1
STATE OF OKLAHOMA
2
1st Extraordinary Session of the 54th Legislature (2013)
3
SENATE BILL 4x
By: Bingman and Sykes of the Senate
4 and
5 Shannon of the House
6 7 AS INTRODUCED
8
An Act relating to recovery of payments; repealing 12 O.S. 2011, Section 994.1, which relates to Medicaid recovery; providing for recovery of certain payments; establishing procedures for certain recovery; providing computations; directing determination of recovery amounts; granting certain authority to the Oklahoma Health Care Authority; providing for codification; and declaring an emergency.
9 10 11 12 13 14 15 16 17 18
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: SECTION 1.
REPEALER
12 O.S. 2011, Section 994.1, is
hereby repealed. SECTION 2.
NEW LAW
A new section of law to be codified
19
in the Oklahoma Statutes as Section 994.2 of Title 12, unless there
20
is created a duplication in numbering, reads as follows:
21
A.
Recovery against the party that received payment.
22
1.
General rule.
Medicaid reduces its recovery to take account
23
of the cost of procuring the judgment or settlement, as provided in
24
this section, if:
Req. No. 7
Page 1
1
a.
2
disputed, and
3
b.
4 5
procurement costs are incurred because the claim is
those costs are borne by the party against which the Oklahoma Health Care Authority seeks to recover.
2.
Special rule.
If the Oklahoma Health Care Authority must
6
file suit because the party that received payment opposes the
7
Authority's recovery, the recovery amount is as set forth in
8
subsection E of this section.
9
B.
Recovery against the third-party payer.
If the Oklahoma
10
Health Care Authority seeks recovery from the third-party payer, the
11
recovery amount will be no greater than the amount determined under
12
subsection C, D or E of this section.
13
C.
Medicaid payments are less than the judgment or settlement
14
amount.
15
settlement amount, the recovery is computed as follows:
16 17 18 19 20 21 22 23
1.
If Medicaid payments are less than the judgment or
Determine the ratio of the procurement costs to the total
judgment or settlement payment; 2.
Apply the ratio to the Medicaid payment.
The product is the
Medicaid share of procurement costs; 3.
Subtract the Medicaid share of procurement costs from the
Medicaid payments. D. amount.
The remainder is the Medicaid recovery amount.
Medicaid payments equal or exceed the judgment or settlement If Medicaid payments equal or exceed the judgment or
24
Req. No. 7
Page 2
1
settlement amount, the recovery amount is the total judgment or
2
settlement payment minus the total procurement costs.
3
E.
The Oklahoma Health Care Authority incurs procurement costs
4
because of opposition to its recovery.
5
Authority must bring suit against the party that received payment
6
because that party opposes the Authority's recovery, the recovery
7
amount is the lower of the following:
If the Oklahoma Health Care
8
1.
Medicaid payment; or
9
2.
The total judgment or settlement amount, minus the party's
10 11
total procurement cost. F.
Medicaid recovery worksheet.
The amount to be recovered
12
from the beneficiary is the amount Medicaid paid, less a
13
proportionate share of the costs of procuring the judgment or
14
settlement.
15
The amount to be refunded is determined as follows:
If the Medicaid payment is less than the amount of judgment or
16
settlement:
17
a.
determine the ratio of the Medicaid payments to the total amount of the judgment or settlement,
18 b.
19
apply this ratio to the costs of procuring the judgment or settlement, including attorney fees, and
20 c.
21
subtract the Medicaid share of procurement costs from
22
Medicaid payments.
23
reimbursement to be refunded to the Medicaid Program.
24
The remainder is the amount of
Step 1:
Req. No. 7
Page 3
1
$_________________
2
Medicaid Payment
/
$__________________ = __________________ Judgment/Settlement
3
Carry out 6 digits
4
Step 2:
5
__________________
6
Ratio from Step 1
7
Carry out 6 digits
8
Step 3:
9
$__________________ -
10
X
Medicaid Payment
$__________________ = __________________ Procurement Costs
Medicaid Share of Procurement Costs
$__________________ = __________________ Medicaid Share of
Refund to Medicare
Procurement Costs
11 12
Ratio
G.
If the Medicaid payments equal or exceed the amount of the
13
judgment or settlement, subtract the total procurement costs from
14
the judgment or settlement.
15
reimbursement to be refunded to the Medicaid Program.
16
individual will not be required to refund more than the liability
17
insurance payment minus the procurement costs.
18
$__________________ -
19
Judgment/Settlement
20
H.
The remainder is the amount of
$___________________ Procurement Costs
=
The
$________________ Refund
The Oklahoma Health Care Authority is authorized to seek
21
from the Centers for Medicare and Medicaid Services any waivers or
22
amendments to existing waivers or to amend the state Medicaid plan
23
in order to accomplish the purposes outlined in this section.
24
Req. No. 7
Page 4
1
SECTION 3.
It being immediately necessary for the preservation
2
of the public peace, health and safety, an emergency is hereby
3
declared to exist, by reason whereof this act shall take effect and
4
be in full force from and after its passage and approval.
5 6
54-1EX-7
TEK
8/30/2013 1:37:32 PM
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Req. No. 7
Page 5
