Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblyman ERIK PETERSON
District 23 (Hunterdon, Somerset and Warren)
SYNOPSIS
Requires Medicaid Fraud Division to enter into data sharing agreement upon request of county to provide access to third party insurance liability data regarding certain COVID-19 related health claims.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning data sharing agreements between the Medicaid Fraud Division and counties, and supplementing Title 52 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. The Medicaid Fraud Division in the Office of the State Comptroller shall enter into a data sharing agreement with a county, upon the county’s request, for the purposes of providing the county with access to third party insurance liability data utilized by the division’s Third Party Liability Unit, and any private entity contracted by the division, to determine whether Medicaid beneficiaries have other insurance. Under the data sharing agreement, the division shall provide all available data, in a manner that complies with federal and State laws and regulations, which will assist the county in:
(1) examining the claims or documentation submitted by individuals to the county upon the provision of publicly-funded health-related services provided in connection with the coronavirus disease 2019 (COVID-19), including, but not limited to, testing, diagnosis, and treatment, administered at any point since the Governor’s declared public health emergency regarding COVID-19, to determine whether the individuals are insured; and
(2) if any individual is determined to be insured, identifying the carrier under which the individual is a covered person so that the county may properly bill the carrier for any health-related services provided to that individual in connection with COVID-19 that are covered by the carrier.
b. As used in this section, “carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
2. This act shall take effect immediately.
STATEMENT
This bill requires the Medicaid Fraud Division in the Office of the State Comptroller to enter into a data sharing agreement with a county, upon the county’s request, for the purposes of providing the county access to third party insurance liability data utilized by the division’s Third Party Liability Unit, and any private entity contracted by the division, to determine whether Medicaid beneficiaries have other insurance. Under the data sharing agreement, the division is required to provide all available data, in a manner that complies with federal and State laws and regulations, which will assist the county in:
1) examining the claims or documentation submitted by individuals to the county upon the provision of publicly-funded health-related services provided in connection with the coronavirus disease 2019 (COVID-19), including, but not limited to, testing, diagnosis, and treatment, administered at any point since the Governor’s declared public health emergency regarding COVID-19, to determine whether the individuals are insured; and
2) if any individual is determined to be insured, identifying the carrier under which the individual is a covered person so that the county may properly bill the carrier for any health-related services provided to that individual in connection with COVID-19 that are covered by the carrier.
As defined under the bill, “carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
States are required under federal Medicaid statute to have laws that compel health insurers in the state to provide at least four data elements to support identification of third party liability: the insured’s name, address, group or member ID number, and periods of coverage. It is the sponsor’s goal that allowing counties to access this information to determine third party liability for COVID-19 health services will protect the limited amount of public funds that have been made available to counties to offer those services.