Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since October 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


R527. Human Services, Recovery Services.

Rule R527-936. Third Party Liability, Medicaid.

As in effect on October 1, 2019

Table of Contents

R527-936-1. Definition and Purpose.

A third party is an individual, institution, corporation, public or private agency, trust, estate, insurance carrier, employee welfare benefit plan, health maintenance organization, health service organization, preferred provider organization, governmental program such as Medicare, CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the medical costs of injury, disease, or disability of a recipient, and a spouse or a parent who:

(i) may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order; or

(ii) has been ordered to maintain health, dental, or disability insurance to cover medical expenses of a spouse or dependent child by court or administrative order. The Utah Third Party Liability Program has been established to assure that all private medical resources have been exhausted before a claim is paid by Medicaid; or that when the agency discovers a liable third party after payment of a claim, reimbursement is sought.

The Utah Third Party Liability Program has been established to assure that all private medical resources have been exhausted before a claim is paid by Medicaid; or that when the agency discovers a liable third party after payment of a claim, reimbursement is sought.

R527-936-2. Authority.

Federal Regulations 42 CFR 433.135 through 433.154(1995) require the state agency to establish and administer a Third Party Liability Program, and specify the requirements for a state plan concerning Third Party Liability. The office adopts these sections and incorporates them by reference. Sections 26-19-1 through 26-19-19 authorize a Third Party Liability Medicaid Recovery Program and establish the legal liabilities of third parties and recipients.

R527-936-3. Assignment of Benefits.

Federal regulations 42 CFR 433.145 and 433.146 specify the applicant/recipient responsibility to assign their rights to third party payments as a condition of eligibility.

R527-936-4. Cooperation as a Condition of Eligibility.

The applicant/recipient must cooperate in establishing paternity and obtaining medical support and other third party payments as specified in 42 CFR 433.147. Office of Recovery Services will initiate sanctions for non-cooperation in accordance with the Federal regulations and state procedures.

R527-936-5. Payor of Last Resort.

Medicaid shall be the payor of last resort as specified in 42 CFR 433.138, 42 CFR 433.139, and Subsection 26-18-10(4).

KEY

medicaid, debt

Date of Enactment or Last Substantive Amendment

August 3, 2001

Notice of Continuation

November 3, 2015

Authorizing, Implemented, or Interpreted Law

26-19-1 through 19; 26-18-8; 26-18-10(4)


Additional Information

Contact

For questions regarding the content or application of rules under Title R527, please contact the promulgating agency (Human Services, Recovery Services). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.