For purposes of this subpart—
Private insurer means:
(1) Any commercial insurance company offering health or casualty insurance to individuals or groups (including both experience-rated insurance contracts and indemnity contracts);
(2) Any profit or nonprofit prepaid plan offering either medical services or full or partial payment for services included in the State plan; and
(3) Any organization administering health or casualty insurance plans for professional associations, unions, fraternal groups, employer-employee benefit plans, and any similar organization offering these payments or services, including self-insured and self-funded plans.
Third party means 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-D agency means the organizational unit in the State 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.
[49 FR 8984, Feb. 11, 1980, as amended at 50 FR 46664, Nov. 12, 1985; 50 FR 49389, Dec. 2, 1985]
Notes of Decisions
Dist. of Columbia v. Jackson, 451 A.2d 867 (D.C. 1982).
· cites it 7× “136 (3) (1980), [2] have modified the common law collateral source rule, with the result that "Medicaid recipients simply cannot keep that portion of a recovery from a tortfeasor which represents amounts previously paid by Medicaid." In the alternative, the District argues that…”
Olszewski v. Scripps Health, 69 P.3d 927 (Cal. 2003).
· cites it 2× “" ( 42 C.F.R. § 433.136 , italics added.) The state Medicaid agency must "take all reasonable measures to ascertain the legal liability of third parties.”
Costello v. Geiser, 647 N.E.2d 1261 (NY 1995).
· cites it 2× “), the Court confirmed "third party” liability under the Family Court Act and Federal Medicaid statutes and regulations (see, 42 USC § 1396a [a] [25]; 42 CFR 433.136). We held that governing Federal law did not expressly declare a father —whether or not wed to the mother — to be…”
Palumbo v. Myers, 149 Cal. App. 3d 1020 (Cal. Ct. App. 1983).
· cites it 2× “" ( 42 C.F.R. § 433.136 (1982).) As explained in the Health Care Financing Administration Regional Office Manual implementing these regulations, "Section 1902(a)(25) of the [Social Security] Act [42 U.”
Miller v. Gorski Wladyslaw Est., 547 F.3d 273 (5th Cir. 2008).
“” 42 C.F.R. § 433.136 . The federal Medicaid statute requires that each state’s Medicaid agency take measures to find out when third parties, such as private insurers and Medicare, are legally obliged to pay for services covered by Medicaid.”
Cricchio v. Pennisi, 683 N.E.2d 301 (NY 1997).
“A third party is defined as an individual, entity or program that is or may be liable to pay all or part of the expenditures for medical assistance furnished under the State plan (42 CFR 433.136). Recoupment from responsible third parties is necessary to ensure that the Medicaid…”
State, Agency for Health Care v. Estabrook, 711 So. 2d 161 (Fla. 4th DCA 1998).
· cites it 3× “at 1312 (quoting 42 C.F.R. § 433.136 (3))as the very purpose of UME payments is to reimburse the recipient for his own out-of-pocket expenses.”
Tristani Ex Rel. Karnes v. Richman, 609 F. Supp. 2d 423 (W.D. Pa. 2009).
“” 42 C.F.R. § 433.136 (3). 7 . The reference to “subsection (d)” in section 1409(b)(7)(i) apparently resulted from an oversight by the Pennsylvania Legislature.”
Massachusetts v. Sebelius, 638 F.3d 24 (1st Cir. 2011).
“See 42 C.F.R § 433.136 (“Third party means 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.”
Annotations are extracted automatically from the opinions in the
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