WSR 97-04-005
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Public Assistance)
[Filed January 24, 1997, 9:04 a.m.]
Date of Adoption: January 23, 1997.
Purpose: To assign medical assistance administration-contracted managed care plans the rights and remedies of the department as they pertain to assignment of client rights to medical care support or payments.
Citation of Existing Rules Affected by this Order: Amending WAC 388-87-020 and 388-505-0540.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.522.
Adopted under notice filed as WSR 97-01-093 on December 18, 1996.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, amended 2, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 2, repealed 0.
Effective Date of Rule: Thirty-one days after filing.
January 23, 1997
Merry Kogut, Manager
Rules and Policies Assistance Unit
AMENDATORY SECTION (Amending Order 3900, filed 9/27/95, effective
10/28/95)
WAC 388-87-020 Subrogation. (1) For the purpose of this section, "liable third party" means:
(a) The tort-feasor or insurer of the tort-feasor, or both; and
(b) Any person who is liable, under any contract or insurance purchased by the client or by any other person, to provide coverage for the illness or injuries for which the assistance or residential care is paid or provided by the department.
(2) As a condition of medical care eligibility ((as described under
WAC 388-505-0540,)) a client shall assign to the state any right the
client may have to receive payment from any liable third party ((for
reimbursement of state-made expenses for medical care)). Except as
provided in subsection (3) of this section, to the extent that payment
has been made under medical care programs under chapter 74.09 RCW for
health care items or services ((provided to the client)) furnished to an
eligible client, the state shall have been subrogated to the client's
rights to payment by any other party which has a legal or contractual
liability to pay for those health care items or services.
(3) To the extent authorized by a contract executed under RCW 74.09.522, a managed health care plan has the rights and remedies of the department as provided in RCW 43.20B.060 and 70.09.180.
(((2))) (4) The department shall not be responsible to pay for
medical care for a client whose personal injuries are occasioned by the
negligence or wrongdoing of another: Provided, however, That the
secretary of the department or the secretary's designee may furnish the
medical care required as a result of an injury to the client if the
client is otherwise eligible for medical care and no other liable third
party has been identified at the time the claim is filed, and the
department shall thereby be subrogated to the rights of recovery
therefore to the extent of the cost of medical care furnished by the
department.
(((3))) (5) The department may pursue its right to recover the value
of medical care provided to an eligible client from any liable third
party as a subrogee, assignee, or by enforcement of its public assistance
lien as provided under RCW 43.20B.040 through 43.20B.070.
(((4))) (6) Recovery pursuant to the subrogation rights, assignment,
or enforcement of the lien granted to the department shall not be
reduced, prorated, or applied to only a portion of a judgment, award, or
settlement. No settlement or judgment of a lien created under RCW
43.20B.060 shall be discharged or compromised without written consent of
the secretary of the department or the secretary's designee. The
department shall only consider compromise or discharge of a medical care
lien as authorized by federal regulation at 42 CFR 433.139.
(((5))) (7) The doctrine of equitable subrogation shall not apply
to defeat, reduce, or prorate recovery by the department as to its
assignment, lien, or subrogation rights.
[Statutory Authority: SSB 5419(6) and RCW 74.08.090. 95-20-031 (Order
3900), 388-87-020, filed 9/27/95, effective 10/28/95; Order 264 (part),
388-87-020, filed 11/24/67.]
AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)
WAC 388-505-0540 Assignment of medical support rights. (1) As a condition of eligibility for any medical program, a client shall assign to the state of Washington all right, title, and interest to any medical care support available as a result of:
(a) A court order; or
(b) An administrative agency order; or
(c) Any third-party payments for medical care.
(2) When payments for covered services have been made under medical care programs under chapter 74.09 RCW, or under a contract between a managed health care plan and the department under RCW 74.09.522, for health care items or services furnished to an eligible client, if a third party has a legal or contractual liability to make payments, the state acquires the rights of the client to payment from any other party for those health care items or services.
(3) The client shall assign rights of payment to any medical care support the client may have in the client's own behalf or on the behalf of any other client for whom the client can legally assign such rights.
(((3))) (4) As assignee of the eligible client's right to receive
medical support payments, the department may sign coordination of benefit
forms or other forms, as necessary, to ensure the efficient and proper
payment of medical care support.
[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-505-0540, filed 5/3/94, effective 6/3/94. Formerly WAC 388-83-012.]