Tenn. Comp. R. & Regs. 0940-03-05-.05 - REIMBURSEMENT

(1) The department shall reimburse an approved and participating mental health supportive living facility for each day of care and services given to an approved and participating resident. Reimbursement will be available for days that the resident is away from the facility for weekend trips, camping trips, or other absences that are temporary in nature, with the resident returning to the facility after the brief absence.

(2) The amount of reimbursement shall be two ($2.00) dollars per day of residence.

(3) No mental health supportive living facility shall receive the payment as provided for in these rules for more than thirty percent (30%) of its licensed residential capacity.

(4) Claims for reimbursement must be submitted each month to the department on forms approved by the department. At the end of the month the authorized representative of the mental health supportive living facility must certify the participant's continued eligibility for services during the previous month, attesting that the representative has personally examined documents demonstrating that continued eligibility.

(5) Claims for reimbursement can be made for days of care and services to eligible current residents by the mental health supportive living facility that were provided beginning from the effective date of the rules.

(6) The department may recoup or recover funds paid to any provider for services provided to an ineligible recipient, or if the provider has accepted prohibited payments as described under Rule 0940-3-5-.03(e), from any other individual on behalf of the resident.

(7) Reimbursement is limited to the amount appropriated through state funds for the program. Reimbursement will be made on the first come first served basis with the date the claim is received at the department as the date of eligibility for reimbursement. The program will terminate if the total appropriated for this program has been expended.

Notes

Tenn. Comp. R. & Regs. 0940-03-05-.05

Original rule filed February 3, 1989; effective March 23, 1989. Amendment filed May 10, 1989; effective June 24, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Authority: T.C.A. § 12-4-330 and Chapter 12, Public Acts, 1989.