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HRD-77-73 1 (1977-05-02)

handle is hein.gao/gaobaacdu0001 and id is 1 raw text is: DCCUKENT SESUME 01948 - (A1252235) Problems in Carrying Out Medicaid Secovery Prcgrams from Third Parties. HRD-77-73; E-164031(3). May 2, 1977. 26 pp. Report to Secretary, Department of Health, Education, and Welfare; by Morton R. Henig (for Gregory J. Ahart, Director. Human Resources and Development Div.). Iusue Area: Health Programs: Compliance With Fiaancing Laws and Regulations (1207); Health Programs: Reimbursement Policies and Utilization Ccntrols (1208);Health Programs: Impact of Nationai Health Insurance (1209). Contact: Human Resources and Development Div. Budget Function: Health: Health Care Services (551). Congressional Relevance: House Consittee on Interstate and Foreign Comaercc; Senate Committee on Finance. Authority: Social Security Act, title XIX, as amended (42 U.S.C. 1395). Social Security Amendments ovi 1967, sec. 229 (P.L. 90-248). H.R. 3 (95th Cong.). H.R. 1128 (95th Cong.). 45 C.F.R. 250.31(c). 45 C-F.R. 201.5. Hawaii Bevised Statute 294-5(b). Hawaii Act 168, Laws 1974. There ara prcblems involved in implementing the third-party recovery programs which are required to be part of the states' Medicaid programs. Findings/Coiclusions: Third parties, such as health or autnmcb.ile accident insurance companies, may be liable tc pay part or all of the medical costs of injury, disease, or disability of a melicaid applicant or recipiert. States are responsible for identifying and recoverinr funds from these third parties. The Department of Health, Education, and Welfare's (HEW's) Audit Agency and consultants have repeatedly reported inadequacies in state recovery. The six states whose programs were reviewed used various procedures and approaches to identify liable third parties, tc recover or avoid cost applicable to them, and to account for and report recoveries or cost avoidances. Claims are sometimes paid without a thorough investigation of third-party liability. Recommepations: Tht Secretary of BEW should direct the Administrator of the Health Care Financing Administration to work with the states tc develop a mandatory xeForting system for quantitatively measuring the effects of state third-party ret-very programs designed to be useful to both Federal and State management. The Secretary should ask states having eligibility determination agreements with the Lepartment: (1) to identify the information they believe is needed from individuals during the eligibility process; and (2) to decide whether the information would be compatible with their third-party system and useiul in administering their Frograms. (Author/SC)

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