Medicaid program; identification of third party liability resources for medical assistance--HCFA. Final rule

This final rule revises regulations governing a Medicaid State agency's responsibility to take reasonable measures to determine the legal liability of third parties to pay for services under the plan. The final regulations require that the agency at a minimum: Obtain certain health insurance information for Medicaid applicants or recipients during the initial application and redetermination processes; conduct, or in some cases attempt to secure agreements to conduct, certain types of data exchanges with specific State and Federal agencies, or in some cases alternate sources, to identify legally liable third parties; conduct diagnosis and trauma code edits to identify third party resources; and follow other specified procedures regarding frequency of conducting the above activities, follow up, safeguarding information obtained and exchanged, and reporting and reimbursement requirements. The objectives of these requirements are to improve State agency performance in the identification of third party resources and to assure the timely incorporation of this resource information into the third party claims payment processing system. This regulation also makes minor technical revisions to the Income and Eligibility Verification System final rule published in the Federal Register on February 28, 1986.