Section 17-1739.1-14 - Medical payment involving third party liability(a) The liability of a third party for the cost of the medical services shall be treated as a resource applicable to the cost of needed medical services when: (1) It has been verified that a legal obligation actually exists; and(2) The amount of the obligation may be determined within thirty days from the time of the recipient's need for medical care.(b) No Medicaid payment may be made under a refund plan for that portion of cost for which a third party has been determined to be liable and reimbursement is forthcoming. An exception is Medicaid's agreement with Medicare on durable medical equipment processing.(c) If a liability by an identified third party exists, the recipient shall be required to satisfy all conditions set forth by that third party to receive third party coverage, to the extent coverage is available, before Medicaid payment is allowed.(d) When the existence or extent of third party liability is in question, medical assistance payments may be made: (1) In part, if the recipient has excess income and other assets; or(2) For the entire cost of the medical services, if the recipient assigns to the department in writing, the third party payment; provided that where third party policy prohibits assignment of payment, the recipient shall, in writing, agree to refund the department upon being paid by the third party.Haw. Code R. § 17-1739.1-14
[Eff 10/26/01; am 02/07/05] (Auth: HRS § 346-59) (Imp: 42 C.F.R. §§433.135 through 433.154, 447.20 )