A child with special needs who resides in this state and who is the subject of an adoption assistance agreement with another state is entitled to receive a medical assistance identification from this state on the filing in the state medical assistance agency of a certified copy of the adoption assistance agreement obtained from the adoption assistance state. In accordance with rules of the state medical assistance agency, the adoptive parents, at least annually, shall show that the agreement is still in effect or has been renewed.
The state medical assistance agency shall consider the holder of a medical assistance identification as any other holder of a medical assistance identification under the laws of this state and shall process and make payment on claims on the holder’s account in the same manner and under the same conditions and procedures as for other recipients of medical assistance.
The state medical assistance 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 Department of Protective and Regulatory Services for the coverage or benefits, if any, not provided by the residence state. 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 for those amounts. Services or benefit amounts covered under any insurance or other third-party medical contract or arrangement held by the child or the adoptive parents may not be reimbursed. The additional coverage and benefit amounts provided are for services for which there is no federal contribution or services that, if federally aided, are not provided by the residence state. The rules shall include procedures for obtaining prior approval for services in cases in which prior approval is required for the assistance.
The submission of a false, misleading, or fraudulent claim for payment or reimbursement for services or benefits or the making of a false, misleading, or fraudulent statement in connection with the claim is an offense if the person submitting the claim or making the statement knows or should know that the claim or statement is false, misleading, or fraudulent. A person who commits an offense may be liable for a fine not to exceed $10,000 or imprisonment for not more than two years, or both the fine and the imprisonment. An offense that also constitutes an offense under other law may be punished under either this subsection or the other applicable law.
This article applies only to medical assistance for children under adoption assistance agreements with 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 under adoption assistance agreements entered into by this state are eligible to receive the medical assistance in accordance with the laws and procedures that apply to the agreement.
If considering adoption, do not hesitate to call the San Antonio attorneys of the law office of Arthur G. Augustine at (210)299-4777 for a free consultation.
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