55 Pa. Code § 178.6 - Third-party liability for all categories of MA
(a) An applicant/recipient may have sources
other than MA that cover the cost of his medical services and care. The
third-party liability sources which are available to pay for medical services
and care shall be identified and used to the fullest extent possible before
payment is made by MA. The Department is the payer of last resort.
(b) Third-party resources include, but are
not limited to:
(1) Blue Cross and commercial
hospital insurance.
(2) Health
insurance benefits-Medicare.
(i) Hospital
insurance.
(A) Inpatient hospital
care.
(B) Skilled nursing care
after hospitalization.
(C) Home
health benefits after hospitalization.
(ii) Medical insurance.
(3) Other hospital insurance paid to the
person.
(4) Medical insurance
included as part of a support agreement.
(5) Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS).
(6) Workers compensation.
(7) Negligence action or other
tort.
(8) Institutional care
contracts. This includes a contract between a person and a facility which gives
the person the right to receive care at zero or reduced cost at the
facility.
(9) Payments made toward
the cost of medical service by an LRR or other person.
(10) LRRs, including spouses and parents of
unemancipated minor children.
(11)
Long term care/nursing home care insurance.
Notes
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