23.8046.01000
Sixty-eighth
Legislative Assembly HOUSE BILL NO. 1047
of North Dakota
Introduced by
Human Services Committee
(At the request of the Department of Health and Human Services)
1 A BILL for an Act to amend and reenact section 50-24.1-29 of the North Dakota Century Code,
2 relating to the requirement that health insurers provide certain information to the department of
3 health and human services.
4 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
5 SECTION 1. AMENDMENT. Section 50-24.1-29 of the North Dakota Century Code is
6 amended and reenacted as follows:
7 50-24.1-29. Insurers to provide certain information to the department.
8 1. For purposes of this section:
9 a. "Department" means the department of health and human services or its agent.
10 b. "Health insurer" includes self-insured plans, group health plans as defined in
11 section 607(1) of the Employee Retirement Income Security Act of 1974
12 [29 U.S.C. 1167(1)], service benefit plans, managed care organizations,
13 pharmacy benefit managers, or other parties that legally are responsible by
14 statute, contract, or agreement for payment of a claim for a health care item or
15 service.
16 2. a. As a condition of doing business in this state, health insurers shall provide to the
17 department upon its request and in a manner prescribed by the department
18 information about individuals who are eligible for medical assistance so the
19 department may determine during what period the individual or the individual's
20 spouse or dependents may be or may have been covered by a health insurer and
21 the nature of the coverage provided by the health insurer, including the name,
22 address, and identifying number of the plan, and duration of the health insurance
23 coverage. Notwithstanding any other provision of law, every health insurer, not
24 more frequently than twelve times in a year, shall provide to the department upon
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Sixty-eighth
Legislative Assembly
1 its request information, including automated data matches conducted under the
2 direction of the department, as necessary, to:
3 a. (1) Identify individuals covered under the insurer's health benefit plans who are
4 also recipients of medical assistance;
5 b. (2) Determine the period during which the individual or the individual's spouse
6 or the individual's dependents may be or may have been covered by the
7 health benefit plan; and
8 c. (3) Determine the nature of the coverage.
9 b. The insurer must provide the information required in this subsection to the
10 department at no cost if the information is in a readily available structure or
11 format. If the department requests the information in a structure or format that is
12 not readily available, the insurer may charge a reasonable fee for providing the
13 information, not to exceed the actual cost of providing the information.
14 3. To facilitate the department in obtaining the information required by this section, a
15 health insurer shall:
16 a. Cooperate with the department to determine whether a medical assistance
17 recipient may be covered under the insurer's health benefit plan and is eligible to
18 receive benefits under the health benefit plan for services provided under the
19 medical assistance program.
20 b. Respond to the request for information within ninety days after receipt of written
21 proof of loss or claim for payment for health care services provided to a recipient
22 of medical assistance who is covered by the insurer's health benefit plan.
23 c. Accept the department's right of recovery, entitlement to payment, and the
24 assignment to the department of any right of an individual or other entity to
25 payment from a liable third party for an item or service for which payment has
26 been made under the state medical assistance plan.
27 d. Respond to any inquiry by the department within sixty days regarding a claim for
28 payment for any health care item or service that is submitted no later than three
29 years after the date of the provision of the health care item or service.
30 e. Agree not to deny a claim submitted by the department solely on the basis of the
31 date of submission of the claim, the type of format of the claim form, or a failure
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Legislative Assembly
1 to present proper documentation at the point of sale that is the basis of the claim
2 if:
3 (1) The claim is submitted by the department within the three-year period
4 beginning on the date on which the item or service was furnished; and
5 (2) Any action by the department to enforce its rights with respect to such claim
6 is commenced within six years of the department's submission of the claim.
7 f. Accept Medicaid's authorization that the item or service is covered under the
8 state plan as if the authorization were the prior authorization made by the third
9 party for the item or service.
10 g. Agree to not deny a claim submitted by the department for failure to obtain prior
11 authorization for an item or service.
12 4. A health insurer is prohibited, in enrolling an individual or on the individual's behalf,
13 from taking into account that the individual is eligible for or is provided medical
14 assistance.
15 5. The department may not use or disclose any information provided by the insurer other
16 than as permitted or required by law. The insurer may not be held liable for the release
17 of insurance information to the department or a department agent if the release is
18 authorized under this section.
Page No. 3 23.8046.01000
Statutes affected: INTRODUCED: 50-24.1-29
Enrollment: 50-24.1-29
PREFILED: 50-24.1-29