249A.37 - HEALTH CARE INFORMATION SHARING.
249A.37 HEALTH CARE INFORMATION SHARING.
1. As a condition of doing business in the state, health insurers
including self-insured plans, group health plans as defined in the
federal Employee Retirement Income Security Act of 1974, Pub. L. No.
93-406, service benefit plans, managed care organizations, pharmacy
benefits managers, and other parties that are, by statute, contract,
or agreement, legally responsible for payment of a claim for a health
care item or service, shall do all of the following:
a. Provide, with respect to individuals who are eligible for
or are provided medical assistance under the state's medical
assistance state plan, upon the request of the state, information to
determine during what period the individual or the individual's
spouse or dependents may be or may have been covered by a health
insurer and the nature of the coverage that is or was provided by the
health insurer, including the name, address, and identifying number
of the plan, in accordance with section 505.25, in a manner
prescribed by the department of human services or as agreed upon by
the department and the entity specified in this section.
b. Accept the state's right of recovery and the assignment to
the state 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 medical assistance state plan.
c. Respond to any inquiry by the state 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.
d. Agree not to deny any claim submitted by the state solely
on the basis of the date of submission of the claim, the type or
format of the claim form, or a failure to present proper
documentation at the point-of-sale that is the basis of the claim, if
all of the following conditions are met:
(1) The claim is submitted to the entity by the state within the
three-year period beginning on the date on which the item or service
was furnished.
(2) Any action by the state to enforce its rights with respect to
such claim is commenced within six years of the date that the claim
was submitted by the state.
2. The department of human services may adopt rules pursuant to
chapter 17A as necessary to implement this section. Rules governing
the exchange of information under this section shall be consistent
with all laws, regulations, and rules relating to the confidentiality
or privacy of personal information or medical records, including but
not limited to the federal Health Insurance Portability and
Accountability Act of 1996, Pub. L. No. 104-191, and regulations
promulgated in accordance with that Act and published in 45 C.F.R.
pts. 160--164. Section History: Recent Form
2008 Acts, ch 1187, §124