Section 17-1705-38 - Medical payment involving third party(a) The liability of a third party shall be treated as a resource applicable to the cost of needed medical services when: (1) It has been verified that a legal obligation actually exists; and(2) The amount of the obligation may be determined within thirty days from the time of the recipient's need for medical care.(b) No Medicaid payment shall be made under a refund plan for that portion of cost for which a third party has been determined to be liable and reimbursement is forthcoming.(c) If a liability by an identified third party exists, the recipient shall be required to satisfy all conditions set forth by that third party to receive coverage, to the extent coverage is available through that third party, before Medicaid payment is allowed.(d) When the existence or extent of third party liability is in question, medical assistance payments may be made in: (1) Part, if the recipient has excess income and other assets; or(2) Whole, if the recipient accepts, in writing, an assignment of the recipient's third party payment to refund the department. However, when third party policy prohibits assignment of payment, the recipient, in writing, shall agree to refund the department or health plan upon being paid.
(e) After a claim is paid or medical services are rendered, if the department or health plan learns of the existence of a liable third party, the department or health plan shall seek reimbursement from the third party within thirty days after the end of the month it learned of the existence of the liable third party.(f) The department or health plan shall suspend or terminate an effort to seek reimbursement from a liable third party if it determines that the effort would not be cost effective because the amount it reasonably expects to recover will be less than the cost of recovery.(g) The department or health plan shall accumulate billings with respect to a liable third party when making a decision whether to seek recovery. When the accumulated amount is $500 or more, the department or health plan shall seek recovery.Haw. Code R. § 17-1705-38
[Eff 08/01/94; am 11/25/96; am 04/11/03; am 02/07/05 ] Auth: HRS §§ 346-14, 346-37) (Imp: HRS § 346-37; 42 C.F.R. §433.139 )