[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: 42CFR433.145]



[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.  433.145  Assignment of rights to benefits--State plan requirements.



    (a) A State plan must provide that, as a condition of eligibility, 

each legally able applicant or recipient is required to:

    (1) Assign to the Medicaid agency his or her rights, or the rights 

of any other individual eligible under the plan for whom he or she can 

legally make an assignment, to medical support and to payment for 

medical care from any third party;

    (2) Cooperate with the agency in establishing paternity and in 

obtaining medical support and payments, unless the individual 

establishes good cause for not cooperating, and except for individuals 

described in section 1902(l)(1)(A) of the Act (poverty level pregnant 

women), who are exempt from cooperating in establishing paternity and 

obtaining medical support and payments from, or derived from, the father 

of the child born out of wedlock; and

    (3) Cooperate in identifying and providing information to assist the 

Medicaid agency in pursuing third parties who may be liable to pay for 

care and services under the plan, unless the individual establishes good 

cause for not cooperating.

    (b) A State plan must provide that the requirements for assignments, 

cooperation in establishing paternity and obtaining support, and 

cooperation in identifying and providing information to assist the State 

in pursuing any liable third party under Sec. Sec.  433.146 through 

433.148 are met.

    (c) A State plan must provide that the assignment of rights to 

benefits obtained from an applicant or recipient is effective only for 

services that are reimbursed by Medicaid.



[55 FR 48606, Nov. 21, 1990, as amended at 58 FR 4907, Jan. 19, 1993]