[Federal Register Volume 62, Number 82 (Tuesday, April 29, 1997)]
[Rules and Regulations]
[Page 23140]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-11023]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 433
[MB-112-F]
Medicaid Program; Third Party Liability (TPL) Cost-Effectiveness
Waivers
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correcting amendment.
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SUMMARY: This document makes technical corrections to final regulations
published on July 10, 1995, at 60 FR 35498, concerning Medicaid
agencies' actions where third party liability (TPL) may exist for
expenditures for medical assistance covered under the State plan.
EFFECTIVE DATE: These amendments are effective as of September 8, 1995,
the effective date of the final rule that contained the errors.
FOR FURTHER INFORMATION CONTACT: Deborah Helms, (410) 786-7132.
SUPPLEMENTARY INFORMATION: Final regulations published on July 10,
1995, at 60 FR 35498 amended 42 CFR part 433 to revise Medicaid
regulations concerning Medicaid agencies' actions where third party
liability (TPL) may exist for expenditures for medical assistance
covered under the State plan. The regulations allow Medicaid agencies
to request waivers from certain procedures in regulations that are not
expressly required by the Social Security Act. In the regulations, we
unintentionally deleted the entire text of Sec. 433.139(b)(3) through
an error in our amendatory language and presentation of the CFR text.
Consequently, we need to restore the deleted text in
Sec. 433.139(b)(3). This document corrects the error by amending
Sec. 433.139, to reinstate the deleted language.
List of Subjects in 42 CFR Part 433
Administrative practice and procedure, Claims, Grant programs--
health, Medicaid, Reporting and recordkeeping requirements.
42 CFR Part 433 is corrected by making the following correcting
amendments:
PART 433--STATE FISCAL ADMINISTRATION
1. The authority citation for Part 433 continues to read as
follows:
Authority: Secs. 1102, 1137, 1902(a)(4), 1902(a)(18),
1902(a)(25), 1902(a)(45), 1902(t), 1903(a)(3), 1903(d)(2),
1903(d)(5), 1903(o), 1903(p), 1903(r), 1903(w), 1912, and 1919(e) of
the Social Security Act (42 U.S.C. 1302, 1320b-7, 1396a(a)(4),
1396a(a)(18), 1396a(a)(25), 1396a(a)(45), 1396a(t), 1396b(a)(3),
1396b(d)(2), 1396a(d)(5), 1396b(i), 1396b(o), 1396b(p), 1396b(r),
1396b(w), and 1396k.
2. Section 433.139 is amended by adding paragraph (b)(3) to read as
follows:
Sec. 433.139 Payment of claims.
* * * * *
(b) Probable liability is established at the time claim is filed. *
* *
(3) The agency must pay the full amount allowed under the agency's
payment schedule for the claim and seek reimbursement from any liable
third party to the limit of legal liability (and for purposes of
paragraph (b)(3)(ii) of this section, from a third party, if the third
party liability is derived from an absent parent whose obligation to
pay support is being enforced by the State title IV-D agency),
consistent with paragraph (f) of this section if--
(i) The claim is prenatal care for pregnant women, or preventive
pediatric services (including early and periodic screening, diagnosis
and treatment services provided for under part 441, subpart B of this
chapter), that is covered under the State plan; or
(ii) The claim is for a service covered under the State plan that
is provided to an individual on whose behalf child support enforcement
is being carried out by the State title IV-D agency. The agency prior
to making any payment under this section must assure that the following
requirements are met:
(A) The State plan specifies whether or not providers are required
to bill the third party.
(B) The provider certifies that before billing Medicaid, if the
provider has billed a third party, the provider has waited 30 days from
the date of the service and has not received payment from the third
party.
(C) The State plan specifies the method used in determining the
provider's compliance with the billing requirements.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Programs)
Dated: April 17, 1997.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 97-11023 Filed 4-28-97; 8:45 am]
BILLING CODE 4120-01-P
