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2007 SESSION
075422312Be it enacted by the General Assembly of Virginia:
1. That § 32.1-325.2 of the Code of Virginia is amended and reenacted as follows:
§ 32.1-325.2. Department is payor of last resort.
A. Insurers, including group health plans as defined in §
607(1) of the Employee Retirement Income Security Act of 1974, self-insured
plans, health services plans, service benefit plans and,
health maintenance organizations, managed care organizations, pharmacy
benefits 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, are
prohibited from including any clause in health care contracts which would
exclude enrolling an individual or in making any payment for benefits to the
individual or on the individual's behalf for health care when the individual is
eligible for medical assistance.
B. The Department of Medical Assistance Services shall be the
payor of last resort to any insurer, including a group health plan as defined
in § 607(1) of the Employee Retirement Income Security Act of 1974, a
self-insured plan, a health services plan, a service benefit plan and,
a health maintenance organization, a managed care organization, a pharmacy
benefits manager, or other party that is, by statute, contract, or agreement
legally responsible for payment of a claim for a health care item or service which
contracts to pay health care costs for persons eligible for medical
assistance in the Commonwealth. The above entities, as a condition of doing
business in the Commonwealth, shall comply with the requirements set forth in
42 U.S.C. 1396a(a)(25)(I)(i)-(iv).
C. To the extent the Department of Medical Assistance Services has made payment for medical services where a third party has a legal obligation to make payment for such services, the Commonwealth shall automatically acquire all rights to such payment from the third party.
D. To the extent the Department of Medical Assistance Services is permitted by law to obtain recoveries from third parties, actions at law for such recoveries shall be decided under the same laws, rules and standards including applicable bases of liability and defenses as would apply if the individual receiving the services had brought the action directly; provided that nothing herein shall affect the sovereign immunity of the Commonwealth.
E. The term "insurer" as used herein shall be deemed to include without limitation "insurance carriers."