Page:United States Statutes at Large Volume 120.djvu/110

 PUBLIC LAW 109–171—FEB. 8, 2006

120 STAT. 79

(1) in subparagraph (A), in the matter preceding clause (i)— (A) by inserting ‘‘, self-insured plans’’ after ‘‘health insurers’’; and (B) by striking ‘‘and health maintenance organizations’’ and inserting ‘‘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’’; and (2) in subparagraph (G)— (A) by inserting ‘‘a self-insured plan,’’ after ‘‘1974,’’; and (B) by striking ‘‘and a health maintenance organization’’ and inserting ‘‘a managed care organization, a pharmacy benefit manager, or other party that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service’’. (b) REQUIREMENT FOR THIRD PARTIES TO PROVIDE THE STATE WITH COVERAGE ELIGIBILITY AND CLAIMS DATA.—Section 1902(a)(25) of such Act (42 U.S.C. 1396a(a)(25)) is amended— (1) in subparagraph (G), by striking ‘‘and’’ at the end; (2) in subparagraph (H), by adding ‘‘and’’ after the semicolon at the end; and (3) by inserting after subparagraph (H), the following: ‘‘(I) that the State shall provide assurances satisfactory to the Secretary that the State has in effect laws requiring health insurers, including self-insured plans, group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974), service benefit plans, 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, as a condition of doing business in the State, to— ‘‘(i) provide, with respect to individuals who are eligible for, or are provided, medical assistance under the State plan, upon the request of the State, information to determine during what period the individual or their spouses or their dependents may be (or may have been) covered by a health insurer and the nature of the coverage that is or was provided by the health insurer (including the name, address, and identifying number of the plan) in a manner prescribed by the Secretary; ‘‘(ii) accept the State’s right 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 under the State plan; ‘‘(iii) respond to any inquiry by the State regarding a claim for payment for any health care item or service that is submitted not later than 3 years after the date of the provision of such health care item or service; and ‘‘(iv) agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim, the type or format of the claim form,

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