A BILL TO BE ENTITLED AN ACT TO MODIFY THE MEDICAID SUBROGATION STATUTE IN RESPONSE TO THE UNITED STATES SUPREME COURT DECISION IN WOS V. E.M.A.
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.
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