SB 809 Summary

• MO HealthNet is designated as payer of last resort and may recover payments made on behalf of participants from liable third parties, with recovery limited to actual MO HealthNet benefits provided.

• Health benefit plans, third party administrators, administrative service organizations, and pharmacy benefits managers must process and pay properly submitted subrogation claims within three years of service date, regardless of other filing requirements or claim format issues.

• State may enforce collection rights within six years of claim submission against persons, corporations, or agencies liable to participants for injuries, disease, disability, or health insurance benefits.

• Participants must promptly notify MO HealthNet division when pursuing legal action against third parties and must repay benefits from third-party recovery within 60 days or place funds in trust pending determination of the division's rights.

• Court may reduce the state's lien proportionate to recovery, considering factors including injury severity, costs incurred, attorney fees, settlement amounts, and participant's ability to repay; department may compromise claims if recovery is not cost-effective.