Title 907 | Chapter 001 | Regulation 005
SUPERSEDED
This document is no longer current.
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.)
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.)