SB 411
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AN ACT
RELATING TO PUBLIC ASSISTANCE; PROVIDING A STATUTE OF
LIMITATIONS ON THIRD PARTY LIABILITY CLAIMS; AMENDING A
SECTION OF THE NMSA 1978.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. Section 27-2-23 NMSA 1978 (being Laws 1969,
Chapter 232, Section 1) is amended to read:
"27-2-23. THIRD PARTY LIABILITY.--
A. The income support division of the department
shall make reasonable efforts to ascertain any legal
liability of third parties who are or may be liable to pay
all or part of the medical cost of injury, disease or
disability of an applicant for or recipient of medical
assistance pursuant to the provisions of Chapter 27 NMSA
1978.
B. When the department makes medical assistance
payments on behalf of a recipient, the department is
subrogated to any right of the recipient against a third
party for recovery of medical expenses to the extent that the
department has made payment.
C. Health insurers, including self-insured plans,
group health plans, service benefit plans, managed care
organizations, pharmacy benefit managers or other parties,
that are, by statute, contract or agreement, legally
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responsible for payment of a claim for a health care item or
service, as a condition of doing business with New Mexico,
shall:
(1) provide, with respect to individuals who
are eligible for or are provided medical assistance under the
medicaid program, upon the request of the state, information
to determine during what period the individual, the
individual's spouse or the individual's dependents may be, or
may have been, covered by a health insurer and the nature of
the coverage provided by the health insurer, including the
name, address and identifying number of the plan;
(2) accept New Mexico's right of recovery
and the assignment to New Mexico of any right of an
individual or other entity to payment from the party for an
item or service for which payment has been made under the
medicaid program;
(3) respond to any inquiry by New Mexico
regarding a claim for payment for any health care item or
service that is submitted no later than three years after the
date of the provision of such health care item or service;
and
(4) agree not to deny a claim submitted by
New Mexico solely on the basis of the date of submission of
the claim by the provider, the type of the claim form or a
failure to present proper documentation at the point-of-sale
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that is the basis of the claim, if:
(a) the claim is submitted by New
Mexico within the three-year period beginning on the date on
which the item or service was furnished; and
(b) any action by New Mexico to enforce
its rights with respect to such claim is commenced within six
years of New Mexico's submission of such claim.
D. Nothing in this section shall be construed to
preclude the application of common law principles in
determining equitable reimbursement from any third-party
source for New Mexico or a health insurer, including
self-insured plans, group health plans, service benefit plans,
managed care organizations, pharmacy benefit managers or other
parties."