Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 2 - APPLICANT AND RECIPIENT REQUIREMENTS
Section 354.2315 - Duty of Attorney or Representative of a Recipient

Universal Citation: 1 TX Admin Code § 354.2315

Current through Reg. 49, No. 38; September 20, 2024

(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.

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