63.2-1404 - Medical assistance; penalties. - Virginia Statutes

§ 63.2-1404. Medical assistance; penalties.

A. A child with special needs resident in this Commonwealth who is thesubject of an adoption assistance agreement with another state shall beentitled to receive a medical assistance identification from thisCommonwealth upon the filing in the Department of a certified copy of theadoption assistance agreement obtained from the adoption assistance state. Inaccordance with regulations of the Department, the adoptive parents shall berequired at least annually to show that the agreement is still in force orhas been renewed.

B. The Department of Medical Assistance Services shall consider the holder ofmedical assistance identification pursuant to this section as any otherholder of a medical assistance identification under the laws of thisCommonwealth and shall process and make payment on claims on account of suchholder in the same manner and pursuant to the same conditions and proceduresas for other recipients of medical assistance.

C. The Department shall provide coverage and benefits not provided by thestate plan for medical assistance in the residence state for a child who isin another state and who is covered by an adoption assistance agreement madein Virginia to the extent required by the agreement. However, there shall beno reimbursement for services or benefit amounts covered under any insuranceor other third party medical contract or arrangement held by the child or theadoptive parents. The Department of Medical Assistance Services shall adoptregulations implementing this subsection. The additional coverages andbenefit amounts provided pursuant to this subsection shall be for servicesfor which there is no federal financial contribution or which, if federallyaided, are not provided by the residence state. Such regulations shallinclude procedures to be followed in obtaining prior approvals for serviceswhen such approval is required for the assistance.

D. The submission of any claim for payment or reimbursement for services orbenefits pursuant to this section or the making of any statement inconnection therewith, which claim or statement the maker knows or should knowto be false, misleading or fraudulent shall be punishable as perjury andshall also be subject to a fine of not more than $10,000, or imprisonment fornot more than two years, or both.

E. The provisions of this section shall apply only to medical assistance forchildren under adoption assistance agreements from states that have enteredinto a compact with this Commonwealth under which the other state providesmedical assistance to children with special needs under adoption assistanceagreements made by this Commonwealth. All other children entitled to medicalassistance pursuant to adoption assistance agreements entered into by thisCommonwealth shall be eligible to receive it in accordance with the laws andprocedures applicable thereto.

(1988, c. 154, § 63.1-238.10; 2002, c. 747.)