Medicaid Compliance

State Medicaid programs have taken note of Mandatory Insurer Reporting required by Medicare. Rhode Island was the first state to require data reporting to help it identify Third Party Liability (TPL) payments from those responsible for workers’ compensation and liability claims.

The Medicaid Assistance Intercept System (MAIS) was authorized under state statute on July 1, 2012 (P.L. 2012, Ch. 241) and operational on October 15, 2012. Other States are planning to enhance TPL recovery processes, because of the Federal Government. At the end of 2013, both political parties reached a compromise on the Budget that included a mandate to the States to improve TPL recoveries. Included in the Budget deal were changes to the Medicaid law to provide Medicare-like powers to demand full reimbursement for medical services paid related to a claim. The new law was to take effect October 1, 2014, but was extended 2 years by H.R. 3402. Several states are currently penning new legislation to meet this law. This means that, more than likely, data exchanges with claims processors and the state governments will take place across the country.

Franco Signor is taking a lead in monitoring state law development of Medicaid MIR. We have in place reporting services to meet any State requirements as such laws come on line. Today, we offer such reporting services for the MAIS Rhode Island program and also offer services to identify and dispute TPL reimbursement claims of any state for our clients.

Medicaid Secondary Payer Compliance

State Medicaid programs have taken note of Mandatory Insurer Reporting required by Medicare. Rhode Island was the first state to require data reporting to help it identify Third Party Liability (TPL) payments from those responsible for workers’ compensation and liability claims.

The Medicaid Assistance Intercept System (MAIS) was authorized under state statute on July 1, 2012 (P.L. 2012, Ch. 241) and operational on October 15, 2012. Other States are planning to enhance TPL recovery processes, because of the Federal Government. At the end of 2013, both political parties reached a compromise on the Budget that included a mandate to the States to improve TPL recoveries. Included in the Budget deal were changes to the Medicaid law to provide Medicare-like powers to demand full reimbursement for medical services paid related to a claim. The new law was to take effect October 1, 2014, but was extended 2 years by H.R. 3402. Several states are currently penning new legislation to meet this law. This means that, more than likely, data exchanges with claims processors and the state governments will take place across the country.

Franco Signor is taking a lead in monitoring state law development of Medicaid MIR. We have in place reporting services to meet any State requirements as such laws come on line. Today, we offer such reporting services for the MAIS Rhode Island program and also offer services to identify and dispute TPL reimbursement claims of any state for our clients.

Rhode Island MAIS Reporting

On July 1, 2012, Rhode Island made changes to Article 11 of the FY13 Budget law (P.L. 2012, Ch. 241), which created a Medical Assistance (Medicaid) Insurance Intercept reporting requirement. The effective date of the regulations to implement this law is September 4, 2012.All insurance companies who do business in the State of Rhode Island are required to participate with the MAIS Program.

MAIS requires a data exchange between insurance companies (including self-insurance) that do business in Rhode Island to identify Third Party Liability (TPL) situations involving liability and workers’ compensation insurance claims. Medicaid recipients, as a condition of benefits, assign their reimbursement rights automatically to Rhode Island. Insurance companies must check the data base before settling a loss to determine if a claimant is a Medicaid recipient, and if so, to hold settlement until the TPL issues between the State and Medicaid recipient are resolved. MAIS is designed to intercept payments of $500 or more for reimbursement to the State of Rhode Island’s Medicaid Program.

Medicaid.gov is a valuable resource for state by state policies.

 

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For more information about this service, engage us today at: engage@francosignor.com

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