Medicaid-third party payor conditions.

Plain English Breakdown

The official summary does not provide information on the specific conditions under which insurers cannot deny claims based on lack of prior authorization or proper documentation, leaving some uncertainty about what those conditions are.

Medicaid Third-Party Payor Conditions

This law requires health insurance companies to respond to state inquiries about Medicaid claims within 60 days and not deny payments based on certain conditions.

What This Bill Does

• Requires health insurers to respond to the state's inquiries about Medicaid claims within sixty (60) days if submitted no later than three years after the date of service.
• Prohibits health insurers from denying a claim submitted by the state solely due to lack of prior authorization or proper documentation, provided that certain conditions are met.

Who It Names or Affects

• Health insurance companies operating in Wyoming
• The state government

Terms To Know

Medicaid

A federal program that helps with medical costs for some people with limited income and resources.

Prior Authorization

Approval from an insurance company before a health care service or treatment can be provided.

Limits and Unknowns

• The law does not specify what happens if insurers do not comply with the requirements.
• It is unclear how this will affect people who are not covered by Medicaid but have private insurance.

Official Summary Text

Bill Summary - 24LSO-0014

Bill No.:

HB0025

Effective:

7/1/2024

LSO No.:

24LSO-0014

Enrolled Act No.:

HEA No. 0019

Chapter No.:

24

Prime Sponsor:

Joint Labor, Health & Social Services Interim Committee

Catch Title:

Medicaid-third party payor conditions.

Has Report:

No

Subject:

Wyoming Medical Assistance and Services Act.

Summary/Major Elements:

Current law requires all health insurers (and other specified entities and persons) that are legally responsible for payment of a claim for a health care item or service to agree, as a condition of doing business in the state of Wyoming, to comply with certain requirements. This act amends two (2) of the requirements to clarify that health insurers (and other specified entities and persons) must:

Respond within sixty (60) days to any inquiry by the state regarding a claim for payment for any health care item or service that is submitted not later than three (3) years after the date of the provision of the health care item or service; and
Agree not to deny a claim submitted by the state solely on the basis of a failure to obtain required prior authorization if the state meets specified conditions regarding the claim.

The above summary is not an official publication of the Wyoming Legislature and is not an official statement of legislative intent.

While the Legislative Service Office endeavored to provide accurate information in this summary, it should not be relied upon as a comprehensive abstract of the bill.

Current Bill Text

24LSO-0014

ORIGINAL House

Bill No
.
HB0025

ENROLLED ACT NO. 19,

HOUSE OF REPRESENTATIVES

SIXTY-SEVENTH LEGISLATURE OF THE STATE OF WYOMING
2024 Budget Session

AN ACT relating to the Wyoming Medical Assistance and Services Act; requiring health insurers to respond to state inquiries within sixty (60) days; prohibiting health insurers from denying Medicaid payments as specified; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1
.

W.S. 42
‑
4
‑
204(e)(iii) and (iv)(intro) is amended to read:

42
‑
4
‑
204.

Department subrogated to right of recovery of applicant or recipient; utilization of personal health insurance; insurance coverage of recipients.

(e)

In addition to the separate requirements set forth in W.S. 42
‑
4
‑
205, all health insurers, including all 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, shall agree, as a condition of doing business in the state of Wyoming, to:

(iii)

Respond
within sixty (60) days

to any inquiry by the state regarding a claim for payment for any health care item or service that is submitted not later than three (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
, a failure to obtain required prior authorization
or a failure to present proper documentation at the point of sale that is the basis of the claim, if:

Section 2
.

This act is effective July 1, 2024
.

(END)

Speaker of the House

President of the Senate

Governor

TIME APPROVED: _________

DATE APPROVED: _________

I hereby certify that this act originated in the House.

Chief Clerk

1