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All Medicaid Programs |
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Obsolete Policy |
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.
Reported Changes.
When workers are notified of a change in TPL, the eligibility worker must gather the new TPL information from the recipient(s).
Reviews.
The eligibility worker is required to verify if there is a change or no change in the TPL information at each review.
Review forms include TPL questions for the customer to complete. If the information is incomplete, contact the customer to gather the necessary information.
Eligibility workers may gather TPL information by:
o sending a TPL form to the customer to complete, sign and return
o by phone or
o by sending a notice to the customer to request the information.
A recipient's medical assistance will end if the recipient fails to complete their review. When this happens, the recipient may reapply in the month immediately following the effective closure date, or for MAGI programs within 90 days after closure, by responding to the review, providing all requested verification, or filing a new application form. The eligibility agency treats the response as a new application. If the recipient provided updated TPL information during the failed review process, do not request it again as part of this application process.
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 Bureau of Managed Health Care.
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:
recipient name and case number,
date (or approximate date) of the accident or injury,
nature of the accident or injury, and
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.