                                 CODE OF VIRGINIA

MEDICAL ASSISTANCE; PENALTIES (§ 63.2-1404)

A. A child with special needs resident in this Commonwealth who is the subject
of an adoption assistance agreement with another state shall be entitled to
receive a medical assistance identification from this Commonwealth upon the
filing in the Department of a certified copy of the adoption assistance
agreement obtained from the adoption assistance state. In accordance with
regulations of the Department, the adoptive parents shall be required at least
annually to show that the agreement is still in force or has been renewed.

B. The Department of Medical Assistance Services shall consider the holder of
medical assistance identification pursuant to this section as any other holder
of a medical assistance identification under the laws of this Commonwealth 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 Department shall provide coverage and benefits not provided by the state
plan for medical assistance in the residence state for a child who is in another
state and who is covered by an adoption assistance agreement made in Virginia to
the extent required by the agreement. 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 Medical Assistance Services shall adopt regulations implementing
this subsection. The additional coverages and benefit amounts provided pursuant
to this subsection shall be for services for which there is no federal financial
contribution or which, if federally aided, are not provided by the residence
state. Such regulations shall include procedures to be followed in obtaining
prior approvals for services when such approval is 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 more than $10,000, or imprisonment for not more than
two years, or both.

E. The provisions of this section shall apply only to medical assistance for
children under adoption assistance agreements from states that have entered into
a compact with this Commonwealth under which the other state provides medical
assistance to children with special needs under adoption assistance agreements
made by this Commonwealth. All other children entitled to medical assistance
pursuant to adoption assistance agreements entered into by this Commonwealth
shall be eligible to receive it in accordance with the laws and procedures
applicable thereto.

HISTORY: 1988, c. 154, § 63.1-238.10; 2002, c. 747.