View Bill Status
View Bill Text
View Amendment
View Engrossed Bill (Original Bill with Amendment(s) Incorporated)
View Statement of Purpose / Fiscal Impact
S1344aa...............................................by HEALTH AND WELFARE
INSURERS - HEALTH AND WELFARE DEPARTMENT - Amends existing law to provide
for specific cooperation with the Department of Health and Welfare by
specified insurers as a condition for doing business in Idaho; and to
provide a penalty for failure to cooperate.
01/24 Senate intro - 1st rdg - to printing
01/25 Rpt prt - to Health/Wel
02/12 Rpt out - to 14th Ord
02/19 Rpt out amen - to engros
02/20 Rpt engros - 1st rdg - to 2nd rdg as amen
02/21 2nd rdg - to 3rd rdg as amen
02/25 3rd rdg as amen - PASSED - 33-0-2
AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
Cameron, Corder, Darrington, Davis, Fulcher, Geddes, Goedde, Hammond,
Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little, Lodge,
Malepeai(Sagness), McGee, McKague, McKenzie, Pearce, Richardson,
Schroeder, Siddoway, Stegner, Stennett, Werk
NAYS -- None
Absent and excused -- Coiner, Gannon
Floor Sponsor - Werk
Title apvd - to House
02/26 House intro - 1st rdg - to Bus
03/04 Rpt out - rec d/p - to 2nd rdg
03/05 2nd rdg - to 3rd rdg
03/11 3rd rdg - PASSED - 63-0-7
AYES -- Anderson, Andrus, Barrett, Bedke, Bell, Bilbao, Black, Block,
Bock, Boe, Bolz, Bowers, Brackett, Bradford, Chadderdon, Chavez,
Chew, Clark, Collins, Crane, Durst, Eskridge, Hagedorn, Hart,
Harwood, Henderson, Jaquet, Killen, King, Kren, Labrador, Lake,
LeFavour, Loertscher, Luker, Marriott, Mathews, McGeachin, Nielsen,
Nonini, Pasley-Stuart, Patrick, Pence, Raybould, Ringo, Ruchti,
Rusche, Sayler, Schaefer, Shepherd(02), Shepherd(08), Shirley,
Shively, Smith(30), Stevenson, Thayn, Thomas, Trail, Vander Woude,
Wills, Wood(27), Wood(35), Mr. Speaker
NAYS -- None
Absent and excused -- Bayer, Henbest, Mortimer, Moyle, Roberts,
Smith(24), Snodgrass
Floor Sponsor - Rusche
Title apvd - to Senate
03/12 To enrol
03/13 Rpt enrol - Pres signed - Sp signed
03/14 To Governor
03/17 Governor signed
Session Law Chapter 147
Effective: 07/01/08
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-ninth Legislature Second Regular Session - 2008IN THE SENATE SENATE BILL NO. 1344 BY HEALTH AND WELFARE COMMITTEE 1 AN ACT 2 RELATING TO INSURANCE; AMENDING CHAPTER 3, TITLE 41, IDAHO CODE, BY THE ADDI- 3 TION OF A NEW SECTION 41-318, IDAHO CODE, TO PROVIDE FOR SPECIFIC COOPERA- 4 TION WITH THE DEPARTMENT OF HEALTH AND WELFARE BY SPECIFIED INSURERS AS A 5 CONDITION FOR DOING BUSINESS IN THE STATE AND TO PROVIDE A PENALTY FOR 6 FAILURE TO COOPERATE. 7 Be It Enacted by the Legislature of the State of Idaho: 8 SECTION 1. That Chapter 3, Title 41, Idaho Code, be, and the same is 9 hereby amended by the addition thereto of a NEW SECTION, to be known and des- 10 ignated as Section 41-318, Idaho Code, and to read as follows: 11 41-318. COOPERATION WITH THE DEPARTMENT OF HEALTH AND WELFARE. (1) An 12 insurer, including self-insured plans, group health plans as defined in sec- 13 tion 607(1) of the employee retirement income security act of 1974, service 14 benefit plans, managed care organizations, pharmacy benefit managers or other 15 parties that are by statute, contract or agreement legally responsible for 16 payment of a claim for a health care item or service with respect to medical 17 assistance programs under chapter 2, title 56, Idaho Code, shall, as a condi- 18 tion of doing business in the state of Idaho, cooperate with the Idaho depart- 19 ment of health and welfare by doing the following: 20 (a) Provide, with respect to an individual who is eligible for or who is 21 or has been provided medical assistance under chapter 2, title 56, Idaho 22 Code, within sixty (60) days of a request of the department, information 23 to determine the period the individual or the individual's spouse or 24 dependents are, or have been, covered by the insurer and the nature of 25 that coverage. The information shall include the name and address of the 26 insurer and the identifying number of the health care insurance plan. The 27 format of the information provided shall include the data elements, medium 28 and frequency of reporting, any costs of the insurer to be reimbursed and 29 procedures that will be followed when a data match is found; 30 (b) Accept the department's right of recovery on behalf of the state of 31 Idaho, and the assignment to the department of any right of an individual 32 or other entity to payment from the party for an item or service for which 33 payment has been made under chapter 2, title 56, Idaho Code; 34 (c) Respond to any inquiry by the department regarding a claim for pay- 35 ment for any health care item or service submitted not later than three 36 (3) years after the date of the provision of the health care item or ser- 37 vice; and 38 (d) Agree not to deny a claim submitted by the department solely on the 39 basis of the date of submission of the claim, the type or format of the 40 claim form, or a failure to present proper documentation at the point-of- 41 sale that is the basis of the claim, if: 42 (i) The claim is submitted by the department within the three (3) 43 year period beginning on the date on which the item or service was 2 1 furnished; and 2 (ii) Any action by the department to enforce its rights with respect 3 to the claim is commenced within six (6) years after the department's 4 submission of the claim. 5 (2) Failure to cooperate with the department as set forth in subsection 6 (1) of this section shall subject the insurer to suspension or revocation of 7 its certificate of authority pursuant to section 41-326, Idaho Code.
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-ninth Legislature Second Regular Session - 2008Moved by Werk Seconded by Lodge IN THE SENATE SENATE AMENDMENT TO S.B. NO. 1344 1 AMENDMENT TO SECTION 1 2 On page 1 of the printed bill, in line 11, delete "An" and in line 12, 3 delete "insurer," and insert: "A health insurer that provides disability 4 insurance as defined in section 41-503, Idaho Code,".
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-ninth Legislature Second Regular Session - 2008IN THE SENATE SENATE BILL NO. 1344, As Amended BY HEALTH AND WELFARE COMMITTEE 1 AN ACT 2 RELATING TO INSURANCE; AMENDING CHAPTER 3, TITLE 41, IDAHO CODE, BY THE ADDI- 3 TION OF A NEW SECTION 41-318, IDAHO CODE, TO PROVIDE FOR SPECIFIC COOPERA- 4 TION WITH THE DEPARTMENT OF HEALTH AND WELFARE BY SPECIFIED INSURERS AS A 5 CONDITION FOR DOING BUSINESS IN THE STATE AND TO PROVIDE A PENALTY FOR 6 FAILURE TO COOPERATE. 7 Be It Enacted by the Legislature of the State of Idaho: 8 SECTION 1. That Chapter 3, Title 41, Idaho Code, be, and the same is 9 hereby amended by the addition thereto of a NEW SECTION, to be known and des- 10 ignated as Section 41-318, Idaho Code, and to read as follows: 11 41-318. COOPERATION WITH THE DEPARTMENT OF HEALTH AND WELFARE. (1) A 12 health insurer that provides disability insurance as defined in section 13 41-503, Idaho Code, including self-insured plans, group health plans as 14 defined in section 607(1) of the employee retirement income security act of 15 1974, service benefit plans, managed care organizations, pharmacy benefit man- 16 agers or other parties that are by statute, contract or agreement legally 17 responsible for payment of a claim for a health care item or service with 18 respect to medical assistance programs under chapter 2, title 56, Idaho Code, 19 shall, as a condition of doing business in the state of Idaho, cooperate with 20 the Idaho department of health and welfare by doing the following: 21 (a) Provide, with respect to an individual who is eligible for or who is 22 or has been provided medical assistance under chapter 2, title 56, Idaho 23 Code, within sixty (60) days of a request of the department, information 24 to determine the period the individual or the individual's spouse or 25 dependents are, or have been, covered by the insurer and the nature of 26 that coverage. The information shall include the name and address of the 27 insurer and the identifying number of the health care insurance plan. The 28 format of the information provided shall include the data elements, medium 29 and frequency of reporting, any costs of the insurer to be reimbursed and 30 procedures that will be followed when a data match is found; 31 (b) Accept the department's right of recovery on behalf of the state of 32 Idaho, and the assignment to the department of any right of an individual 33 or other entity to payment from the party for an item or service for which 34 payment has been made under chapter 2, title 56, Idaho Code; 35 (c) Respond to any inquiry by the department regarding a claim for pay- 36 ment for any health care item or service submitted not later than three 37 (3) years after the date of the provision of the health care item or ser- 38 vice; and 39 (d) Agree not to deny a claim submitted by the department solely on the 40 basis of the date of submission of the claim, the type or format of the 41 claim form, or a failure to present proper documentation at the point-of- 42 sale that is the basis of the claim, if: 43 (i) The claim is submitted by the department within the three (3) 2 1 year period beginning on the date on which the item or service was 2 furnished; and 3 (ii) Any action by the department to enforce its rights with respect 4 to the claim is commenced within six (6) years after the department's 5 submission of the claim. 6 (2) Failure to cooperate with the department as set forth in subsection 7 (1) of this section shall subject the insurer to suspension or revocation of 8 its certificate of authority pursuant to section 41-326, Idaho Code.
STATEMENT OF PURPOSE
RS 17432
The purpose of this proposed legislation is to bring Idaho in
compliance with Federal Law. Specifically to address changes
enacted by the Deficit Reduction Act Of 2005, Section 6035.
Enhancing Third Party Identification and Payment.
(A) Clarification of third parties legally responsible for
payment of a claim for a health care item or service.
Section 1902(A)(25) of the Social Security Act (42
U.S.C.1396a(A)(25))
(B) Requirement for third parties to provide the state with
coverage eligibility and claims data.
Section 1902(A)(25) of such Act (42 U.S.C. 1396a(A)(25))
This legislation would require insurance companies to share
coverage information about Medicaid recipients and enhances the
Department's ability to recover funds that should have been paid
by insurance carriers.
FISCAL NOTE
The fiscal impact would be positive, as this legislation would
allow the Medicaid program to identify insurance coverage that is
required to pay prior to Medicaid coverage payments. It would
also increase recoveries from insurance coverage that should have
paid prior to Medicaid coverage. At this time it is not possible
to accurately estimate the positive fiscal impact.
CONTACT
Name: Larry Tisdale
Agency: Health and Welfare
Phone: 208-287-1141
STATEMENT OF PURPOSE/FISCAL NOTE S1344
REVISED REVISED REVISED REVISED REVISED