House Bill 6231 Summary

• Amends the health care coverage information sharing law (2006 PA 593) to require entities providing health coverage to share monthly information with the Department of Community Health to identify individuals who are both health coverage recipients and medical assistance (Medicaid) recipients.

• Requires health entities to respond to department inquiries about health coverage verification and to pay the department or assign recovery rights for covered health claims where medical assistance payments have been made within 180 days of request.

• Prohibits health entities from denying claims submitted by the department based solely on submission date, submission method, claim form type, or missing documentation if the claim is submitted within 3 years of service and state enforcement action is commenced within 6 years.

• Prohibits health entities from denying claims for which medical assistance payment was made solely because prior authorization was not received; entities must adjudicate such claims as if prior authorization had been requested.

• Allows the Department of Community Health to share information about health coverage recipients who are child support order dependents with the Department of Human Services to update child support databases; increases administrative fines for violations from $500 to $750 per day of noncompliance.