227.17 Family Planning MA Third Party Liability (TPL) (MAM)

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Receipt of Family Planning medical assistance (MA) is an automatic assignment to DHHS of the applicant's rights to all third party insurance or medical payments without the individual having to sign any other form, per RSA 167:14-a. Because all available parties must be billed and all resulting payments must be applied to the cost of medical care before DHHS will pay, DFA Form 800FP, Application for Family Planning Medical Assistance, asks for other medical insurance information. However, if cooperation is against the best interests of the applicant for Family Planning MA because it is anticipated that cooperation will result in reprisal against, and cause physical or emotional harm to, the individual, the Family Planning applicant is considered to have "good cause" for failing to meet the third-party liability (TPL) requirements.

DFA Form 808FP, Information Necessary to Support Your Family Planning Medical Assistance Application, includes a request for a waiver of cooperating with the third-party liability requirement. If the applicant for Family Planning MA:

. checks the box on DFA Form 808FP requesting the waiver and signs the form, do not pursue third-party liability; the applicant has good cause for not complying with the TPL requirement.

. does not check the box on DFA Form 808FP requesting the waiver, pursue third-party liability per current Medicaid policy.

References: He-W 509, He-W 626, RSA 126-A:4-c, RSA 167:14-a, Section 1902(a)(10)(A)(ii) of the Social Security Act [42 U.S.C. 1396a(a)(10)(A)(ii)], 42 USC 1396r-1c, 42 U.S.C. 1396a(ii)(3)