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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER JMEDICAID THIRD PARTY RECOVERY
DIVISION 2APPLICANT AND RECIPIENT REQUIREMENTS
RULE §354.2315Duty of Attorney or Representative of a Recipient

(a) An attorney or other person who represents or acts on behalf of a recipient in a third party claim or action for damages for personal injuries, regardless of whether a legal action has been filed, for which medical services are provided and paid for by Medicaid must send written notice of representation to the Commission. The written notice must be signed by the attorney or representative of the recipient and sent to the address listed in Subchapter J Division 4 §354.2334 of this chapter for notices and Commission contact. The written notice must be submitted within 45 days from the date the attorney or representative undertakes representation of the recipient, or from the date a potential third party is identified. The written notice must include the following information, if known at the time of initial filing:

  (1) the name and address and identifying information of the recipient (either the date of birth and the Social Security number, or the date of birth and the Medicaid identification number);

  (2) the name and address of any third party or third party health insurer against whom a third party claim is or may be asserted for injuries to the Medicaid applicant or recipient;

  (3) the name and address of any health care provider who has asserted a claim for payment provided to the Medicaid applicant or recipient for medical services provided to the Medicaid applicant or recipient for which a third party may be liable for payment, whether or not the claim may have been submitted to or paid by the Commission; and

  (4) if any of the information described in subsection (a) of this section is unknown at the time the initial notice is filed, this should be indicated on the notice, and revised if and when the information becomes known.

(b) An authorization to release information relating to the recipient directly to the attorney or representative may be included as a part of the notice and must be signed by the recipient. A notice containing an authorization for release of information will be considered valid until revoked in writing by the recipient, and no separate authorization will be required of the recipient or the attorney or the representative at the time of a request for information.

(c) Any settlement, trust, judgment, order or distribution of proceeds which is required to be disclosed to the Commission to carry out the purpose of this chapter is protected from further disclosure by the Commission or its agents under the provisions of the Social Security Act, §1902(a)(7) (codified at 42 U.S.C 1396a(a)(7)), relating to restrictions on information disclosure).

(d) The Commission must be paid all amounts owed under this chapter prior to placing any proceeds from a third party into a trust created under the provisions of the Social Security Act §1917(d)(4) (codified at 42 U.S.C 1396p(d)(4)), unless the Commission agrees otherwise.


Source Note: The provisions of this §354.2315 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

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