HAR §17-1739.1-5. Methods of payment

(a) State payments for medical services shall not be provided to anyone except the: (1) Provider; or (2) Recipient for settlement of a legal suit or fair hearing. (b) Payment to an individual shall be prohibited, except in specified circumstances where payment is reassigned to another person, facility, or organization by the provider. The circumstances include payment made: (1) In accordance with a reassignment from the provider to a government agency or reassignment by a court order; (2) To a business agent, such as a billing service or an accounting firm, that furnishes statements and receives payments UNOFFICIAL 1739.1-13 in the name of the provider. The agent's compensation for the service shall be related to the cost of processing the billing, and not on a percentage or other basis of the amount that is billed or collected, and the compensation shall not be dependent upon the collection of the payment; and (3) To the following: (A) The employer of the practitioner, if the practitioner is required as a condition of employment to turn over the fees to the employer; (B) The facility in which the service is provided, if the practitioner has a contract under which the facility submits the claim; or (C) A foundation, plan, or similar organization operating an organized health care delivery system, if the practitioner has a contract under which the organization submits the claim. (c) Payment for any service furnished to a recipient by a provider shall not be made to or through a factor, either directly or by power of attorney. (d) Participation in the State's Medicaid program shall be limited to providers who accept, as payment in full, the amounts paid by Medicaid with the exception of amounts specifically identified as the recipient's spend-down or cost-share. [Eff 10/26/01 ] (Auth: HRS §346-59) (Imp: 42 C.F.R. §§447.10, 447.15)