ENROLLED
Senate Bill No. 632
(By Senator Prezioso)
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[Passed April 8, 2009; in effect ninety days from passage.]
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AN ACT to amend and reenact §9-5-11b of the Code of West Virginia,
1931, as amended, relating to
requiring insurers to share
information with the Bureau for Medical Services with regard
to services provided to an individual during a period of
coverage with another insurer.
Be it enacted by the Legislature of West Virginia:
That §9-5-11b of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-11b. Release of information.
(a) All recipients of medical assistance under the Medicaid
program are considered to have authorized all third parties,
including, but not limited to, insurance companies and providers of
medical care, to release to the Department of Health and Human
Resources information needed by the department to secure or enforce
its rights as assignee under this chapter.
(b) As a condition of doing business in the state, health
insurers, including self-insured plans, group health plans as defined in §6074(a) of the Employee Retirement Income Security Act
of 1974, service benefit plans, third-party administrators, managed
care organizations, pharmacy benefit managers or other parties that
are by statute, contract or agreement, legally responsible for
payment of a claim for a health care item or service are required
to comply with the following:
(1) Upon the request of the Bureau for Medical Services, or
its contractor, provide information to determine the period that
the service recipients, their spouse or dependents may be or may
have been covered by the health insurer, including the nature of
the coverage that is or was provided by the health insurer, the
name, address, date of birth, Social Security number, group number,
identifying number of the plan, and effective and termination
dates. The information shall be provided in a format suitable for
electronic data matches, conducted under the direction of the
Department of Health and Human Resources, no less than monthly or
as prescribed by the secretary. The health insurer must respond
within sixty working days after receipt of a written request for
enrollment data from the department or its contractor;
(2) Accept the right of the Bureau for Medical Services of
recovery and the assignment to the state 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 by the Bureau for Medical
Services;
(3) Respond to any inquiry by the Bureau for Medical Services
regarding a claim for payment for any health care item or service that is submitted not later than three years after the date of the
provision of the health care item or service; and
(4) Accept a claim submitted by the Bureau for Medical
Services regardless of the date of submission of the claim, the
type or format of the claim form, lack of preauthorization or the
failure to present proper documentation at the point-of-sale that
is the basis of the claim: Provided, That the claim is submitted
by the Bureau for Medical Services within the three-year period
beginning on the date on which the item or service was furnished
and any action by the Bureau for Medical Services to enforce its
right with respect to the claim is commenced within six years of
the Bureau for Medical Services' submission of the claim.