2006 Code of Virginia § 32.1-325.1:1 - Definitions; recovery of overpayment for medical assistance services

32.1-325.1:1. Definitions; recovery of overpayment for medical assistanceservices.

A. For the purposes of this section, the following definitions shall apply:

"Agreement" means any contract executed for the delivery of services torecipients of medical assistance pursuant to subdivision D 2 of 32.1-325.

"Successor in interest" means any person as defined in 1-230 havingstockholders, directors, officers, or partners in common with a health careprovider for which an agreement has been terminated.

"Termination" means (i) the cessation of operations by a provider, (ii) thesale or transfer of the provider, (iii) the reorganization or restructuringof the health care provider, or (iv) the termination of an agreement byeither party.

B. The Director of Medical Assistance Services shall collect by any meansavailable to him at law any amount owed to the Commonwealth because ofoverpayment for medical assistance services. Upon making an initialdetermination that an overpayment has been made to the provider pursuant to 32.1-325.1, the Director shall notify the provider of the amount of theoverpayment. Such initial determination shall be made within the earlier of(i) four years, or (ii) 15 months after filing of the final cost report bythe provider subsequent to sale of the facility or termination of theprovider. The provider shall make arrangements satisfactory to the Directorto repay the amount due. If the provider fails or refuses to makearrangements satisfactory to the Director for such repayment or fails orrefuses to repay the Commonwealth for the amount due for overpayment in atimely manner, the Director may devise a schedule for reducing the Medicaidreimbursement due to any successor in interest.

C. In any case in which the Director is unable to recover the amount due foroverpayment pursuant to subsection B, he shall not enter into anotheragreement with the responsible provider or any person who is the transferee,assignee, or successor in interest to such provider unless (i) he receivessatisfactory assurances of repayment of all amounts due or (ii) the agreementwith the provider is necessary in order to ensure that Medicaid recipientshave access to the covered services rendered by the provider.

Further, to the extent consistent with federal and state law, the Directorshall not enter into any agreement with a provider having any stockholderpossessing a material financial interest, partner, director, officer, orowner in common with a provider which has terminated a previous agreement forparticipation in the medical assistance services program without makingsatisfactory arrangements to repay all outstanding Medicaid overpayment.

D. The provisions of this section shall not apply to successors in interestwith respect to transfer of a medical care facility pursuant to contractsentered into before February 1, 1990.

(1990, c. 389; 1994, c. 669; 1999, c. 1024; 2005, c. 839.)