22 Va. Admin. Code § 30-80-60 - Reimbursement

A. Any payments contributed toward the cost of basic services as defined in 22VAC30-80-30 and 22VAC30-80-35 pending AG eligibility determination shall be reimbursed to the individual or contributing party by the ALF , AFC, or SH provider once eligibility for AG is established and that payment received. The payment shall be made payable to the individual, who will then reimburse the appropriate providers for basic services. If the individual is not capable of managing his finances, his authorized representative or authorized payee is responsible for reimbursing the provider.
B. In the event an ALF is closed, the facility shall prorate the rate up to the date of the individual's discharge and return the balance of the AG to the local department of social services that determined the individual's eligibility for the AG. If the facility maintained the individual's personal needs allowance, the facility shall provide a final accounting of the individual's personal needs allowance account within 60 days of the individual's discharge. Verification of the accounting and of the reimbursement to the individual shall be sent to the case management agency responsible for the individual's annual reassessment. In the event of the individual's death, the provider shall give to the individual's authorized representative a final accounting of the individual's funds within 60 calendar days of the event. All AG funds received after the death or discharge date shall be returned to the local department of social services responsible for determining the individual's AG eligibility as soon as practicable.
C. Providers who do not comply with the requirements of this chapter may be subject to adverse action, which may include suspension of new AG admissions or termination of provider agreements.

Notes

22 Va. Admin. Code § 30-80-60
Derived From Virginia Register Volume 30, Issue 2, eff. October 23, 2013; Amended, Virginia Register Volume 34, Issue 01, eff. 10/4/2017; Amended, Virginia Register Volume 35, Issue 10, eff. 2/6/2019.

Statutory Authority: §§ 51.5-131 and 51.5-160 of the Code of Virginia.

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