§ 5405. Medical assistance.
500 words·~2 min read·
/de/title-31/chapter-54-interstate-adoption-assistance-compacts/5405·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(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 Medical Assistance Office of a certified copy of the adoption assistance agreement obtained from the adoption assistance state. In accordance with regulations of the Medical Assistance Office, the adoptive parents shall be required at least annually to show that the agreement is still in force or has been renewed.
(b)The State Medical Assistance Office 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 Medical Assistance Office or other appropriate state agency 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 State Adoption Assistance Agency 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 Department of Services for Children, Youth and Their Families shall make regulations 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 regulations shall include procedures to be followed in obtaining prior approvals for services in those instances where required for the assistance.
(d)The submission of any claim for payment or reimbursement for services or benefits pursuant to this section or the making of any statement in connection therewith, which claim or statement the maker knows or should know to be false, misleading or fraudulent shall be punishable as perjury and shall also be subject to a fine of not to exceed $10,000 or imprisonment for not to exceed 2 years, or both such fine and imprisonment.
(e)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.