Medicaid Policy                                                                 

225-3 Changing and Updating TPL Information

Effective Date: May 1, 2015

Previous Policy

 

A. Changes and Updates

Recipients must report changes in Third Party Liability (TPL) information within 30 days of the change.  If the 30th day is a Non-business Day, recipients have until the Business Day following that 30th day. They can report changes to the eligibility agency in writing, over the phone, by available electronic methods, or in person.   

 

1. Reported Changes.

When workers are notified of a change in TPL, the eligibility worker must gather the new TPL information from the recipient(s).  

 

2. Reviews.

1. The eligibility worker is required  to complete an ex parte review whenever possible (see 721-1). The worker does not update the TPL information as part of the ex parte review. However, the notice of decision will remind the recipient to report any TPL change that occurs. 
2. If an ex parte can't be completed, eREP will send a prepopulated review form which includes TPL questions for the customer to complete.  If the member leaves the TPL information blank or incomplete, contact the customer to gather the necessary information.    

Eligibility workers may gather TPL information by:

• sending a TPL form to the recipient to complete, sign and return   
• by phone or
• by sending a notice to the customer to request the information.  

An adult recipient's medical assistance will end if the recipient fails to complete their review. Section 721-1 discusses the process for completing an eligibility review.   If the recipient provided updated TPL information during the failed review process, do not request it again as part of the application process.

3. Report to ORS.

Eligibility workers must report TPL changes to the Office of Recovery Services.  Do not report TPL information to the Health Program Representatives (HPR) with the Office of Managed Health Care.

B. Accidents, Injuries

The eligibility worker must notify ORS of any information received about a possible TPL arising from the negligence of others, or from accidents or injury situations (such as automobile accidents, public liabilities, homeowner's accidents, etc.)  Provide ORS with as much of the following information as you can:

1. recipient name and case number,
2. date (or approximate date) of the accident or injury,
3. nature of the accident or injury, and
4. any other pertinent information, such as the company involved, policy holder, and court information.

Remember that money received from a TPL source for medical expenses cannot count as income for Medicaid eligibility if it is recouped by ORS.