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 4 - DUTIES OF THE COMMISSION
Section 354.2331 - Requests for Information

Universal Citation: 1 TX Admin Code ยง 354.2331

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

(a) HHSC will provide assistance and cooperation to recipients, attorneys and representatives of recipients who seek recovery on behalf of HHSC for amounts owed to HHSC under this subchapter. HHSC will provide information, evidence and documents required to settle and receive judgment for the amounts owed HHSC and provide appropriate and necessary releases and authorizations to settle and distribute amounts owed to HHSC under this subchapter.

(b) HHSC is required to safeguard the best interests of the recipient under the provisions of Social Security Act §1902(a)(19) (codified at 42 U.S.C. § 1396a(a)(19)).

(c) HHSC is required to provide safeguards which restrict the use and disclosure of information concerning applicants and recipients to purposes directly connected with the administration of the Medicaid program under the provisions of Social Security Act §1902(a)(7) (codified at 42 U.S.C. § 1396a(a)(7)).

(d) Requests for information relating to third party recoveries under this subchapter must fall within the requirements of subsections (a) and (b) of this section.

(e) A recipient or an attorney or representative of a recipient may request information relating to claims submitted or paid or payable by HHSC, and records within the custody and control of HHSC, as they relate to this subchapter if:

(1) the request is signed by the recipient or a person with legal authority to act on behalf of the recipient; or

(2) the attorney or representative making the request has filed a notice which complies with the requirements of § 354.2315 of this subchapter (relating to Duty of Attorney or Representative of a Recipient).

(f) HHSC will respond to all requests for information within 10 business days from receipt of the request. HHSC will produce records and provide information to a person making a request under this section only if all requirements of this subsection are met. HHSC will provide the requested information, if all requirements of this subsection are met, within 15 business days from receipt of the request.

(g) HHSC has no duty to produce records or to provide information, which does not meet the requirements of this subsection, or which would disclose information which HHSC is prohibited from disclosing by state or federal law.

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