[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR433.140]



[Page 102]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 433_STATE FISCAL ADMINISTRATION--Table of Contents

 

                     Subpart D_Third Party Liability

 

Sec.  433.140  FFP and repayment of Federal share.



    (a) FFP is not available in Medicaid payments if--

    (1) The agency failed to fulfill the requirements of Sec. Sec.  

433.138 and 433.139 with regard to establishing liability and seeking 

reimbursement from a third party;

    (2) The agency received reimbursement from a liable third party; or

    (3) A private insurer would have been obligated to pay for the 

service except that its insurance contract limits or excludes payments 

if the individual is eligible for Medicaid.

    (b) FFP is available at the 50 percent rate for the agency's 

expenditures in carrying out the requirements of this subpart.

    (c) If the State receives FFP in Medicaid payments for which it 

receives third party reimbursement, the State must pay the Federal 

government a portion of the reimbursement determined in accordance with 

the FMAP for the State. This payment may be reduced by the total amount 

needed to meet the incentive payment in Sec.  433.153.



                    Assignment of Rights to Benefits