Medical assistance identification; conditions; payment of benefits;
nonresidents; rules; violations
Sec. 5. (a) A child with special needs resident in this state who is
the subject of an adoption assistance agreement with another state
shall be entitled to receive a medical assistance identification from
this state upon the filing in the county office of family and children
for the county in which the child resides of a certified copy of the
adoption assistance agreement obtained from the adoption assistance
state. In accordance with rules of the division of family and children
the adoptive parents shall be required at least annually to show that
the agreement is still in force or has been renewed.
(b) The division of family and children shall consider the holder
of a medical assistance identification pursuant to this section as any
other holder of a medical assistance identification under the laws of
this state and shall process and make payment on claims on account
of such holder in the same manner and pursuant to the same
conditions and procedures as for other recipients of medical
assistance.
(c) The division of family and children shall provide coverage and
benefits for a child who is in another state and who is covered by an
adoption assistance agreement made by the division of family and
children for the coverage or benefits, if any, not provided by the
residence state. To this end, the adoptive parents acting for the child
may submit evidence of payment for services or benefit amounts not
payable in the residence state and shall be reimbursed therefor.
However, there shall be no reimbursement for services or benefit
amounts covered under any insurance or other third party medical
contract or arrangement held by the child or the adoptive parents.
The division of family and children shall adopt rules implementing
this subsection. The additional coverages and benefit amounts
provided pursuant to this subsection shall be for services to the cost
of which there is no federal contribution, or which, if federally aided,
are not provided by the residence state. Among other things, such
rules shall include procedures to be followed in obtaining prior
approvals for services in those instances where required for the
assistance.
(d) A person who submits any claim for payment or
reimbursement for services or benefits pursuant to this section or
makes any statement in connection therewith, which claim or
statement the maker knows or should know to be false, misleading,
or fraudulent commits a Class D felony.
(e) The provisions of this section shall apply only to medical
assistance for children under adoption assistance agreements from
states that have entered into a compact with this state under which
the other state provides medical assistance to children with special
needs under adoption assistance agreements made by this state. All
other children entitled to medical assistance pursuant to adoption
assistance agreements entered into by this state shall be eligible to
receive it in accordance with the laws and procedures applicable
thereto.
As added by P.L.1-1997, SEC.11.
Last modified: May 24, 2006