NRS 695A.151 Effect of eligibility for medical assistance under Medicaid on eligibility for coverage; assignment of rights to state agency.

550 words·~3 min read·/nv/chapter-695a-fraternal-benefit-societies/695a-151·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

1. A society shall not, when considering eligibility for coverage or making payments under a certificate for health benefits, consider the availability of, or eligibility of a person for, medical assistance under Medicaid.

2. To the extent that payment has been made by Medicaid for health care, a society:

(a)Shall treat Medicaid as having a valid and enforceable assignment of an insured’s benefits regardless of any exclusion of Medicaid or the absence of a written assignment; and

(b)May, as otherwise allowed by its certificate for health benefits, evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any reimbursement rights of a recipient of Medicaid against any other liable party if:

(1)It is so authorized pursuant to a contract with Medicaid for managed care; or

(2)It has reimbursed Medicaid in full for the health care provided by Medicaid to its insured.

3. If a state agency is assigned any rights of a person who is:

(a)Eligible for medical assistance under Medicaid; and

(b)Covered by a certificate for health benefits,

Ê the society that issued the health policy shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by the certificate.

4. If a state agency is assigned any rights of an insured who is eligible for medical assistance under Medicaid, a society that issues a certificate for health benefits, evidence of coverage or contract shall:

(a)Upon request of the state agency, provide to the state agency information regarding the insured to determine:

(1)Any period during which the insured, a spouse or dependent of the insured may be or may have been covered by the society; and

(2)The nature of the coverage that is or was provided by the society, including, without limitation, the name and address of the insured and the identifying number of the certificate for health benefits, evidence of coverage or contract;

(b)Not later than 60 days after receiving any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service to the person who is eligible for medical assistance under Medicaid and who the state agency reasonably believes is covered by the society that is submitted not later than 3 years after the date of the provision of the medical item or service, respond to such inquiry; and

(c)Agree not to deny a claim submitted by the state agency solely on the basis of:

(1)Lack of prior authorization if the state agency authorized the medical item or service; or

(2)The date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:

(I)The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service; and

(II)Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.