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Developed and maintained by the Division of Legislative Automated Systems.
1994 SESSION
LD1643813Patrons--Albo, Fisher, Forbes, Giesen, Howell, McClure, O'Brien, Orrock, Parrish, Purkey, Wagner, Wardrup and Wilkins
Be it enacted by the General Assembly of Virginia:
1. That §§ 32.1-325.1 and 32.1-325.1:1 of the Code of Virginia is amended and reenacted as follows:
§ 32.1-325.1. Adverse determination of overpayment; appeals of agency
determinations. A. The Director Department shall make
an initial a determination as to whether an
overpayment has been made to a provider in accordance with the state plan for
medical assistance, the provisions of § 9-6.14:11 and applicable
federal law. Once a determination of overpayment has been made, the
Director Department shall undertake full recovery of
such overpayment whether or not the provider disputes, in whole or in part,
the initial determination of overpayment. Interest charges on the
unpaid balance of any overpayment shall accrue pursuant to § 32.1-313 from
the date of the Director's Department's
determination becomes final. Nothing in § 32.1-313 shall be
construed to require interest payments on any portion of overpayment other
than the unpaid balance referenced herein. In any case in which an
initial the determination of overpayment has been reversed
in a subsequent agency or judicial proceeding, the provider shall be
reimbursed that portion of the payment to which he is entitled plus any
applicable interest.
B. An appeal of the Director's initial Department's
determination concerning provider reimbursement shall be heard in
accordance with the Administrative Process Act (§ 9-6.14:1 et seq.) and the
state plan for medical assistance provided for in § 32.1-325. Court review of
final agency determinations concerning provider reimbursement shall be made
in accordance with the Administrative Process Act. This provision shall apply
to all administrative appeals pending as of its effective date in which no
agency hearing has been held.
C. For the purposes of this chapter, a determination shall be deemed to occur on the date of issuance of a notice of amount of program reimbursement (NPR).
§ 32.1-325.1:1. Definitions; recovery of overpayment for medical assistance services.
A. For the purposes of this section chapter, the
following definitions shall apply:
"Agreement" means any contract executed for the delivery of services to recipients of medical assistance pursuant to subsection C of § 32.1-325.
"Determination" means a notice of the amount of program reimbursement (NPR) issued pursuant to a provider's filed cost report.
"Initial determination" means the first notice of the amount of program reimbursement (NPR) issued pursuant to a provider's filed cost report.
"Successor in interest" means any person as defined in § 1-13.19 of this Code having stockholders, directors, officers, or partners in common with a health care provider for which an agreement has been terminated.
"Termination" means (i) the cessation of operations by a provider, (ii) the sale or transfer of the provider, (iii) the reorganization or restructuring of the health care provider, or (iv) the termination of an agreement by either party.
B. The Director Department of Medical Assistance
Services shall collect by any means available to him at law any
amount owed to the Commonwealth because of overpayment for medical assistance
services. Upon making an initial a determination that
an overpayment has been made to the provider pursuant to § 32.1-325.1, the
Director or his designee shall notify the provider of the amount
of the overpayment. Such An initial determination
shall be made within the earlier of (i) four years from the
sale or transfer of the facility or termination of the provider, or
(ii) fifteen months after filing of the final cost report by the provider
subsequent to sale of the facility or termination of the provider. The
provider shall make arrangements satisfactory to the Director to repay the
amount due. If the provider fails or refuses to make arrangements
satisfactory to the Director for such repayment or fails or refuses to repay
the Commonwealth for the amount due for overpayment in a timely manner, the
Director may devise a schedule for reducing the Medicaid reimbursement due to
any successor in interest.
C. In any case in which the Director is unable to recover the amount due for overpayment pursuant to subsection B, he shall not enter into another agreement with the responsible provider or any person who is the transferee, assignee, or successor in interest to such provider unless (i) he receives satisfactory assurances of repayment of all amounts due or (ii) the agreement with the provider is necessary in order to ensure that Medicaid recipients have access to the covered services rendered by the provider.
Further, to the extent consistent with federal and state law, the Director shall not enter into any agreement with a provider having any stockholder, partner, director, officer, or owner in common with a provider which has terminated a previous agreement for participation in the medical assistance services program without making satisfactory arrangements to repay all outstanding Medicaid overpayment.