Title 907 | Chapter 001 | Regulation 005


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907 KAR 1:005.Nonduplication of payments.

Section 1.

Nonduplication of Payment.

(1)

In accordance with 42 C.F.R. 447.15, a payment to a provider for a service provided to a recipient shall be payment in full to the provider for the service, except as provided in subsection (3) of this section.

(2)

(a)

A provider shall not seek payment from a recipient for a covered service provided to the recipient, except as permitted pursuant to subsection (3) of this section.

(b)

A recipient shall not be financially liable to a provider for a covered service provided by the provider to the recipient, except as provided pursuant to subsection (3) of this section.

(3)

A cost-sharing obligation that complies with 907 KAR 1:604 and 42 C.F.R. 447.50-447.90 shall not be a violation of this section.

Section 2.

Third-party Liability.

(1)

The department shall comply with 42 C.F.R. Part 433, Subpart D, and consider any third-party liability as a resource.

(2)

A recipient shall cooperate with the department for third-party liability purposes in accordance with 42 U.S.C. 1396k, 42 C.F.R. 433.138, and 42 C.F.R. 433.145.

(3)

If payment for a covered service is due and payable from a third-party source such as Medicare, an insurance plan, or some other third-party with a legal obligation to pay, the amount payable by the cabinet shall be reduced by the amount of the third-party obligation.

HISTORY: (2 Ky.R. 100; 9-10-1975; Recodified from 904 KAR 1:005, 5-2-1986; 17 Ky.R. 148; eff. 9-13-1990; 45 Ky.R. 1439; eff. 2-1-2019.)

7-Year Expiration: 3/10/2029

Last Updated: 3/14/2022


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