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Version 00 · Introduced in House · Feb 7, 2017
Medicaid Third Party Liability Act
This bill alters provisions related to third-party liability for medical assistance paid under the Medicaid program. Specifically, with respect to such liability, the bill:
expands the definition of "responsible third party" to include, among other health insurers, the TRICARE program;
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eliminates special rules with respect to certain services provided to children;
requires the inclusion, in a contract between a state Medicaid program and a health insurer, of certain information regarding whether the state is delegating or transferring to the insurer a right of third-party recovery;
provides for the treatment as overpayment of reimbursements made by a responsible third party to a health insurer;
disallows a responsible third party from denying a state's claim solely on the basis of a failure to obtain a prior authorization;
imposes a timeline for a responsible third party to respond to a state's inquiry regarding a claim for payment;
provides for reductions to a state Medicaid program's federal matching rate if the state fails to comply with third-party insurance requirements; and
modifies other provisions related to third-party liability under the Medicaid program.
Third-party liability requirements applicable under Medicaid shall also apply under the Children's Health Insurance Program (CHIP).
The Centers for Medicare & Medicaid Services must:
publish on its website, and annually update, best practices for assessing third-party liability;
monitor and analyze efforts to assess that liability;
in consultation with states, develop and make available a model uniform reporting field for identifying information related to responsible third parties; and
provide other specified information and guidance to states.
People & committees
Rep. Burgess, Michael C. [R-TX-26] · R–TX
Legislative record
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Referred to the Subcommittee on Health.
Referred to the House Committee on Energy and Commerce.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We currently store references to these documents.
Source last updated: Dec 5, 2025. Consult Congress.gov for the current record.
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