safety clause. The general assembly finds,

• Page 3, Line 2determines, and declares that this act is necessary for the immediate

• Page 3, Line 3preservation of the public peace, health, or safety or for appropriations for

• Page 3, Line 4the support and maintenance of the departments of the state and state institutions.