2006 Code of Virginia § 32.1-325.2 - Department is payor of last resort

32.1-325.2. Department is payor of last resort.

A. Insurers, including group health plans as defined in 607(1) of theEmployee Retirement Income Security Act of 1974, health services plans,service benefit plans and health maintenance organizations, are prohibitedfrom including any clause in health care contracts which would excludeenrolling an individual or in making any payment for benefits to theindividual or on the individual's behalf for health care when the individualis eligible for medical assistance.

B. The Department of Medical Assistance Services shall be the payor of lastresort to any insurer, including a group health plan as defined in 607(1)of the Employee Retirement Income Security Act of 1974, a health servicesplan, a service benefit plan and a health maintenance organization, whichcontracts to pay health care costs for persons eligible for medicalassistance in the Commonwealth.

C. To the extent the Department of Medical Assistance Services has madepayment for medical services where a third party has a legal obligation tomake payment for such services, the Commonwealth shall automatically acquireall rights to such payment from the third party.

D. To the extent the Department of Medical Assistance Services is permittedby law to obtain recoveries from third parties, actions at law for suchrecoveries shall be decided under the same laws, rules and standardsincluding applicable bases of liability and defenses as would apply if theindividual receiving the services had brought the action directly; providedthat nothing herein shall affect the sovereign immunity of the Commonwealth.

E. The term "insurer" as used herein shall be deemed to include withoutlimitation "insurance carriers."

(1986, c. 550; 1994, c. 213; 1996, c. 851.)