Section 60. Reimbursement

A. Any moneys contributed toward the cost of care pending AG eligibility determination shall be reimbursed to the individual or contributing party by the ALF or AFC provider once eligibility for AG is established and that payment received. The payment shall be made payable to the individual, who will then reimburse the provider for care. If the individual is not capable of managing his finances, his personal representative is responsible for reimbursing the provider.

B. In the event an ALF is closed, the facility shall prorate the rate up to the date of the individual's discharge and return the balance to the local department of social services that determined the individual's eligibility for the grant. If the facility maintained the individual's personal needs allowance, the facility shall provide a final accounting of the individual's personal needs allowance account within 60 days of the individual's discharge. Verification of the accounting and of the reimbursement to the individual shall be mailed to the case management agency responsible for the individual's annual reassessment. In the event of the individual's death, the provider shall give to the individual's personal representative a final accounting of the individual's funds within 60 calendar days of the event. All AG funds received after the death or discharge date shall be returned to the local department of social services responsible for determining the individual's AG eligibility as soon as practicable. Providers who do not comply with the requirements of this regulation may be subject to adverse action.

Historical Notes

Former 22VAC40-25-60, derived from VR615-01-51 § 6, eff. February 1, 1996; amended, Volume 23, Issue 20, eff. August 1, 2007; Volume 29, Issue 05, eff. December 5, 2012; renumbered as 22VAC30-80-60, Virginia Register Volume 30, Issue 02, eff. October 23, 2013.

Statutory Authority

§§ 51.5-131 and 51.5-160 of the Code of Virginia.