Effective July 1, 2013, insurers shall take reasonable
steps to discover whether the Department of Vermont Health Access has paid
medical bills associated with workers’ compensation claims. 33 V.S.A. §1910 (b)(2).
The legislation provides that the State of Vermont Human Service Agency has a
lien against the insurer for monies paid for medical expenses on behalf of a
person who has an injury, illness or disease and the person initiates a claim
against an insurer for that injury, illness or disease. Additionally the
legislation provides that “Payment to the recipient instead of the agency does
not discharge the insurer from payment of the agency’s claim.” 33 V.S.A. §1910
(b)(2).
The statute is:
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=33&Chapter=019&Section=01910
The Department of Vermont Health Access has written a
memorandum on the insurer procedure for determining the existence of Medicaid
Liens.
Most importantly
the Department has noted that “the claim file should
contain documentation (electronic, recorded language, typed or
handwritten) to support the insurer's actions.”
The procedure sets forth that reasonable
steps to determine the existence of such a lien include: (1) Asking the
claimant or claimant’s representative at the beginning of the process by
telephone, letter or electronic mail if he or she was a Medicaid recipient at
the time of the injury.
If the answer is
yes then the insurer should contact the Department of Vermont Health Access and
refrain from payment until the lien is determined.
If the answer is no then the insurer must
continue to review bills to determine if there is evidence that the Department
of Vermont Health Access has paid bills on the claimant’s behalf and if so the
insurer should determine the amount of the lien.
If not the insurer may proceed to resolve the
claim; (2) An insurer may contact the Department of Vermont Health Access at
any time to determine if a lien exists by contacting
the Department at:
DVHATPLTeam@state.vt.us;
by telephone at 802-879-5646; or by fax at 802-879-5959. The memorandum indicates that the insurer should
document the claim files as to when and who was contacted at DVHA. The memorandum concludes that if a lien
exists the insurer must ensure reimbursement out of settlement proceeds by the
claimant, the claimant’s representative, the insurer, or by naming Department
of Vermont Health Access on monies paid to the claimant. Then the claim may be closed and
documentation of these actions protects the insurer from claims of bad faith or
duplicate payment to the Department or the claimant.
The outreach document prepared by the Department of
Vermont Health Access is located here:
http://dvha.vermont.gov/budget-legislative/insurer-procedure-medicaid-liens.pdf
