Under existing law, if a state agency is assigned any rights of a person who is eligible for medical assistance under Medicaid, insurers and certain other providers of health coverage are subject to certain requirements. Among other requirements, existing law requires the insurer or other provider to: (1) respond to any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service not later than 3 years after the date of the provision of the medical item or service; and (2) agree not to deny a claim submitted by the state agency for certain reasons. (NRS 689A.430, 689B.300, 695A.151, 695B.340, 695C.163, 695F.440) Section 202 of the federal Consolidated Appropriations Act, 2022, Pub. L. No. 117-103, revised certain requirements for a state plan for medical assistance concerning the liability of third parties for payment of a claim for a health care item or service. (42 U.S.C. § 1396a) Sections 1-6 of this bill revise existing law to comply with those requirements. Sections 1-6 require insurers and certain other providers of health coverage that the state agency reasonably believes cover the person who is eligible for medical assistance under Medicaid to respond to an inquiry regarding a claim for payment for the provision of any medical item or service not later than 60 days after receiving the inquiry. Sections 1-6 also require insurers and certain other providers of health coverage to agree not to deny a claim submitted by the state agency solely on the basis of lack of prior authorization if the state agency authorized the medical item or service.

Statutes affected:
As Introduced: 689A.430, 689B.300, 695A.151, 695B.340, 695C.163, 695F.440