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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>87103</law_id><section_number>32.1-325.1:1</section_number><catch_line>Definitions; recovery of overpayment for medical assistance services</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="10">Department of Medical Assistance Services</unit><unit label="article" level="3" order_by="1" identifier="1">General Provisions</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> For the purposes of this section, the following definitions shall apply:
			&#x201C;<span class="dictionary">Agreement</span>&#x201D; means any <span class="dictionary">contract</span> executed for the delivery of services to recipients of medical assistance pursuant to subdivision D 2 of &#xA7; <a class="law" title="Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers" href="/32.1-325/">32.1-325</a>.
			&#x201C;<span class="dictionary">Successor in interest</span>&#x201D; means any <span class="dictionary">person</span> as defined in &#xA7; <a class="law" title="Person" href="/1-230/">1-230</a> having stockholders, directors, officers, or partners in common with a health care provider for which an <span class="dictionary">agreement</span> has been terminated.
			&#x201C;<span class="dictionary">Termination</span>&#x201D; means (i) the cessation of operations by a provider, (ii) the sale or transfer of the provider, (iii) the reorganization or restructuring of the health care provider, or (iv) the <span class="dictionary">termination</span> of an <span class="dictionary">agreement</span> by either <span class="dictionary">party</span>. <a id="paragraph-311901" class="section-permalink" href="https://vacode.org/32.1-325.1_1/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The Director of Medical Assistance Services shall collect by any means available to him at <span class="dictionary">law</span> any amount owed to the Commonwealth because of overpayment for medical assistance services. Upon making an initial determination that an overpayment has been made to the provider pursuant to &#xA7; <a class="law" title="Appeals of agency determinations" href="/32.1-325.1/">32.1-325.1</a>, the Director shall notify the provider of the amount of the overpayment. Such initial determination shall be made within the earlier of (i) four years, or (ii) 15 months after filing of the final cost report by the provider subsequent to sale of the facility or <span class="dictionary">termination</span> of the provider. The provider shall make arrangements satisfactory to the Director to repay the amount due. If the provider fails or refuses to make arrangements satisfactory to the Director for such repayment or fails or refuses to repay the Commonwealth for the amount due for overpayment in a timely manner, the Director may devise a schedule for reducing the Medicaid reimbursement due to any <span class="dictionary">successor in interest</span>. <a id="paragraph-311902" class="section-permalink" href="https://vacode.org/32.1-325.1_1/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> In any case in which the Director is unable to recover the amount due for overpayment pursuant to subsection B, he shall not enter into another <span class="dictionary">agreement</span> with the responsible provider or any <span class="dictionary">person</span> who is the transferee, assignee, or <span class="dictionary">successor in interest</span> to such provider unless (i) he receives satisfactory assurances of repayment of all amounts due or (ii) the <span class="dictionary">agreement</span> with the provider is necessary in <span class="dictionary">order</span> to ensure that Medicaid recipients have access to the covered services rendered by the provider.
			Further, to the extent consistent with federal and state <span class="dictionary">law</span>, the Director shall not enter into any <span class="dictionary">agreement</span> with a provider having any stockholder possessing a <span class="dictionary">material</span> financial interest, partner, director, officer, or owner in common with a provider which has terminated a previous <span class="dictionary">agreement</span> for participation in the medical assistance services program without making satisfactory arrangements to repay all outstanding Medicaid overpayment. <a id="paragraph-311903" class="section-permalink" href="https://vacode.org/32.1-325.1_1/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> The provisions of this section shall not apply to successors in interest with respect to transfer of a <span class="dictionary">medical care facility</span> pursuant to <span class="dictionary">contracts</span> entered into before February 1, 1990. <a id="paragraph-311904" class="section-permalink" href="https://vacode.org/32.1-325.1_1/#D"><i class="fa fa-link"/></a></p></section></text><history>1990, c. 389; 1994, c. 669; 1999, c. 1024; 2005, c. 839.</history><metadata></metadata></law>
