Current through Register Vol. 46, No. 39, September 25, 2024
(a)
(1) When care and services are or may be
provided to an applicant/recipient for treatment of injury, disease or
disability, the State or social services district will take all reasonable
measures to ascertain the legal liability of third parties (including health
insurers) to pay for such care and services.
(2) The social services district, when
determining or redetermining eligibility, must collect sufficient information
to enable the State to pursue claims against such third parties, including all
information specifically required by the department.
(3) As a condition of eligibility, an
applicant/recipient must cooperate with the State or social services district
in identifying third parties who may be liable to pay for care. The
applicant/recipient must provide information to assist the State in pursuing
such third parties. An applicant/recipient may refuse to cooperate only for
good cause.
(4) As a condition of
eligibility, an applicant/recipient with the legal capacity to execute an
assignment, must assign to the State and social services district any rights
against any third party for support (specified as support for medical care by a
court or administrative order) and for payment of medical care. The requirement
extends to any person with the legal authority to execute an assignment on
behalf of an applicant/recipient.
(5) The State or social services district
will seek reimbursement for MA when there is a third party legal liability and
the expected amount of reimbursement is more than the costs of making the
recovery.
(6) Upon furnishing MA to
a recipient, the social services district or the department will be subrogated,
to the extent of the expenditures by such district or the department, to any
rights the recipient may have to medical support or third party reimbursement.
For purposes of this section, the term medical support means the right to
support for purposes of medical care as specified by court or administrative
order. The social services district or the department will issue a written
notice of the exercise of subrogation rights to the appropriate party or
parties.
(b) A recipient
is eligible to receive MA even if he/she has a right of action, suit, claim,
counterclaim or demand against a third party for personal injuries suffered, if
all other eligibility requirements are met. If the social services district
finds that the third party has paid or will pay within a reasonable time, the
district will pay only the amount by which the allowable MA claim exceeds the
third party liability. If payment will not be made within a reasonable time,
the social services district must file a lien covering the cost of such
assistance in accordance with section 104-b of the Social Services Law. The
recipient will be required to assign to the district the proceeds of such right
or demand.
(c) Whenever a social
services district authorizes hospital care for the treatment of recipient's
personal injuries, it must obtain a satisfaction or discharge of any hospital
lien covering such care before or at the time payment to the hospital is made.
The district must file the satisfaction or discharge in accordance with the
Lien Law.
