Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part IV - Third Party Liability › Section 12VAC30-20-190 - Requirements for third party liability; identifying liable resources

Current through Register Vol. 40, No. 24, July 15, 2024
1. Definitions
"IEVS" - the Income and Eligibility Verification
					 System.
"Third Party" - any individual, entity or program that is
					 or may be liable to pay all or part of the expenditures for medical assistance
					 furnished under a State Plan.
"Title IV-A agency" - the organizational unit in the State,
					 the Department of Social Service, that has the responsibility for determining
					 eligibility for all groups covered by Medicaid.
"Title IV-D agency" - the organizational unit in the State,
					 the Department of Social Services, that has the responsibility for
					 administering or supervising the administration of a State plan for child
					 support enforcement under Title IV-D of the Act.
"Title XIX agency" - the organizational unit in the State
					 responsible for administering the implementation of programs created by the
					 nineteenth amending title to the Social Security Act.
"TPQY" - Third Party Information Query system administered
					 by the Social Security Administration.
"VEC" - the Virginia Employment Commission (the state SWICA
					 agency) which is the state organizational unit responsible for providing a work
					 ready labor force, temporary income protection to workers involuntarily
					 unemployed, and labor market and economic information.
2. Determining liability of third
				  parties.
2.1. The agency takes all
				  reasonable measures to determine the legal liability of third parties to pay
				  for care and services furnished under the Plan. The Commonwealth is a "209b"
				  state and all eligibility is determined by the Department of Social Services
				  (DSS). At a minimum, such measures include the requirements specified
				  below.
2.2. Health insurance
				  information.
A. Health insurance information
				  is obtained by the Title IV-A agency (DSS) during the initial application and
				  redetermination processes for Medicaid eligibility.
B. The information is coded on the
				  recipient's eligibility card and in the computer system.
C. Health insurance information may include,
				  but is not limited to, the policy holder's name, the relationship to the
				  applicant or recipient, the policy holder's social security number (SSN) and
				  policy number, and the name and address of the insurance company.
D. The Title XIX agency has an agreement with
				  the IV-A agency to collect and to transmit from the applicant or recipient
				  during the initial application and each redetermination process such health
				  insurance information as is useful in identifying legally liable third party
				  resources so that the Medicaid agency may process claims under the third party
				  liability payment procedures specified in
				  42 CFR
				  433.139 b-f. Health insurance information may
				  include, but is not limited to, those elements described in item C
				  above.
E. The Title IV-A agency
				  incorporates into the eligibility case file the names and SSNs of absent or
				  custodial parents of Medicaid recipients to the extent such information is
				  available.
F. Payment of health
				  insurance premiums when identified as cost effective.