AGING AND DISABILITY SERVICES ADMINISTRATION

2006 NH "Dear Administrator" Letters

April 18, 2006

ADSA NH #2006-012
Update to change in policy regarding Third Party Liability Payments on Behalf of Medicaid Residents

Dear Nursing Facility/Home Administrator:

This letter is an update to Dear Administrator Letter #2006-001. That letter informed you that CMS will no longer allow the state to pay for services provided to Medicaid clients until all other sources of payment have been made on behalf of the client. This change in policy will be phased-in beginning April 1, 2006 with completion by December 31, 2006.

Information you received from Susan Pemberton from Health and Recovery Services Administration indicated that beginning April 1, 2006 payments for Medicaid clients who have coverage under any of the following types of insurance or carriers will not be made until all insurance proceeds have been paid or proof of denial is provided to the state:

• All policies that exclusively cover long term care
• DEERS / Tricare for Life
• Champ VA
• Tricare Prime
• Tricare Plus
• Champus
• Pacific Medical Center
• Uniform Health Plan / Public Employees Benefit Board
• Any other insurance Medicaid had previously requested nursing homes bill

The above list represents the first phase of this process and is a small portion of all insurance carriers. Additional policy types and/or carriers will be added to the list as the phase-in period progresses. We will notify you as these additions are made.

Please refer to your packet of information provided by Susan Pemberton regarding the best way to proceed in this endeavor. If you have any questions, please call Susan Pemberton at (360) 725-1164.

Sincerely,

Tom Kearns, Chief
Office of Rates Management
Aging and Disability Services Administration

Andy Renggli, Chief
Coordination of Benefits Office
Health and Recovery Services Administration