C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)

42 C.F.R. § 405.908

Medicaid State agencies

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When a beneficiary is enrolled to receive benefits under both Medicare and Medicaid, the Medicaid State agency may file a request for an appeal with respect to a claim for items or services furnished to a dually eligible beneficiary only for services for which the Medicaid State agency has made payment, or for which it may be liable. A Medicaid State agency is considered a party only when it files a timely redetermination request with respect to a claim for items or services furnished to a beneficiary in accordance with 42 CFR parts 940 through 958. If a State agency files a request for redetermination, it may retain party status at the QIC, OMHA, Council, and judicial review levels.

[70 FR 11472, Mar. 8, 2005, as amended at 82 FR 5106, Jan. 17, 2017]
Notes of Decisions
Cited in 2 cases, 2011–2014 · leading case: Hull v. Burwell, 66 F. Supp. 3d 278 (D. Conn. 2014).
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Hull v. Burwell, 66 F. Supp. 3d 278 (D. Conn. 2014). “1988); 42 C.F.R. § 405.908 . And that is what has happened for the claims of each of the plaintiffs in this lawsuit Medicaid has covered the claims, and the DSS in turn has invoked the denial-of-claim review process seeking to recoup its expenses from Medicare.”
United Healthcare Ins. v. Sebelius, 774 F. Supp. 2d 1014 (D. Minn. 2011). “§ 1396a(a)(25) and 42 C.F.R. § 405.908 , and is thus also a proper defendant.”
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