D.C. Mun. Regs. tit. 29, r. 29-1401

Current through Register 71, No. 45, November 7, 2024

Rule 29-1401 - NOTICE OF KNOWN OR SUSPECTED THIRD-PARTY LIABILITY

1401.1

Any individual or institutional health-care provider that bills the District for health-care assistance furnished to a beneficiary shall provide the Department with written notice of any known or suspected third-party liability as soon as the health-care provider acquires knowledge of or suspects the existence of such liability.

1401.2

The written notice shall include the following:

(a) The beneficiary's name, address, social security number, and Medicaid recipient number, if any;

(b) The name, address, and telephone number of the other person(s) involved in the incident, if any; and

(c) A description of the incident causing the injury or illness, including the date and location.

1401.3

A beneficiary, or if represented, the beneficiary's attorney, shall provide the Department with written notice of any known or suspected third-party liability before taking any steps to recover damages or costs arising from an incident involving the third party.

1401.4

The written notice shall include the following:

(a) The beneficiary's name, address, social security number, and Medicaid recipient number, if any;

(b) The name, address, and telephone number of the beneficiary's attorney, if any;

(c) The name, address, and telephone number of the third party;

(d) The name, address, and telephone number of the third party's attorney, if known;

(e) The name, address, and telephone number of the third party's insurer, if known;

(f) The name, address, and telephone number of beneficiary's insurer, if known; and

(g) A description of the incident causing the injury or illness, including the date and location.

1401.5

Upon receipt of a written notice of known or suspected liability of a third party pursuant to §§ 1401.1, 1401.2, 1401.3, and 1401.4, the Department shall immediately send a copy of the written notice to the Corporation Counsel, together with information concerning the dollar amount or monetary value of health-care assistance provided to or paid for on behalf of the beneficiary by the District.

1401.6

If the beneficiary separately institutes a proceeding against or settlement negotiations with a third party, the beneficiary or if represented, the beneficiary's attorney shall inform the third party that the District also has a claim, and shall give the Corporation Counsel written notice of the action or settlement negotiations, by personal service or certified mail, within twenty (20) calendar days.

1401.7

If a court proceeding has been instituted, proof of timely notice shall be filed with the court.

D.C. Mun. Regs. tit. 29, r. 29-1401

Final Rulemaking published at 33 DCR 1320 (March 7, 1986)