Section 1200.50 General Responsibilities of Individuals Receiving DSCC Program Benefits

Section 1200.50  General

Responsibilities of Individuals Receiving DSCC Program Benefits

a)         The LRA and provider shall

truthfully and factually supply all information and shall not in any way

falsify or cause the falsification of documents necessary to determine

eligibility for and provision of DSCC Program benefits.

b)         The

LRA shall promptly report any change in contact information.

c)         The LRA shall consent to

release of, or verification of, medical and financial information needed to

determine eligibility.

d)         The LRA shall promptly

report, within 30 days, any changes that may affect eligibility for DSCC

Program benefits, including but not limited to changes in medical insurance that

results in coverage for covered supports and services or diagnostic services

for which DSCC has been providing financial assistance and is the payer of last

resort.

e)         The LRA must make maximum

use of third party payments available for the applicant or recipient child,

including but not limited to enrolling in State and federally funded healthcare

programs such as Medicaid, CHIP, All Kids and Medicare; enrolling in private healthcare

insurance; and, in the sole discretion of the Director or designee, utilizing

private funds available to the applicant or recipient child.

f)         Maximum insurance benefits

must be used.  The LRA is responsible for and shall cause any other

responsible individuals to comply with insurance contract provisions required

to maximize the level of insurance benefits.

g)         The LRA must sign a

Reimbursement Agreement for the total amount of financial assistance provided

by DSCC whenever monies are recovered or can be recovered arising from any

claim, demand, or cause of action relating to the medical condition of the applicant

or recipient child from sources including but not limited to a lawsuit

judgment, settlement of a lawsuit, settlement in anticipation of litigation, or

insurance recovery or settlement

r the total amount of financial assistance provided

by DSCC whenever monies are recovered or can be recovered arising from any

claim, demand, or cause of action relating to the medical condition of the applicant

or recipient child from sources including but not limited to a lawsuit

judgment, settlement of a lawsuit, settlement in anticipation of litigation, or

insurance recovery or settlement.  At the request of DSCC, the LRA shall cause

any other individual with authority over the monies, including the attorney

retained to represent the LRA, applicant child or recipient child, to also sign

the Reimbursement Agreement.

h)         Failure to meet any

requirements of this Part may result in a complete or partial ineligibility

determination, termination, or suspension in DSCC Program benefits.  DSCC will

notify the LRA of these determinations through a Notice of Determination in

accordance with Section 1200.180.

i)          DSCC may, in its sole

discretion, pursue any actions necessary against all liable persons, including

but not limited to LRAs, for any payments made by DSCC that were inappropriate.