                                 CODE OF VIRGINIA

DEPARTMENT IS PAYOR OF LAST RESORT (§ 32.1-325.2)

A. Insurers, including group health plans as defined in &#xA7; 607(1) of the
Employee Retirement Income Security Act of 1974, self-insured plans, health
services plans, service benefit plans, health maintenance organizations, managed
care organizations, pharmacy benefits managers, or other parties that are, by
statute, contract, or agreement legally responsible for payment of a claim for a
health care item or service, are prohibited from including any clause in health
care contracts which would exclude enrolling an individual or in making any
payment for benefits to the individual or on the individual&#8217;s behalf for
health care when the individual is eligible for medical assistance.

B. The Department of Medical Assistance Services shall be the payor of last
resort to any insurer, including a group health plan as defined in &#xA7; 607(1)
of the Employee Retirement Income Security Act of 1974, a self-insured plan, a
health services plan, a service benefit plan, a health maintenance organization,
a managed care organization, a pharmacy benefits manager, or other party that
is, by statute, contract, or agreement legally responsible for payment of a
claim for a health care item or service for persons eligible for medical
assistance in the Commonwealth. The above entities, as a condition of doing
business in the Commonwealth, shall comply with the requirements set forth in 42
U.S.C. 1396a (a) (25) (I) (i)-(iv).

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

D. To the extent the Department of Medical Assistance Services is permitted by
law to obtain recoveries from third parties, actions at law for such recoveries
shall be decided under the same laws, rules and standards including applicable
bases of liability and defenses as would apply if the individual receiving the
services had brought the action directly; provided that nothing herein shall
affect the sovereign immunity of the Commonwealth.

E. The term &#8220;insurer&#8221; as used herein shall be deemed to include
without limitation &#8220;insurance carriers.&#8221;

HISTORY: 1986, c. 550; 1994, c. 213; 1996, c. 851; 2007, c. 535.