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.

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.