SECTION 354.2301. Basis and Purpose

(a) This subchapter implements the requirements of Texas Health & Human Services Commission (HHSC) under federal and state law to:

(1) set forth the requirements of Medicaid applicants and recipients, and representatives of applicants and recipients regarding assignment, identification, and cooperation with HHSC in establishing third party liability and recovery;

(2) set forth the rights, restrictions, and limitations of providers to third party recovery; and

(3) establish the priority of distributions of third party recoveries, including distributions into a trust established under the provisions of the Social Security Act §1917(d)(4) (codified at 42 U.S.C. §1396p(d)(4)).

(b) This subchapter applies:

(1) to Medicaid fee-for-service (FFS); and

(2) except for §354.2322(e) - (g) of this subchapter (relating to Provider Billing and Recovery from Other Liable Third Parties), §354.2331 of this subchapter (relating to Requests for Information), §354.2332 of this subchapter (relating to Distribution of Recoveries), and §354.2333 of this subchapter (relating to Waiver Authority of the Executive Commissioner), to Medicaid managed care.

Source Note: The provisions of this §354.2301 adopted to be effective April 30, 1999, 24 TexReg 3083; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4562; amended to be effective March 28, 2004, 29 TexReg 2867; amended to be effective February 22, 2024, 49 TexReg 855