Colorado DHCPF Tort/Casualty Recovery Program

Section 1902(a)(25) of the Social Security Act, 42 CFR 433.135, requires that States take all reasonable measures to ascertain the legal liability of third parties to pay for medical services furnished to a Medicaid client. Pursuant to 1902(a)(25), Colorado Revised Statutes Section 25.5-4-301 provides that the Department of Health Care Policy & Financing (DHCPF) collect all amounts determined available from liable third parties. The subsection further requires that clients or their legal representatives notify the Agency of the existence of any third party benefits. Furthermore, the Agency has a statutory lien for the full amount of medical care furnished and this lien attaches and is perfected automatically when a client first receives treatment for which the agency may be obligated to provide medical assistance under the Medicaid program.

By law, you or your representative must provide the Department written notice within fifteen days after the filing of an action or claim against a third party..:. Section 25.5-4-301 (6) C.R.S.

The Colorado Department of Health Care Policy & Financing (DHCPF) contracted with Health Management Systems Inc., (HMS) to identify, manage, and recover Colorado Medicaid paid funds when a Colorado Medicaid client is involved in a tort or casualty accident/incident. If you are an attorney with a Colorado Medicaid client involved in a tort accident /incident, or if you are an insurance adjuster involved in a case where a Colorado Medicaid client was injured please do the following:

1. Complete a Tort Information Form or send a letter of representation to the DHCPF Tort Unit. Along with the Tort Information Form or letter of representation please include a release signed by the Medicaid client. The release can be any standard Medical Records release as long as it indicates that the Medicaid client has agreed to allow you to receive his/her Medical information. If you send a letter of representation please be sure to include at a minimum:
   • Medicaid Client's Name
   • Medicaid Client's SSN
   • Medicaid Client's DOB
   • Date of accident or incident
   • Details of accident or incident
2. When we receive the form /letter and release, we will enter the data into our Case Management System which will assign the case to a case worker. The case worker will then analyze the case to determine what claims, if any, DHCPF paid that are related to the accident/incident. You will receive:
   • A Statement of Aid Paid stating the lien amount along with supporting documentation; or
   • If we can not identify the individual as a Medicaid client, a letter stating that fact, including the information submitted to the recovery unit and a request to verify the information or provide additional information; or
   • If the request was incomplete, a letter requesting the missing items
3. Please note that Medical providers have one hundred and twenty (120) days from the date of service to bill DHCPF. Accordingly, you must request an updated lien amount at the time of settlement.

If you have any questions, please feel free to contact us.