(A) by striking ‘‘and’’ at the end of sub-
paragraph (H); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (I); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(J) that the State shall provide assur-
ances satisfactory to the Secretary that the 
State has in effect laws requiring the State to 
make inquiries to third parties, including health 
insurers, self-insured plans, group health plans 
(as defined in section 607(1) of the Employee 
Retirement Income Security Act of 1974), serv-
ice benefit plans, managed care organizations, 
pharmacy benefit managers, or other parties 
that are, by statute, contract, or agreement, le-
gally responsible for payment of a claim for a 
health care item or service, operating in any 
State;’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(dd) RESPONSIBILITIES OF THIRD PARTIES.— 
‘‘(1) IN GENERAL.—Third parties described in 
subsection (a)(25)(J) shall— 
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‘‘(A) provide, with respect to individuals 
who are eligible for, or are provided, medical as-
sistance under the State plan, upon the request 
of the State, information to determine during 
what period the individual (or the individual’s 
spouse or dependents) may be (or may have 
been) covered by a health insurer and the na-
ture of the coverage that is or was provided by 
the health insurer (including the name, address, 
and identifying number of the plan) in a man-
ner prescribed by the Secretary; 
‘‘(B) 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 pay-
ment has been made under the State plan; 
‘‘(C) 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 
‘‘(D) 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, or a failure to present proper 
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documentation at the point-of-sale that is the 
basis of the claim, if— 
‘‘(i) the claim is submitted by the 
State within the 3-year period beginning 
on the date on which the item or service 
was furnished; and 
‘‘(ii) any action by the State to en-
force its rights with respect to such claim 
is commenced within 6 years of the State’s 
submission of such claim. 
‘‘(2) INQUIRIES OF THIRD PARTIES.—Entities 
providing services and items to individuals receiving 
medical assistance under this title (or to individuals 
the entity reasonably believes may receive medical 
assistance under this title) may make inquiries to 
third parties described in subsection (a)(15)(J) that 
are, by statute, contract, or agreement, legally re-
sponsible for payment of a claim, operating in any 
State, for the purpose of determining eligibility and 
coverage for those individuals.’’. 
(b) REFERRALS TO THE SECRETARY; MAINTAINING 
THE INTEGRITY OF THE MEDICAID PROGRAM.—Section 
1909 of such Act (42 U.S.C. 1396h) is amended— 
(1) in subsection (b), by adding at the end the 
following new paragraph: 
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‘‘(5) The law contains a requirement for mak-
ing a referral to the Secretary for the purposes of 
subsection (e).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) FEDERAL CIVIL PENALTIES AND PAYMENTS TO 
STATES.— 
‘‘(1) FEDERAL CIVIL PENALTIES.— 
‘‘(A) IN GENERAL.—Upon referral from a 
State, if the Secretary finds that a third party, 
including any third party described in section 
1902(a)(25)(J), that is, by statute, contract, or 
agreement, legally responsible for payment of a 
claim for a health care item or service, failed to 
reply to inquiries about an individual sent pur-
suant to such section, the Secretary shall im-
pose a civil penalty upon that third party of not 
less than $5,000 and not more than $10,000, 
plus 3 times the amount of the claim for that 
individual without regard to any other legal re-
sponsibility of the third party for payment of a 
claim for a health care item or service for that 
individual. 
‘‘(B) FAILURE DEFINED.—For purposes of 
subparagraph (A), the term ‘failed’ means the 
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failure of a third party described to provide the 
information required by section 1902(a)(25)(J) 
about an individual within 10 days of the date 
the inquiry is first made to the party. 
‘‘(2) PAYMENTS
TO
STATES.—The Secretary 
shall pay a State an amount equal to the Federal 
medical assistance percentage of any amount obli-
gated to the United States under paragraph (1).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2009. 
Æ 
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