| (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 health care items or services are provided and paid
for by Medicaid must send written notice of representation to HHSC.
The written notice must be signed by the attorney or representative
of the recipient and sent according to the provisions of §354.2334
of this subchapter (relating to Notices and Payments). 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 resource 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 resource
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 health care items or services provided to the Medicaid
applicant or recipient for which a third party resource may be liable
for payment, whether or not the claim may have been submitted to or
paid by HHSC; 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 HHSC to carry out
the purpose of this subchapter is protected from further disclosure
by HHSC or its agents under the provisions of the Social Security
Act §1902(a)(7) (codified at 42 U.S.C. §1396a(a)(7)).
(d) HHSC must be paid all amounts owed under this subchapter
prior to placing any proceeds from a third party resource 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 HHSC 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; amended to be effective February 22, 2024, 49 TexReg 855 |
