Section He-W 521.09 - Recovery For Expenses Related to Third Party Settlements(a) Pursuant to RSA 167:14-a, IV, the recipient or the recipient's legal representative shall notify the department or MCO of any accident or injury in which a liable third party is responsible for expenses.(b) Upon notification of a personal injury of a medicaid recipient, the department or MCO shall determine if there is a claim for third party liability recovery.(c) The department or MCO shall request accident related information regarding third party liability to the medicaid recipient. If the recipient or the recipient's legal representative fails to respond to the department's notice of claim, the department or MCO shall withhold the processing of or deny the claim for medicaid payment until the department or MCO receives a response from the recipient or the recipient's legal representative.(d) Upon the department or MCO's request, the recipient or the recipient's legal representative shall provide the department or MCO with the following information and completed documents: (1) The date and location of when and where the injury occurred;(2) The type of injuries incurred due to the accident;(3) A description of how the injury happened;(4) The involved insurance company or other liable party;(5) The amount of a proposed or anticipated offer of settlement made by the liable third party; and(6) The letter of representation and completed and notarized authorization to release records if the recipient has legal representation.(e) When the department or MCO makes a claim for recovery of medical expenses paid on behalf of a recipient, the recipient or the recipient's legal representative shall, within 15 business days of receipt of notification of the department or MCO's claim, submit a written statement to the department or MCO which: (1) Acknowledges the department or MCO's claim; and(2) Includes a proposed distribution of the recovery.(f) In addition to the statement in (e) above, a disbursement of any award, judgment, or settlement shall not be made to a recipient without the recipient or the recipient's legal representative first providing at least 30-days written notice of any scheduled trial, alternative dispute resolution hearing, or settlement to the department or MCO per RSA 167:14-a, IV. The recipient or the recipient's legal representative shall include the department or MCO in all settlement negotiations.(g) Pursuant to RSA 167:14-a, III, when a recipient receives a settlement or an award from a liable third party prior to notifying the department or MCO, the recipient shall repay the amount of medical assistance furnished by the department or MCO.(h) If the recipient or the recipient's legal representative fails to respond to the department or MCO's notice of lien, the department shall suspend further payments related to the incident until a response is received from the recipient or the recipient's legal representative unless the recipient is a minor. Claims shall not be suspended when the recipient is under 18 years of age.(i) If any injury is the result of a work-related accident, and the employer, the insurance carrier, or both, deny the injured employee medical expenses for the periods the injury requires, the recipient may request a hearing from the NH department of labor worker's compensation division, in accordance with Lab 204.01.(j) Pursuant to RSA 167:14-a, III, when a recipient receives a settlement or an award from worker's compensation or a liable third person or party, the recipient shall repay the amount of medical assistance furnished by the department to the extent that the amount of the recovery makes repayment possible.N.H. Admin. Code § He-W 521.09
Derived from Number 10, Filed March 7, 2024, Proposed by #13884, Effective 2/22/2024, Expires 2/22/2034 (See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521).