[Federal Register Volume 62, Number 82 (Tuesday, April 29, 1997)]
[Rules and Regulations]
[Page 23140]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-11023]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 433

[MB-112-F]


Medicaid Program; Third Party Liability (TPL) Cost-Effectiveness 
Waivers

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Correcting amendment.

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SUMMARY: This document makes technical corrections to final regulations 
published on July 10, 1995, at 60 FR 35498, concerning Medicaid 
agencies' actions where third party liability (TPL) may exist for 
expenditures for medical assistance covered under the State plan.

EFFECTIVE DATE: These amendments are effective as of September 8, 1995, 
the effective date of the final rule that contained the errors.

FOR FURTHER INFORMATION CONTACT: Deborah Helms, (410) 786-7132.

SUPPLEMENTARY INFORMATION: Final regulations published on July 10, 
1995, at 60 FR 35498 amended 42 CFR part 433 to revise Medicaid 
regulations concerning Medicaid agencies' actions where third party 
liability (TPL) may exist for expenditures for medical assistance 
covered under the State plan. The regulations allow Medicaid agencies 
to request waivers from certain procedures in regulations that are not 
expressly required by the Social Security Act. In the regulations, we 
unintentionally deleted the entire text of Sec. 433.139(b)(3) through 
an error in our amendatory language and presentation of the CFR text. 
Consequently, we need to restore the deleted text in 
Sec. 433.139(b)(3). This document corrects the error by amending 
Sec. 433.139, to reinstate the deleted language.

List of Subjects in 42 CFR Part 433

    Administrative practice and procedure, Claims, Grant programs--
health, Medicaid, Reporting and recordkeeping requirements.

    42 CFR Part 433 is corrected by making the following correcting 
amendments:

PART 433--STATE FISCAL ADMINISTRATION

    1. The authority citation for Part 433 continues to read as 
follows:

    Authority: Secs. 1102, 1137, 1902(a)(4), 1902(a)(18), 
1902(a)(25), 1902(a)(45), 1902(t), 1903(a)(3), 1903(d)(2), 
1903(d)(5), 1903(o), 1903(p), 1903(r), 1903(w), 1912, and 1919(e) of 
the Social Security Act (42 U.S.C. 1302, 1320b-7, 1396a(a)(4), 
1396a(a)(18), 1396a(a)(25), 1396a(a)(45), 1396a(t), 1396b(a)(3), 
1396b(d)(2), 1396a(d)(5), 1396b(i), 1396b(o), 1396b(p), 1396b(r), 
1396b(w), and 1396k.

    2. Section 433.139 is amended by adding paragraph (b)(3) to read as 
follows:


Sec. 433.139  Payment of claims.

* * * * *
    (b) Probable liability is established at the time claim is filed. * 
* *
    (3) The agency must pay the full amount allowed under the agency's 
payment schedule for the claim and seek reimbursement from any liable 
third party to the limit of legal liability (and for purposes of 
paragraph (b)(3)(ii) of this section, from a third party, if the third 
party liability is derived from an absent parent whose obligation to 
pay support is being enforced by the State title IV-D agency), 
consistent with paragraph (f) of this section if--
    (i) The claim is prenatal care for pregnant women, or preventive 
pediatric services (including early and periodic screening, diagnosis 
and treatment services provided for under part 441, subpart B of this 
chapter), that is covered under the State plan; or
    (ii) The claim is for a service covered under the State plan that 
is provided to an individual on whose behalf child support enforcement 
is being carried out by the State title IV-D agency. The agency prior 
to making any payment under this section must assure that the following 
requirements are met:
    (A) The State plan specifies whether or not providers are required 
to bill the third party.
    (B) The provider certifies that before billing Medicaid, if the 
provider has billed a third party, the provider has waited 30 days from 
the date of the service and has not received payment from the third 
party.
    (C) The State plan specifies the method used in determining the 
provider's compliance with the billing requirements.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Programs)

    Dated: April 17, 1997.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 97-11023 Filed 4-28-97; 8:45 am]
BILLING CODE 4120-01-P