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CMS Issues Guidance for States on Medicaid Third-Party Liability Requirements

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The Centers for Medicare & Medicaid Services has issued guidance for states on two new Medicaid third-party liability requirements. The guidance is based on requirements reflected in the Consolidated Appropriations Act of 2022 and from the U.S. Supreme Court ruling in Gallardo v. Marstiller

The first new provision increases state flexibility with respect to third-party liability. It requires states to have laws in effect that bar liable third-party payers from refusing payment for an item or service solely on the basis that an item or service did not receive prior authorization under the third-party payer’s rules.  

The second change in third-party liability requirements permits a state to create a lien over injury settlement proceeds attributable to future medical expenses.