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Agreement for Title IV-E Agencies and Providers for the Provision of Child Placement

Original Comment:

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Michele White
09-28-2017 (11:07am)
Addition to Article VIII. Article VIII Item F Medicaid/Insurance Upon receipt of formal documentation, agency will submit to Service Provider Medicaid/insurance numbers for children in agency custody, as applicable. The service provider is required to utilize Medicaid-approved healthcare providers in the appropriate managed care network for the provision of mental health, dental and/or medical services (hereafter referred to collectively as "medical services") to children in the custody of agency. The Service Provider will report applicable Medicaid/insurance information to the healthcare providers and instruct healthcare providers to seek payment from Medicaid or any other available third party payer for medical services rendered to children in agency custody. agency will not pay for the provision of any medical services to children in agency custody unless the agency Executive Director or authorized designee has provided specific prior written authorization for such medical services and associated costs. In situations where the Service Provider does not possess a Medicaid/insurance number or other information required to bill an alternative source for services provided to children in the custody of agency, the Service Provider must take the following actions. A. The Service Provider will contact agency for assistance with resolving Medicaid/insurance number issues. B. Within thirty (30) days if an invoice from a healthcare provider for services rendered to a child in agency custody, the Service Provider should forward the invoice to the agency information Failure to forward this invoice to agency within thirty (30) days will constitute a waiver of any claim against agency for payment of the invoice. If the Service Provider receives additional notices regarding the invoice, the Service Provider must contact the agency to confirm that agency received the initial invoice and to obtain the status of payment arrangements. The Service Provider SHALL NOT pay the invoice and expect or request reimbursement from FCCPS without the prior written approval of agency. C. If a child who is in custody of FCCPS requires pharmaceutical supplies, Service Provider must obtain the supplies from a pharmacy that accepts Medicaid/insurance payments. agency retains the right to recoup funds from the Service Provider upon the determination that third party funds are duplicative (in the aggregate) of agency payments to the Service Provider, or in the event that the Service Provider fails to properly credit any and all such third party payments. Relative to recouping funds, agency may withhold from subsequent reimbursement to the Service Provider an amount equal to any un-credited or duplicate third party payments. For purposes of this paragraph, "third party" includes, but is not limited to, Medicaid and private insurance companies. The Service Provider shall obtain and provide a written estimate for any non-routine, non-emergency, or out-of-network medical and dental expenses to agency along with the written recommendation of the physician or dentist. The Service Provider is not permitted to deliver or authorize any health/dental care or treatment services (including, but not limited to, mental health services), without the prior written consent of the agency Executive Director or authorized designee (see Consent for Medical Treatment letter).
0 Disagree with this
1 Agree with this