FINAL BILL REPORT

HB 2677

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Federal law requires a state administering a Medicaid program to take reasonable efforts to ascertain the legal liability of third parties, including health insurers, that are legally responsible to pay for care and services available under the Medicaid program. The state must submit a plan to the federal government for pursuing claims for reimbursement against such third parties.

Under state law, the Health Care Authority (HCA) must provide routine, periodic information to health insurers to identify joint beneficiaries. The data must be provided at least semiannually. If an insurer identifies any joint beneficiaries, it must send the information to the HCA. The stated purpose of this information exchange is to improve coordination and administration of benefits and ensure that medical insurance benefits are properly utilized.

The State Auditor has found that the HCA has not performed semiannual data sharing with insurers as required by state law. Rather, the HCA has invited insurers to share the information using a format recommended by the federal government for data sharing. According to the State Auditor, the identification of joint beneficiaries is then done by the HCA, not by the insurers as is required by state law.

Summary:

The primary responsibility for sharing information on joint beneficiaries is changed from the Health Care Authority (HCA) to the insurers. Health insurers must share information on beneficiary eligibility and coverage with the HCA for the purpose of identifying joint beneficiaries.

The requirement that the information be provided at least semiannually is eliminated.

Votes on Final Passage:

House	96	0
Senate	49	0