RCPA - Rehabilitation and Community Providers Association


CMS Issues TPL Guidance
January 26, 2007

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to state Medicaid directors on the Deficit Reduction Act (DRA) provisions regarding Medicaid (MA) third party liability (TPL). Section 6035 of the DRA identifies entities that are considered third parties and health insurers. It also requires states to pass laws requiring health insurers to provide certain information to states regarding identification of third parties, honor assignment to the state of the MA recipient’s right to payment by insurers, and not to deny assignment or refuse to pay claims for procedural reasons. A question and answer document offers more guidance, including information about interaction of the DRA and the Employee Retirement Income Security Act. Medicaid is the payer of last resort and is required to be more diligent in ensuring that covered services are paid first by responsible third parties. Copies of all recent guidance documents are available as a single attached PDF file. Please contact Betty Simmonds with questions.

TPL Guidance Third Party Liability (TPL) Guidance from CMS

< Back