SB1083 - 472R - House Bill Summary

House of Representatives

SB 1083

AHCCCS; liens; notification requirements

Sponsors: Senator Allen, Representative Quelland

X	Committee on Health
	Caucus and COW
	As Engrossed and As Passed the House

SB1083 requires an Arizona Health Care Cost Containment System (AHCCCS) member to notify AHCCCS when certain civil actions or other proceedings are commenced.

History

AHCCCS is Arizona’s Medicaid program and the Arizona Long-Term Care System (ALTCS) is the long-term care program under AHCCCS. Both programs are subject to federal laws regarding Medicaid programs, unless those laws are waived by the federal government. In Arizona, the federal government pays approximately two-thirds of the costs of the Medicaid program.

Under federal law, the Medicaid program is considered the payer of last resort and should only pay after other third party sources have met their legal obligation to pay for a member’s care. Currently, if an AHCCCS or ALTCS member is injured, requiring hospital or medical care paid for by AHCCCS, and then files a claim for liability or indemnity for damages, AHCCCS may place a lien on these claims to recover any charges it paid for the member. Under federal law, states must attempt to recover the amounts paid for services to the member and return the appropriate share to the federal government.

Current statute does not require a member to notify AHCCCS upon the commencement of legal action. AHCCCS reports that its employees must discover the action on their own and sometimes this discovery occurs too late to successfully place the lien.

The recovered funds are used to pay the contractor for the costs of recovery. Of the monies remaining after paying the contractor, the corresponding federal share is returned to the federal government and the state share is retained by AHCCCS to offset the state costs of the program. AHCCCS reports that in FY 2004-2005, recoveries totaled $4.4 million, of which approximately $1.5 million was the state’s share.

Provisions

· Requires an AHCCCS or ALTCS member or the member’s legal representative, to provide written notice to the AHCCCS administration within twenty days of the commencement of a civil action or other proceedings to establish the liability of a third party or to collect payment from specified insurance coverage or any other source.

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· Forty-seventh Legislature