Md. Code Regs. 10.09.83.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.83.03 - Recipient Responsibility

A. A recipient shall cooperate with and assist the Department in identifying and providing information concerning third parties who may be liable to pay for care and services received by the recipient under the Program.

B. A recipient is required to assist and cooperate fully with the Department in the Department's efforts to secure the Department's rights in Regulation .02 of this chapter, including but not limited to:

(1) Notifying the Program's Division of Recoveries and Financial Services in writing within 10 days of filing suit or commencing an action against a third party;

(2) Notifying the Program's Division of Recoveries and Financial Services in writing before negotiating or entering a settlement with a third party;

(3) Subject to Regulation .05 of this chapter, paying to the Program within 30 days all funds received from a third party to the extent necessary to satisfy the subrogation rights of the Department;

(4) Disclosing information regarding health insurance or other third party resources when applying for Program benefits;

(5) Notifying providers of health and casualty coverage and other third party resources when requesting medical care;

(6) Notifying the Program of any health insurance obtained after becoming eligible for Medicaid;

(7) Notifying the Program's Division of Recoveries and Financial Services of any casualty or liability insurance that may cover medical treatment received due to an injury; and

(8) Executing and delivering to the Program such documents as reasonably requested by the Program to pursue the Department's subrogation claim.

C. As a condition of medical assistance eligibility, a person who applies for Program benefits shall, at the time of application:

(1) Assign to the Department the applicant's rights of payment for care and services from a third party to the extent the Department has paid for care and services;

(2) Cooperate with and assist the Department in identifying and providing information concerning third parties who may be liable to pay for care and services received by the recipient under the Program; and

(3) Agree to apply for all other available third party resources that may be used to:

(a) Provide or pay for the cost of care or services received by the recipient; or

(b) Finance reimbursement to the State for the cost of care or services received by the recipient.

D. Nothing in this regulation shall require a recipient to file a civil or other action for the purpose of reimbursing the State for the cost of care or services. If a recipient fails or refuses to commence a civil or other action to enforce the legal liability of a third party, the Department may commence an independent action, after notice to the recipient, to recover all medical costs to which the Department is entitled. In any such action by the Department, the recipient in interest may be joined as a party.

E. Failure of the applicant or recipient to cooperate with the Program to secure the Department's rights to subrogation and assignment may result in the denial or termination of the recipient's Program eligibility. Recipients terminated under this regulation shall be notified in writing of the proposed Program action and afforded the opportunity for a fair hearing under COMAR 10.01.04.

Md. Code Regs. 10.09.83.03

Effective date: 40:12 Md. R. 1042, eff.6/24/2013