Ch. 394                                    2003 LAWS OF MARYLAND

SUBTITLE 14A. THIRD PARTY LIABILITY REVIEWS AND AUDITS OF NURSING HOMES.
19-14A-01.

(A)     IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.

(B)     "BOARD" MEANS AN APPEAL BOARD ESTABLISHED BY THE SECRETARY
UNDER THIS SUBTITLE.

(C) "ERROR RATE" MEANS ONE LESS THE AMOUNT OF THE FINAL REPORTS
DIVIDED BY THE AMOUNT OF THE INITIAL REPORTS IN THE CONTRACT PERIOD.

(D) (B) "FINAL REPORT" MEANS THE CONTRACTOR THIRD PARTY LIABILITY
AUDIT REPORT ISSUED TO THE DEPARTMENT AND A NURSING HOME STATING THE
TOTAL AMOUNT DUE TO THE DEPARTMENT AS A RESULT OF THE COMPLETED AUDIT.

(E) "INITIAL REPORT" MEANS THE CONTRACTOR REPORT ISSUED TO THE
PROVIDER STATING THE CONTRACTOR'S PROPOSED ADJUSTMENTS.

(F) (C) "NURSING HOME" HAS THE MEANING STATED IN § 19-1401(E) OF THIS
TITLE.

(G) (D) (1) "THIRD PARTY" MEANS ANY INDIVIDUAL, ENTITY, OR PROGRAM
THAT IS OR MAY BE LIABLE TO PAY ALL OR PART OF THE MEDICAL COST OF ANY
MEDICAL ASSISTANCE FURNISHED TO A RECIPIENT UNDER THE MEDICAL
ASSISTANCE PROGRAM.

(2) "THIRD PARTY" INCLUDES PRIVATE HEALTH INSURANCE,
EMPLOYMENT-RELATED HEALTH INSURANCE, MEDICAL SUPPORT FROM ABSENT
PARENTS, AUTOMOBILE INSURANCE, COURT JUDGMENTS OR SETTLEMENTS FROM A
LIABILITY INSURER, STATE WORKERS' COMPENSATION, FIRST PARTY
PROBATE-ESTATE RECOVERIES, OR ANY FEDERAL PROGRAMS.

(H) (E) "THIRD PARTY LIABILITY AUDIT" MEANS A FINANCIAL REVIEW OF
MEDICAL ASSISTANCE PAYMENTS TO A PROVIDER TO ASCERTAIN THE LEGAL
LIABILITY OF THIRD PARTIES TO PAY FOR CARE AND SERVICES AVAILABLE UNDER
THE MEDICAL ASSISTANCE PROGRAM.

(F) "THIRD PARTY LIABILITY REVIEW" MEANS A FINANCIAL REVIEW OF THE
CREDIT BALANCES OF A NURSING HOME TO ASCERTAIN THE LEGAL LIABILITY OF
THIRD PARTIES TO PAY FOR CARE AND SERVICES AVAILABLE UNDER THE MEDICAL
ASSISTANCE PROGRAM.

19-14A-02.

(A) A NURSING HOME THAT RECEIVES PAYMENT FROM THE MEDICAL
ASSISTANCE PROGRAM SHALL PROVIDE A REPORT OF THE CREDIT BALANCES OF THE
NURSING HOME TO THE DEPARTMENT ON A QUARTERLY BASIS.

(A) (B) THE DEPARTMENT SHALL CONDUCT A THIRD PARTY LIABILITY
AUDIT REVIEW OF THE REPORT OF THE CREDIT BALANCES PROVIDED UNDER

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