SCS CSHB 325(FIN): "An Act relating to priorities, claims, and liens for payment for certain medical services provided to medical assistance recipients; and providing for an effective date."
00SENATE CS FOR CS FOR HOUSE BILL NO. 325(FIN) 01 "An Act relating to priorities, claims, and liens for payment for certain medical 02 services provided to medical assistance recipients; and providing for an effective 03 date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 34.35.460 is amended by adding a new subsection to read: 06 (b) A hospital or the owner or operator of a hospital, or a physician or licensed 07 special nurse who files a notice of lien under (a) of this section for hospitalization or 08 services provided to a recipient of medical assistance under AS 47 shall mail a copy 09 of the notice of lien to the unit of the Department of Health and Social Services that 10 administers medical assistance for needy persons under AS 47. The copy must be sent 11 by certified mail no later than 30 days after the filing of the notice of lien under (a) 12 of this section. 13 * Sec. 2. AS 34.35 is amended by adding a new section to read: 14 Sec. 34.35.481. Priority of liens. A lien perfected by the Department of
01 Health and Social Services under AS 47.05.075 has priority immediately after a lien 02 perfected by a hospital, nurse, or physician under AS 34.35.450 - 34.35.480. 03 * Sec. 3. AS 44.77.015(a) is amended to read: 04 (a) For the purposes of filing claims for medical services provided under 05 AS 47.07 or AS 47.25.120 - 47.25.300, "promptly," in AS 44.77.010(a), means [(1) 06 WITHIN SIX MONTHS AFTER THE DATE OF SERVICE, OR AS PROVIDED IN 07 (b) OF THIS SECTION, IF THERE IS NO THIRD-PARTY CLAIM, OR (2)] within 08 12 months after the date of service or as provided in (b) of this section [IF THERE 09 IS A THIRD-PARTY CLAIM]. Except as provided in (c) of this section, a claim may 10 not be paid if it is not filed promptly; an inference to the contrary may not be drawn 11 from AS 09.10.053, AS 09.50.250 - 09.50.300, or AS 37.25.010. 12 * Sec. 4. AS 44.77.015(b) is amended to read: 13 (b) In accordance with (a) of this section, a claim may be considered to be 14 filed promptly if (1) the claim was filed more than 12 [SIX] months after the date of 15 service because the medical provider had reason to believe that the beneficiary was 16 ineligible for service under AS 47.07 or AS 47.25.120 - 47.25.300; (2) a court of 17 competent jurisdiction or an administrative hearing officer finds that the beneficiary 18 was eligible for service under AS 47.07 or AS 47.25.120 - 47.25.300 on the date of 19 service; and (3) the claim is filed within 12 [SIX] months after the date that the court 20 or administrative finding is rendered. The beneficiary is responsible for notifying the 21 medical provider of the judicial or administrative finding. The department shall make 22 a good faith effort to notify the medical provider of the judicial or administrative 23 finding if the department has reason to believe that services have been provided to the 24 beneficiary. 25 * Sec. 5. AS 44.77.015(c) is amended to read: 26 (c) The commissioner of health and social services may authorize payment to 27 a medical provider of a claim not promptly filed, upon good cause shown. 28 [PAYMENTS UNDER THIS SUBSECTION MAY NOT EXCEED 50 PERCENT OF 29 THE ALLOWABLE CHARGES PRESENTED IN THE CLAIM.] 30 * Sec. 6. AS 47.05.070(b) is amended to read: 31 (b) If the department provides or pays for medical assistance for injury or
01 illness under this title, the department is subrogated to the rights of the recipient of that 02 medical assistance for any claim arising from the injury or illness and to the proceeds 03 of an insurance policy covering the injury or illness to the extent of the value of the 04 medical assistance provided. A recipient of medical assistance or the recipient's 05 attorney must notify the department in writing of any action or claim against a 06 third-party payor if medical assistance was provided by the department to treat 07 an injury or illness for which the third party may be liable. Notwithstanding the 08 assertion of any action or claim by the recipient of medical assistance, the 09 department may bring an action in the superior court against an alleged third- 10 party payor to recover an amount subrogated to the department for medical assistance 11 provided on behalf of a recipient. 12 * Sec. 7. AS 47.05.070(c) is amended to read: 13 (c) If a recipient of medical assistance under this title settles a claim or obtains 14 an award or judgment arising from the injury or illness for which the medical 15 assistance was received, the amount of the claim to which the department is 16 entitled under (b) of this section shall be reduced by a pro rata share of the 17 [DEPARTMENT SHALL REIMBURSE THE RECIPIENT FOR] attorney fees and 18 litigation costs [COMMENSURATE WITH THE AMOUNT OF THE SETTLEMENT, 19 AWARD, OR JUDGMENT TO WHICH THE DEPARTMENT IS ENTITLED 20 UNDER (b) OF THIS SECTION]. Regardless of the manner in which the amount of 21 the attorney fees is derived in the particular case, the pro rata reduction of the 22 subrogated claim for [,] reimbursement of attorney fees shall be calculated in 23 accordance with the applicable rules of court governing the award of attorney fees in 24 civil matters. 25 * Sec. 8. AS 47.05.070 is amended by adding new subsections to read: 26 (e) Notwithstanding (b) of this section, the department may waive the 27 subrogation rights to all or part of the amount of medical assistance paid on behalf of 28 a recipient of medical assistance in cases of undue hardship. 29 (f) The department may adopt regulations to interpret and implement this 30 section. 31 * Sec. 9. AS 47.05 is amended by adding a new section to read:
01 Sec. 47.05.075. Medical assistance lien. (a) The department has a lien upon 02 any sum that may be due to the recipient of medical assistance from a third-party 03 payor. The lien is in the amount of the medical assistance paid for medical services 04 under this title, together with reasonable attorney fees and litigation costs incurred in 05 the enforcement of the lien. 06 (b) A lien against a sum due from a third-party payor for medical services 07 provided to a recipient of medical assistance under this title attaches and is effective 08 upon filing with a recorder's office in any recording district in the state. However, a 09 lien filed under this subsection is not perfected and has no effect unless notice of filing 10 of the lien is served by the department upon the third-party payor, personally or by 11 registered, certified, or insured mail, return receipt requested. 12 (c) If a recipient of medical assistance under this title settles a claim or obtains 13 an award or judgment arising from the injury or illness for which the medical 14 assistance was received, the amount of the lien to which the department is entitled 15 under (a) of this section shall be reduced by a pro rata share of the attorney fees and 16 litigation costs. Regardless of the manner in which the amount of the attorney fees is 17 derived in the particular case, the pro rata reduction of the lien shall be calculated in 18 accordance with the applicable rules of court governing the award of attorney fees in 19 civil matters. 20 (d) A perfected lien under this section has priority immediately after a lien 21 perfected by a hospital, nurse, or physician under AS 34.35.450 - 34.35.480. 22 * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section 23 to read: 24 APPLICABILITY. (a) Sections 3 - 5 of this Act apply to all claims for medical 25 services provided under AS 47 to a recipient of medical assistance that are submitted to the 26 Department of Health and Social Services on or after the effective date of this Act. 27 (b) Except as provided in (a) of this section, this Act applies to all claims for medical 28 services that are provided under AS 47 to a recipient of medical assistance on or after the 29 effective date of this Act. 30 * Sec. 11. This Act takes effect immediately under AS 01.10.070(c).