MISSISSIPPI LEGISLATURE
2007 Regular Session
To: Public Health and Welfare
By: Senator(s) Nunnelee, Burton
AN ACT RELATING TO THE ADMINISTRATION OF THE MISSISSIPPI MEDICAID LAW; TO AMEND SECTION 43-13-107, MISSISSIPPI CODE OF 1972, TO CLARIFY THE QUALIFICATIONS OF THE EXECUTIVE DIRECTOR OF THE DIVISION OF MEDICAID, OFFICE OF THE GOVERNOR, TO DELETE PROVISIONS RELATING TO THE POSITION OF DEPUTY DIRECTOR OF ADMINISTRATION OF THE DIVISION OF MEDICAID, TO PROVIDE FOR THE CHAIRMANSHIP OF THE MEDICAL CARE ADVISORY COMMITTEE, AND TO EXTEND THE AUTOMATIC REPEALER ON THE SECTION WHICH CREATES THE DIVISION OF MEDICAID; TO AMEND SECTION 43-13-213, MISSISSIPPI CODE OF 1972, TO PROVIDE CIVIL PENALTIES AND RESTITUTION FOR PERSONS WHO VIOLATE THE MEDICAID FRAUD CONTROL ACT; TO CODIFY SECTION 43-13-221.1, MISSISSIPPI CODE OF 1972, TO AUTHORIZE A CIVIL ACTION TO BE BROUGHT BY AN INDIVIDUAL FOR THE STATE OF MISSISSIPPI FOR VIOLATIONS OF THE MEDICAID FRAUD CONTROL ACT AND TO PROVIDE THAT THE ATTORNEY GENERAL MAY PROCEED WITH THE ACTION UNDER CERTAIN CIRCUMSTANCES; TO AMEND SECTION 43-13-223, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR VENUE AND A STATUTE OF LIMITATIONS FOR CIVIL ACTIONS BROUGHT IN CONNECTION WITH MEDICAID FRAUD; TO CODIFY SECTION 43-13-126, MISSISSIPPI CODE OF 1972, TO REQUIRE HEALTH INSURERS TO PROVIDE CERTAIN INFORMATION REGARDING INDIVIDUAL COVERAGE TO THE DIVISION OF MEDICAID AS A CONDITION OF DOING BUSINESS IN THE STATE, TO ACCEPT THE DIVISION OF MEDICAID'S RIGHT OF RECOVERY IN THIRD-PARTY ACTIONS AND NOT TO DENY A CLAIM SUBMITTED BY THE DIVISION ON THE BASIS OF CERTAIN ERRORS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 43-13-107, Mississippi Code of 1972, is amended as follows:
43-13-107. (1) The Division of Medicaid iscreated in the Office of the Governor and established to administer this article and perform such other duties as are prescribed by law.
(2) (a) The Governor shall appoint a full-time executive director, with the advice and consent of the Senate, who shall be either (i) a physician or other professional with administrative experience in a medical care or health program, or (ii) a person holding a graduate degree in medical care administration, public health, hospital administration, or the equivalent, or (iii) a person holding a bachelor's degree * * *, with at least ten (10) years' experience in management-level administration * * *. The executive director shall be the official secretary and legal custodian of the records of the division; shall be the agent of the division for the purpose of receiving all service of process, summons and notices directed to the division; and shall perform such other duties as the Governor may prescribe from time to time.
* * *
(b) The Executive Director * * * of the Division of Medicaid shall perform all other duties that are now or may be imposed upon them by law.
(c) The * * * executive director * * * shall serve at the will and pleasure of the Governor. * * *
(d) The executive director * * * shall, before entering upon the discharge of the duties of his office, take and subscribe to the oath of office prescribed by the Mississippi Constitution and shall file the same in the Office of the Secretary of State, and * * * shall execute a bond in some surety company authorized to do business in the state in the penal sum of One Hundred Thousand Dollars ($100,000.00), conditioned for the faithful and impartial discharge of the duties of his office. The premium on this bond shall be paid as provided by law out of funds appropriated to the Division of Medicaid for contractual services.
(e) The executive director, with the approval of the Governor and subject to the rules and regulations of the State Personnel Board, shall employ such professional, administrative, stenographic, secretarial, clerical and technical assistance as may be necessary to perform the duties required in administering this article and fix the compensation for those persons, all in accordance with a state merit system meeting federal requirements. When the salary of the executive director is not set by law, that salary shall be set by the State Personnel Board. No employees of the Division of Medicaid shall be considered to be staff members of the immediate Office of the Governor; however, the provisions of Section 25-9-107(c)(xv) shall apply to the executive director and other administrative heads of the division.
(3) (a) There is established a Medical Care Advisory Committee, which shall be the committee that is required by federal regulation to advise the Division of Medicaid about health and medical care services.
(b) The advisory committee shall consist of not less than eleven (11) members, as follows:
(i) The Governor shall appoint five (5) members, one (1) from each congressional district and one (1) from the state at large;
(ii) The Lieutenant Governor shall appoint three (3) members, one (1) from each Supreme Court district;
(iii) The Speaker of the House of Representatives shall appoint three (3) members, one (1) from each Supreme Court district.
All members appointed under this paragraph shall either be health care providers or consumers of health care services. One (1) member appointed by each of the appointing authorities shall be a board certified physician.
(c) The respective Chairmen of the House Medicaid Committee, the House Public Health and Human Services Committee, the House Appropriations Committee, the Senate Public Health and Welfare Committee and the Senate Appropriations Committee, or their designees, two (2) members of the State Senate appointed by the Lieutenant Governor and one (1) member of the House of Representatives appointed by the Speaker of the House, shall serve as ex officio nonvoting members of the advisory committee.
(d) In addition to the committee members required by paragraph (b), the advisory committee shall consist of such other members as are necessary to meet the requirements of the federal regulation applicable to the advisory committee, who shall be appointed as provided in the federal regulation.
(e) The chairmanship of the advisory committee shall be elected by the voting members of the committee annually and shall not serve more than two (2) consecutive terms.
(f) The members of the advisory committee specified in paragraph (b) shall serve for terms that are concurrent with the terms of members of the Legislature, and any member appointed under paragraph (b) may be reappointed to the advisory committee. The members of the advisory committee specified in paragraph (b) shall serve without compensation, but shall receive reimbursement to defray actual expenses incurred in the performance of committee business as authorized by law. Legislators shall receive per diem and expenses, which may be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session.
(g) The advisory committee shall meet not less than quarterly, and advisory committee members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(h) The executive director shall submit to the advisory committee all amendments, modifications and changes to the state plan for the operation of the Medicaid program, for review by the advisory committee before the amendments, modifications or changes may be implemented by the division.
(i) The advisory committee, among its duties and responsibilities, shall:
(i) Advise the division with respect to amendments, modifications and changes to the state plan for the operation of the Medicaid program;
(ii) Advise the division with respect to issues concerning receipt and disbursement of funds and eligibility for Medicaid;
(iii) Advise the division with respect to determining the quantity, quality and extent of medical care provided under this article;
(iv) Communicate the views of the medical care professions to the division and communicate the views of the division to the medical care professions;
(v) Gather information on reasons that medical care providers do not participate in the Medicaid program and changes that could be made in the program to encourage more providers to participate in the Medicaid program, and advise the division with respect to encouraging physicians and other medical care providers to participate in the Medicaid program;
(vi) Provide a written report on or before November 30 of each year to the Governor, Lieutenant Governor and Speaker of the House of Representatives.
(4) (a) There is established a Drug Use Review Board, which shall be the board that is required by federal law to:
(i) Review and initiate retrospective drug use, review including ongoing periodic examination of claims data and other records in order to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists and individuals receiving Medicaid benefits or associated with specific drugs or groups of drugs.
(ii) Review and initiate ongoing interventions for physicians and pharmacists, targeted toward therapy problems or individuals identified in the course of retrospective drug use reviews.
(iii) On an ongoing basis, assess data on drug use against explicit predetermined standards using the compendia and literature set forth in federal law and regulations.
(b) The board shall consist of not less than twelve (12) members appointed by the Governor, or his designee.
(c) The board shall meet at least quarterly, and board members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(d) The board meetings shall be open to the public, members of the press, legislators and consumers. Additionally, all documents provided to board members shall be available to members of the Legislature in the same manner, and shall be made available to others for a reasonable fee for copying. However, patient confidentiality and provider confidentiality shall be protected by blinding patient names and provider names with numerical or other anonymous identifiers. The board meetings shall be subject to the Open Meetings Act (Section 25-41-1 et seq.). Board meetings conducted in violation of this section shall be deemed unlawful.
(5) (a) There is established a Pharmacy and Therapeutics Committee, which shall be appointed by the Governor, or his designee.
(b) The committee shall meet at least quarterly, and committee members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(c) The committee meetings shall be open to the public, members of the press, legislators and consumers. Additionally, all documents provided to committee members shall be available to members of the Legislature in the same manner, and shall be made available to others for a reasonable fee for copying. However, patient confidentiality and provider confidentiality shall be protected by blinding patient names and provider names with numerical or other anonymous identifiers. The committee meetings shall be subject to the Open Meetings Act (Section 25-41-1 et seq.). Committee meetings conducted in violation of this section shall be deemed unlawful.
(d) After a thirty-day public notice, the executive director, or his or her designee, shall present the division's recommendation regarding prior approval for a therapeutic class of drugs to the committee. However, in circumstances where the division deems it necessary for the health and safety of Medicaid beneficiaries, the division may present to the committee its recommendations regarding a particular drug without a thirty-day public notice. In making that presentation, the division shall state to the committee the circumstances that precipitate the need for the committee to review the status of a particular drug without a thirty-day public notice. The committee may determine whether or not to review the particular drug under the circumstances stated by the division without a thirty-day public notice. If the committee determines to review the status of the particular drug, it shall make its recommendations to the division, after which the division shall file those recommendations for a thirty-day public comment under the provisions of Section 25-43-7(1).
(e) Upon reviewing the information and recommendations, the committee shall forward a written recommendation approved by a majority of the committee to the executive director or his or her designee. The decisions of the committee regarding any limitations to be imposed on any drug or its use for a specified indication shall be based on sound clinical evidence found in labeling, drug compendia, and peer reviewed clinical literature pertaining to use of the drug in the relevant population.
(f) Upon reviewing and considering all recommendations including recommendation of the committee, comments, and data, the executive director shall make a final determination whether to require prior approval of a therapeutic class of drugs, or modify existing prior approval requirements for a therapeutic class of drugs.
(g) At least thirty (30) days before the executive director implements new or amended prior authorization decisions, written notice of the executive director's decision shall be provided to all prescribing Medicaid providers, all Medicaid enrolled pharmacies, and any other party who has requested the notification. However, notice given under Section 25-43-7(1) will substitute for and meet the requirement for notice under this subsection.
(h) Members of the committee shall dispose of matters before the committee in an unbiased and professional manner. If a matter being considered by the committee presents a real or apparent conflict of interest for any member of the committee, that member shall disclose the conflict in writing to the committee chair and recuse himself or herself from any discussions and/or actions on the matter.
(6) This section shall stand repealed on July 1, 2011.
SECTION 2. Section 43-13-213, Mississippi Code of 1972, is amended as follows:
43-13-213. (1) A person shall not make, present or cause to be made or presented a claim for Medicaid benefits, knowing the claim to be false, fictitious or fraudulent.
(2) Any person who:
(a) Knowingly presents, or causes to be presented, to an officer, employee or agent of the State of Mississippi, or any political subdivision or other entity of the State of Mississippi, a false or fraudulent claim for payment or approval;
(b) Knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the State of Mississippi;
(c) Conspires to defraud the State of Mississippi by getting a false or fraudulent claim allowed or paid;
(d) Has possession, custody, or control of property or money used, or to be used, by the State of Mississippi and, intending to defraud the State of Mississippi or willfully to conceal the property, delivers, or causes to be delivered, less property than the amount for which the person receives a certificate or receipt;
(e) Authorized to make or deliver a document certifying receipt of property used, or to be used, by the State of Mississippi and, intending to defraud the State of Mississippi, makes or delivers the receipt without completely knowing that the information on the receipt is true;
(f) Knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer, employee or agent of the State of Mississippi, who lawfully may not sell or pledge the property; or
(g) Knowingly makes, uses, or causes to be made or used, a false record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the State of Mississippi,
is liable to the State of Mississippi for a civil penalty of not less than Five Thousand Dollars ($5,000.00) and not more than Ten Thousand Dollars ($10,000.00), plus three (3) times the amount of damages which the state sustains because of the act of that person.
(3) Provided, however, that if the court finds that:
(a) The person committing the violation of this subsection furnished to officials of the State of Mississippi responsible for investigating false claims violations all information known to such person about the violation within thirty (30) days after the date on which the defendant first obtained the information;
(b) Such person fully cooperated with any investigation of such violation; and
(c) At the time such person furnished the State of Mississippi with the information about the violation, no criminal prosecution, civil action or administrative action had commenced under this title with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,
the court may assess not less than two (2) times the amount of damages which the state sustains because of the act of the person. A person violating this subsection shall also be liable to the United States Government for the costs of a civil action brought to recover any such penalty or damages.
(4) For purposes of this section, the terms "knowing" and "knowingly" mean that a person, with respect to information:
(a) Has actual knowledge of the information;
(b) Acts in deliberate ignorance of the truth or falsity of the information; or
(c) Acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.
(5) For purposes of this section, "claim" includes any request or demand, whether under a contract or otherwise, for money or property which is made to a contractor, grantee, or other recipient if the State of Mississippi provides any portion of the money or property which is requested or demanded, or if the state will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.
(6) Any information furnished pursuant to paragraphs (a) through (c) of subsection (2) shall be exempt from disclosure under the Mississippi Public Records Act.
SECTION 3. The following shall be codified as Section 43-13-221.1, Mississippi Code of 1972:
43-13-221.1. (1) (a) A person may bring a civil action for a violation of the provisions of this article for the person and for the State of Mississippi. The action shall be brought in the name of the State of Mississippi. The action may be dismissed only if the court and the Attorney General give written consent to the dismissal and their reasons for consenting.
(b) A copy of the complaint and written disclosure of substantially all material evidence and information the person possesses shall be served on the Attorney General, on behalf of the state, pursuant to the Mississippi Rules of Civil Procedure. The complaint shall be filed in camera, shall remain under seal for at least sixty (60) days, and shall not be served on the defendant until the court so orders. The state may elect to intervene and proceed with the action within sixty (60) days after it receives both the complaint and the material evidence and information.
(c) The state may, for good cause shown, move the court for extensions of the time during which the complaint remains under seal under subsection (2). Any such motions may be supported by affidavits or other submissions in camera. The defendant shall not be required to respond to any complaint filed under this section until thirty (30) days after the complaint is unsealed and served upon the defendant pursuant to the Mississippi Rules of Civil Procedure.
(d) Before the expiration of the sixty-day period or any extensions obtained under paragraph (c), the Attorney General, on behalf of the state, shall:
(i) Proceed with the action, in which case the action shall be conducted by the state; or
(ii) Notify the court that it declines to take over the action, in which case the person bringing the action shall have the right to conduct the action.
(e) When a person brings an action under this subsection, no person other than the Attorney General, on behalf of the state, may intervene or bring a related action based on the facts underlying the pending action.
(2) (a) If the Attorney General, on behalf of the state, proceeds with the action, it shall have the primary responsibility for prosecuting the action, and shall not be bound by an act of the person bringing the action. Such person shall have the right to continue as a party to the action, subject to the limitations set forth in paragraph (b).
(b) (i) The state may dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the state of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion.
(ii) The state may settle the action with the defendant notwithstanding the objections of the person initiating the action if the court determines, after a hearing, that the proposed settlement is fair, adequate, and reasonable under all the circumstances. Upon a showing of good cause, such hearing may be held in camera.
(iii) Upon a showing by the state that unrestricted participation during the course of the litigation by the person initiating the action would interfere with or unduly delay the state's prosecution of the case, or would be repetitious, irrelevant, or for purposes of harassment, the court may, in its discretion, impose limitations on the person's participation, such as
1. Limiting the number of witnesses the person may call;
2. Limiting the length of the testimony of such witnesses;
3. Limiting the person's cross-examination of witnesses; or
4. Otherwise limiting the participation by the person in the litigation.
(iv) Upon a showing by the defendant that unrestricted participation during the course of the litigation by the person initiating the action would be for purposes of harassment or would cause the defendant undue burden or unnecessary expense, the court may limit the participation by the person in the litigation.
(c) If the state elects not to proceed with the action, the person who initiated the action shall have the right to conduct the action. If the state so requests, it shall be served with copies of all pleadings filed in the action and shall be supplied with copies of all deposition transcripts (at the state's expense). When a person proceeds with the action, the court, without limiting the status and rights of the person initiating the action, may nevertheless permit the state to intervene at a later date upon a showing of good cause.
(d) Whether or not the state proceeds with the action, upon a showing by the state that certain actions of discovery by the person initiating the action would interfere with the state's investigation or prosecution of a criminal or civil matter arising out of the same facts, the court may stay such discovery for a period of not more than sixty (60) days. Such a showing shall be conducted in camera. The court may extend the sixty-day period upon a further showing in camera that the state has pursued the criminal or civil investigation or proceedings with reasonable diligence and any proposed discovery in the civil action will interfere with the ongoing criminal or civil investigation or proceedings.
(e) Notwithstanding subsection (2), the state may elect to pursue its claim through any alternate remedy available to the state, including any administrative proceeding to determine a civil money penalty. If any such alternate remedy is pursued in another proceeding, the person initiating the action shall have the same rights in such proceeding as such person would have had if the action had continued under this section. Any finding of fact or conclusion of law made in such other proceeding that has become final shall be conclusive on all parties to an action under this section. For purposes of the preceding sentence, a finding or conclusion is final if it has been finally determined on appeal to the appropriate court of competent jurisdiction, if all time for filing such an appeal with respect to the finding or conclusion has expired, or if the finding or conclusion is not subject to judicial review.
(3) (a) If the state proceeds with an action brought by a person under subsection (2), such person shall, subject to the second sentence of this paragraph, receive at least fifteen percent (15%) but not more than twenty-five percent (25%) of the proceeds of the action or settlement of the claim, depending upon the extent to which the person substantially contributed to the prosecution of the action. Where the action is one which the court finds to be based primarily on disclosures of specific information (other than information provided by the person bringing the action) relating to allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, Division of Medicaid, Legislative PEER Commission, State Auditor or Government Accounting Office report, hearing, audit, or investigation, or from the news media, the court may award such sums as it considers appropriate, but in no case more than ten percent (10%) of the proceeds, taking into account the significance of the information and the role of the person bringing the action in advancing the case to litigation. Any payment to a person under the first or second sentence of this paragraph shall be made from the proceeds. Any such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
(b) If the state does not proceed with an action under this section, the person bringing the action or settling the claim shall receive an amount which the court decides is reasonable for collecting the civil penalty and damages. The amount shall be not less than twenty-five percent (25%) and not more than thirty percent (30%) of the proceeds of the action or settlement and shall be paid out of such proceeds. Such person shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.
(c) Whether or not the state proceeds with the action, if the court finds that the action was brought by a person who planned and initiated the violation of this article upon which the action was brought, then the court may, to the extent the court considers appropriate, reduce the share of the proceeds of the action which the person would otherwise receive under paragraph (a) or (b) of this subsection, taking into account the role of that person in advancing the case to litigation and any relevant circumstances pertaining to the violation. If the person bringing the action is convicted of criminal conduct arising from his or her role in the violation of this article, that person shall be dismissed from the civil action and shall not receive any share of the proceeds of the action. Such dismissal shall not prejudice the right of the state or the United States to continue the action, represented by the Attorney General or the Department of Justice, respectively.
(d) If the state does not proceed with the action and the person bringing the action conducts the action, the court may award to the defendant its reasonable attorneys' fees and expenses if the defendant prevails in the action and the court finds that the claim of the person bringing the action was clearly frivolous, clearly vexatious, or brought primarily for purposes of harassment.
(4) (a) (i) No court shall have jurisdiction over an action brought under paragraph (b) against a member of the Legislature, a member of the judiciary, or a senior executive branch official if the action is based on evidence or information known to the state when the action was brought.
(ii) In no event may a person bring an action under subsection (2) which is based upon allegations or transactions which are the subject of a civil suit or an administrative civil money penalty proceeding in which the state is already a party.
(b) (i) No court shall have jurisdiction over an action under this section based upon the public disclosure of allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, Legislative PEER Commission, State Auditor or Government Accounting Office report, hearing, audit, or investigation, or from the news media, unless the action is brought by the Attorney General or the person bringing the action is an original source of the information.
(ii) For purposes of this paragraph, "original source" means an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the government before filing an action under this section which is based on the information.
(5) The state is not liable for expenses which a person incurs in bringing an action under this section.
(6) Any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under this section, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement with the same seniority status such employee would have had but for the discrimination, two (2) times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees. An employee may bring an action in the appropriate state court for the relief provided in this subsection.
SECTION 4. Section 43-13-223, Mississippi Code of 1972, is amended as follows:
43-13-223. (1) An action brought in connection with any matter under this article may be filed in the Circuit Court of the First Judicial District of Hinds County or in the circuit court of the county in which the defendant resides, or in the circuit court of the county in which any portion of the offense occurred, and may be prosecuted to final judgment in satisfaction there.
(2) Process issued by a court in which an action is filed may be served anywhere in the state.
(3) A civil action brought under this article, may not be brought:
(a) More than six (6) years after the date on which the violation of this article is committed, or
(b) More than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but in no event more than ten (10) years after the date on which the violation is committed, whichever occurs last.
(4) The preceding subsection (3) shall not apply to actions, civil or criminal brought by the State of Mississippi.
SECTION 5. The following shall be codified as Section 43-13-126, Mississippi Code of 1972:
43-13-126. As a condition of doing business in the state, health insurers, including 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, are required to:
(a) Provide, with respect to individuals who are eligible for, or are provided, medical assistance under the state plan, upon the request of the Division of Medicaid, information to determine during what period the individual or their spouses or their dependents may be (or may have been) covered by a health insurer and the nature of the coverage that is or was provided by the health insurer (including the name, address and identifying number of the plan) in a manner prescribed by the Secretary of the Department of Health and Human Services;
(b) Accept the Division of Medicaid's right of recovery and the assignment to the division of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the state plan;
(c) Respond to any inquiry by the Division of Medicaid 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
(d) Agree not to deny a claim submitted by the Division of Medicaid 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 documentation at the point-of-sale that is the basis of the claim, if:
(i) The claim is submitted by the division within the three-year period beginning on the date on which the item or service was furnished; and
(ii) Any action by the division to enforce its rights with respect to such claim is commenced within six (6) years of the division's submission of such claim.
SECTION 6. This act shall take effect and be in force from and after July 1, 2007.