Code of the District of Columbia

§ 4–324. Medical assistance.

(a) A child with special needs who is resident in the District and who is the subject of an adoption assistance agreement with another state shall be entitled to receive a medical assistance identification from the District upon the filing with 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 shall consider the holder of a medical assistance identification pursuant to this section as any other holder of a medical assistance identification under the laws of the District 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)(1) The Department shall provide coverage and benefits for a child who is in another state and who is covered by an adoption assistance agreement made by the Department for the coverage or benefits, if any, not provided by the residence state. To this end, the adoptive parents acting for the child may submit evidence of payment for services or benefit amounts not payable in the residence state and shall be reimbursed therefore. 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.

(2) The additional coverage and benefit amounts provided pursuant to this subsection shall be for the cost of services for which there is no federal contribution, or which, if federally aided, are not provided by the residence state.

(3) The Mayor shall make regulations implementing this subsection. The regulations shall include procedures to be followed in obtaining prior approvals for services in those instances where 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 not to exceed $10,000 or imprisonment for not to exceed 30 days, or both. A violation of this subsection shall be prosecuted by the Corporation Counsel of the District of Columbia.

(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 the District under which the other state provided medical assistance to children with special needs under adoption assistance agreements made by the District. All other children entitled to medical assistance pursuant to adoption assistance agreements entered into by the District shall be eligible to receive it in accordance with the laws and procedures applicable thereto.