| (a) HHSC will distribute third party recoveries, if
cost effective, as follows:
(1) HHSC will receive an amount equal to HHSC's total
Medicaid expenditures for the recipient, or another individual eligible
for Medicaid benefits under the State Plan for whom he or she can
legally make an assignment to medical support and payment;
(2) the federal government will receive the federal
share of the Medicaid expenditures, minus any incentive payment authorized
by federal law; and
(3) the recipient will receive any remaining amount
and any amount distributed to the recipient is income or resources
for purposes of establishing eligibility for Medicaid benefits.
(b) HHSC may pay reasonable and necessary attorney
fees of fifteen percent (15%) of the entire amount recovered on behalf
of HHSC, and reasonable expenses, to a person authorized to recover
amounts from third party resources, other than a person contracted
by HHSC to recover on behalf of HHSC, if the recovery is made in compliance
with these rules.
(c) HHSC may pay prorated expenses not to exceed ten
percent (10%) of the entire amount recovered on behalf of HHSC if
attorney fees are allowed under subsection (b) of this section.
(d) No attorney fees will be paid if the recovery made
on behalf of the Medicaid program is waived in whole or in part by
the Executive Commissioner under the provisions of §354.2333
of this division (relating to Waiver Authority of the Executive Commissioner).
(e) The amount recovered on behalf of HHSC, for which
attorney fees are authorized under this section, must be deducted
from the total amount of the recovery before attorney fees and expenses
are deducted under the terms of the recipient's contract.
(f) HHSC may pay reasonable and necessary attorney
fees and expenses to a person contracted by HHSC to recover amounts
from third party resources on behalf of the Medicaid program.
|
| Source Note: The provisions of this §354.2332 adopted to be effective April 30, 1999, 24 TexReg 3083; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4562; amended to be effective March 28, 2004, 29 TexReg 2867; amended to be effective February 22, 2024, 49 TexReg 855 |
