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AN ACT

RELATING TO PUBLIC ASSISTANCE; PROVIDING A STATUTE OF

LIMITATIONS ON THIRD PARTY LIABILITY CLAIMS; AMENDING A

SECTION OF THE NMSA 1978.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. Section 27-2-23 NMSA 1978 (being Laws 1969,

Chapter 232, Section 1) is amended to read:

"27-2-23. THIRD PARTY LIABILITY.--

A. The income support division of the department

shall make reasonable efforts to ascertain any legal liability

of third parties who are or may be liable to pay all or part

of the medical cost of injury, disease or disability of an

applicant for or recipient of medical assistance pursuant to

the provisions of Chapter 27 NMSA 1978.

B. When the department makes medical assistance

payments on behalf of a recipient, the department is

subrogated to any right of the recipient against a third party

for recovery of medical expenses to the extent that the

department has made payment.

C. Health insurers, including self-insured plans,

group health plans, 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

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service, as a condition of doing business with New Mexico,

shall:

(1) provide, with respect to individuals who

are eligible for or are provided medical assistance under the

medicaid program, upon the request of the state, information

to determine during what period the individual, the

individual's spouse or the individual's dependents may be, or

may have been, covered by a health insurer and the nature of

the coverage provided by the health insurer, including the

name, address and identifying number of the plan;

(2) accept New Mexico's right of recovery

and the assignment to New Mexico 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 medicaid

program;

(3) respond to any inquiry by New Mexico

regarding a claim for payment for any health care item or

service that is submitted no later than three years after the

date of the provision of such health care item or service; and

(4) agree not to deny a claim submitted by

New Mexico solely on the basis of the date of submission of

the claim by the provider, the type of the claim form or a

failure to present proper documentation at the point-of-sale

that is the basis of the claim, if:

(a) the claim is submitted by New

Mexico within the three-year period beginning on the date on

which the item or service was furnished; and

(b) any action by New Mexico to enforce

its rights with respect to such claim is commenced within six

years of New Mexico's submission of such claim.

D. Nothing in this section shall be construed to

preclude the application of common law principles in

determining equitable reimbursement from any third-party

source for New Mexico or a health insurer, including self-

insured plans, group health plans, service benefit plans,

managed care organizations, pharmacy benefit managers or other

parties."

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