I 

117TH CONGRESS 

2D SESSION H. R. 6622 

To amend title XIX of the Social Security Act to provide clarification with 

respect to the liability of third party payers for medical assistance paid 

under the Medicaid program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 7, 2022 

Mr. BURGESS introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

clarification with respect to the liability of third party 

payers for medical assistance paid under the Medicaid 

program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid Third Party 

5 Liability Act’’. 

6 SEC. 2. MEDICAID THIRD PARTY LIABILITY. 

7 (a) REMOVAL OF SPECIAL TREATMENT OF CERTAIN

8 TYPES OF CARE AND PAYMENTS UNDER MEDICAID


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1 THIRD PARTY LIABILITY RULES.—Section 1902(a)(25) 

2 of the Social Security Act (42 U.S.C. 1396a(a)(25)) is 

3 amended by striking subparagraphs (E) and (F) and re4 designating the subsequent subparagraphs accordingly. 

5 (b) CLARIFICATION OF ROLE OF HEALTH INSURERS

6 WITH RESPECT TO THIRD PARTY LIABILITY.—Section 

7 1902(a)(25) of the Social Security Act (42 U.S.C. 

8 1396a(a)(25)), as amended by subsection (b)— 

9 (1) in subparagraph (F), by striking at the end 

10 ‘‘and’’; 

11 (2) in subparagraph (G), by striking the period 

12 at the end and inserting ‘‘; and’’; and 

13 (3) by adding at the end the following new sub14 paragraph: 

15 ‘‘(H) that, in the case of a State after Jan16 uary 1, 2023, that provides medical assistance 

17 under this title through a contract with a health 

18 insurer (including a group health plan, as de19 fined in section 607(1) of the Employee Retire20 ment Income Security Act of 1974, a self-in21 sured plan, a fully insured plan, a service ben22 efit plan, a managed care organization, a phar23 macy benefit manager, and any other health 

24 plan determined appropriate by the Sec25 retary)— 


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1 ‘‘(i) such contract shall specify— 

2 ‘‘(I) whether the State is dele3 gating to such insurer all or some of 

4 its right of recovery from a respon5 sible third party for an item or service 

6 for which payment has been made 

7 under the State plan (or under a 

8 waiver of the plan); and 

9 ‘‘(II) whether the State is trans10 ferring to such insurer all or some of 

11 the assignment to the State of any 

12 right of an individual or other entity 

13 to payment from a responsible third 

14 party for an item or service for which 

15 payment has been made under the 

16 State plan (or under a waiver of the 

17 plan); and 

18 ‘‘(ii) in the case of a State that elects 

19 an option described in subclause (I) or (I) 

20 of clause (i) with respect to a health in21 surer (including a group health plan, as 

22 defined in section 607(1) of the Employee 

23 Retirement Income Security Act of 1974, a 

24 self-insured plan, a fully insured plan, a 

25 service benefit plan, a managed care orgaVerDate Sep 11 2014 16:21 Feb 09, 2022 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6622.IH H6622

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1 nization, a pharmacy benefit manager, and 

2 any other health plan determined appro3 priate by the Secretary), the State shall 

4 provide assurances to the Secretary that 

5 the State laws referred to in subparagraph 

6 (G) confer to the health insurer the au7 thority of the State with respect to the re8 quirements specified in clauses (i) through 

9 (iv) of such subparagraph.’’. 

10 (c) INCREASING STATE FLEXIBILITY WITH RESPECT

11 TO THIRD PARTY LIABILITY.—Section 1902(a)(25)(G) of 

12 the Social Security Act (42 U.S.C. 1396a(a)(25)(I)), as 

13 redesignated by subsection (a), is amended— 

14 (1) in clause (i), by striking ‘‘medical assistance 

15 under the State plan’’ and inserting ‘‘medical assist16 ance under a State plan (or under a waiver of the 

17 plan)’’; 

18 (2) by striking clause (ii) and inserting the fol19 lowing new clause: 

20 ‘‘(ii) accept— 

21 ‘‘(I) the State’s right of recovery 

22 and the assignment to the State of 

23 any right of an individual or other en24 tity to payment from the party for an 

25 item or service for which payment has 


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1 been made under the respective 

2 State’s plan (or under a waiver of the 

3 plan); and 

4 ‘‘(II) after January 1, 2023, as a 

5 valid authorization of the responsible 

6 third party for the furnishing of an 

7 item or service to an individual eligi8 ble to receive medical assistance under 

9 this title, an authorization made on 

10 behalf of such individual under the 

11 State plan (or under a waiver of such 

12 plan) for the furnishing of such item 

13 or service to such individual;’’; 

14 (3) in clause (iii)— 

15 (A) by inserting ‘‘not later than 60 days 

16 after receiving’’ before ‘‘respond to’’; and 

17 (B) by striking ‘‘; and’’ at the end and in18 serting ‘‘, respond to such inquiry; and’’; and 

19 (4) in clause (iv), by inserting ‘‘a failure to ob20 tain a prior authorization,’’ after ‘‘claim form,’’. 

21 (d) VERIFICATION OF INSURANCE STATUS RE22 QUIRED.— 

23 (1) IN GENERAL.—Section 1902(a)(25)(A)(i) of 

24 the Social Security Act (42 U.S.C. 

25 1396a(a)(25)(A)(i)) is amended by inserting ‘‘, inVerDate Sep 11 2014 16:21 Feb 09, 2022 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6622.IH H6622

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1 cluding the collection of, with respect to an indi2 vidual seeking to receive medical assistance under 

3 this title, information on whether the individual has 

4 health insurance coverage provided through a third 

5 party (as described in such paragraph) and the plan 

6 of such insurer in which the individual is enrolled’’ 

7 after ‘‘sufficient information’’. 

8 (2) FFP UNAVAILABLE WITHOUT INSURANCE

9 STATUS VERIFICATION.—Section 1903(i) of the So10 cial Security Act (42 U.S.C. 1396b(i)) is amended— 

11 (A) in paragraph (26), by striking ‘‘; or’’ 

12 and inserting ‘‘;’’; 

13 (B) in paragraph (27), by striking ‘‘of the 

14 State.’’ and inserting ‘‘of the State; or’’; and 

15 (C) by inserting after paragraph (27) the 

16 following: 

17 ‘‘(28) with respect to any amounts after Janu18 ary 1, 2023, expended for medical assistance for in19 dividuals for whom the State has not obtained and 

20 verified, in accordance with section 

21 1902(a)(25)(A)(i), information on whether such an 

22 individual has coverage provided through a third 

23 party (as described in such paragraph) and the plan 

24 of such coverage in which the individual is en25 rolled.’’. 


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1 SEC. 3. EFFECTIVE DATE. 

2 In the case of a State plan for medical assistance 

3 under title XIX of the Social Security Act that the Sec4 retary of Health and Human Services determines requires 

5 State legislation (other than legislation appropriating 

6 funds) in order for the plan to meet the additional require7 ment imposed by the amendments made under this sec8 tion, the State plan shall not be regarded as failing to 

9 comply with the requirements of such title solely on the 

10 basis of its failure to meet this additional requirement be11 fore the first day of the first calendar quarter beginning 

12 after the close of the first regular session of the State leg13 islature that begins after the date of the enactment of this 

14 Act. For purposes of the previous sentence, in the case 

15 of a State that has a 2-year legislative session, each year 

16 of such session shall be deemed to be a separate regular 

17 session of the State legislature. 

Æ 


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