AN ACT TO MODIFY THE MEDICAID SUBROGATION STATUTE IN RESPONSE TO THE UNITED STATES SUPREME COURT DECISION IN WOS V. E.M.A. Enacted July 18, 2013. Effective July 18, 2013.
Summary date: Jul 22 2013 - View summary
Summary date: Jun 25 2013 - View summary
Senate committee substitute to the 2nd edition makes the following changes.
Amends GS 108A-57 to provide that if the beneficiary rebuts the presumption (concerning what specified amounts are presumed to represent compensation for the Medicaid claim), then the court must determine the portion of the recovery that represents compensation for the claim and order the beneficiary to pay that amount. Also provides that if the beneficiary does not rebut the presumption, then the court must order the beneficiary to pay the presumed amount. Allows the medical assistance beneficiary and the Department of Health and Human Services (Department) to reach an agreement on the portion of the recovery that represents compensation for the Medicaid claim. Requires the medical assistance beneficiary, or the beneficiary's attorney, to pay a certain amount to the Department, with the payment calculation varying depending on whether or not an application disputing the recovery presumptions has been filed, or if an agreement has been reached between the beneficiary and the Department. Makes it a Class 1 misdemeanor for a person who seeks or has been given assistance to willfully fail to disclose to the Department the identity of the person or organization against whom the recipient has a right of recovery.
Provides that the act is effective when it becomes law and it applies to (1) Medicaid claims arising on or after that date and (2) to Medicaid claims arising before that date for which the Department has not been paid in full. Provides that for claims that arose before the effective date of the act where the Department has not been paid in full, the beneficiary has 90 days from the act's effective date to apply to the court under GS 108A-57(a2).
Makes clarifying and technical changes.
Summary date: May 15 2013 - View summary
House committee substitute makes the following changes to the 1st edition.
Amends GS 108A-57to makeorganizational changes, re-labeling the subsections of this section. Provides that a medical assistance beneficiary may dispute the presumption that the gross recovery includes compensation for the full amount ofmedical beneficiary'sMedicaid claim by applying to the courtin which the beneficiary's claimagainst the third party is pending, or if there is none, then to a court of competent jurisdiction(was, to the superior court with jurisdiction over the action).Clarifies that an action filed undersubsection (a2), (was, subsection (c)) is to be served on theDepartment of Health and Human Services (DHHS) no later than30 days after the settlement agreement is executed by all parties, or if the judgment has been entered, no later than 30 days after the date the judgment is entered. Adds that the court must hold an evidentiary hearing no sooner than 30 days after the date the action was filed. Amends the factors that are to apply to the court's determination under subsection (a2) concerning the presumptions.
Requires the medical (2013-2014),assistance beneficiary or the beneficiary's attorney to notify DHHS within 30 days of receiving the proceeds of a settlement or judgment related to a claim under subsection (a) of this section. Amends the standards for calculating the amount of the proceeds to be paid to DHHS out of the proceedsobtained by or on behalf of the beneficiary by settlement with or judgment against, or otherwise from a third party. Provides that DHHS may apply to the court in which the medical assistance beneficiary's claim against a third party is pending or to a court of competent jurisdiction to ensure compliance with this section.
This act remains effective when it becomes law but provides that it applies to claims against a third party by a medical assistance beneficiary in which either there is a settlement agreement executed by all parties or a judgment is entered against the third party on or after the effective date. Gives the medical assistance beneficiary 90 days from the effective date of this act to apply to the court under GS 108A-57(c) regarding claims in which the Medicaid claim has not been satisfied and prior to the effective date of this act, a settlement agreement has been executed by all parties, or judgment has been entered against the third party.
Summary date: Apr 17 2013 - View summary
Amends GS 108A-57(a) deleting the county as an entity that will be subrogated. Also requires a personal injury or wrongful death claim brought by a medical assistance beneficiary against a third party to include a claim for all medical assistance payments for health care items or services furnished to the beneficiary as the result of the injury referred to in the statute as the Medicaid claim.
Amends GS 108A-57, adding subsection (b) establishing presumptions for Medicaid claims that exceed or do not exceed one-third of the medical assistance beneficiary's gross recovery.
Amends GS 108A-57, adding subsection (c) outlining the procedure for a medical assistance beneficiary to dispute the presumptions established in subsection (b).
Amends GS 108A-57(d), changing the amount of assistance distributed to the Department to the portion presumptively determined under subsection (b) or the portion judicially determined under subsection (c) of this section.
Amends GS 108A-57(e) specifying that the United States and the state of North Carolina are entitled to share in each net recovery by the Department of Health and Human Services (DHHS).
Amends GS 108A-57, adding subsection (h) granting authority to enforce this section to DHHS and allowing DHHS to adopt administrative rules for this purpose.