36-2946. Coordination of benefits; third party
payments
A. The administration shall coordinate benefits provided under this article to a
member so that any costs for services payable by the system are costs avoided or
recovered from any available third party payor. The administration may require that the
program contractors are responsible for the coordination of benefits provided pursuant to
this article. The system shall act as a payor of last resort for members unless
specifically prohibited by federal law. The director shall require members to assign to
the system rights to all types of medical benefits to which the member is entitled,
including first party medical benefits under automobile insurance policies. This state
has a right to subrogation against any other person to enforce the assignment of medical
benefits. The provisions of this subsection are controlling over the provisions of an
insurance policy which provides benefits to a member if the policy is inconsistent with
the provisions of this subsection. The administration shall monitor third party payments
collected by providers and noncontracting providers. For purposes of this section,
benefits from third party payors do not include monies available under the older
Americans act of 1965, a social services block grant or an optional state supplemental
payment program if federal monies are available for home and community based services
pursuant to section 36-2939, subsection D.
B. Notwithstanding subsection A of this section, beginning on the first day of the
first calendar quarter following the adjournment of the first regular session of the
fortieth legislature and in accordance with section 4402 of the omnibus budget
reconciliation act of 1990, if the administration determines that according to federal
guidelines it is more cost effective for a person defined as eligible under section
36-2934 to be enrolled in a group health insurance plan in which the person is entitled
to be enrolled, the administration shall pay all of that person's premiums, deductibles,
coinsurance and other cost sharing obligations for services covered under section
36-2934. The person shall apply for enrollment in the group health insurance plan as a
condition of eligibility under section 36-2934.
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