Texas Human Resources Code

§ 32.0424 — REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS

HR § 32.0424Title 2. HUMAN SERVICES AND PROTECTIVE SERVICES IN GENERAL · Part C. ASSISTANCE PROGRAMS · Ch. 32. MEDICAL ASSISTANCE PROGRAM · Art. B. ADMINISTRATIVE PROVISIONS

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(a)A third-party health insurer shall provide to the commission or the commission's designee, on the commission's or the commission's designee's request, information in a form prescribed by the executive commissioner necessary to determine:

(1)the period during which an individual entitled to medical assistance, the individual's spouse, or the individual's dependents may be, or may have been, covered by coverage issued by the health insurer;

(2)the nature of the coverage; and

(3)the name, address, and identifying number of the health plan under which the person may be, or may have been, covered.

(b)A third-party health insurer shall accept the state's right of recovery and the assignment under Section 32.033 to the state of any right of an individual or other entity to payment from the third-party health insurer for an item or service for which payment was made under the medical assistance program, including a waiver program established under the medical assistance program. (b-1) Except as provided by Subsection (b-2), for an item or service provided to an individual entitled to medical assistance that was previously paid for by the commission or the commission's designee and for which a third-party health insurer is responsible for payment, the third-party health insurer shall accept authorization provided by the commission or the commission's designee that the item or service is covered under the medical assistance program as if that authorization is a prior authorization made by the third-party health insurer for the item or service. (b-2) Subsection (b-1) does not apply to a third-party health insurer with respect to providing:

(1)hospital insurance benefits or supplementary insurance benefits under Part A or B of Title XVIII of the Social Security Act (42 U.S.C. Section 1395c et seq. or 1395j et seq.);

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Legislative history

Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.118, eff. April 2, 2015. Acts 2023, 88th Leg., R.S., Ch. 1098 (S.B. 1342), Sec. 3, eff. September 1, 2023.