Ala. Admin. Code r. 560-X-33-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-33-.04 - Recoupments

(1) Direct Reimbursement - At the time of original identification of the expected amount of recoupment, a letter will be sent to the recipient/authorized representative or provider outlining the allegations and stating the amount of reimbursement and the specific dates when overpayment or recoverable benefits occurred. The recipient/authorized representative or provider will be offered the opportunity to present evidence to rebut the requirement for recoupment or to submit the reimbursement. If no rebuttal is offered, the original assessment will be presumed correct. The Alabama Medicaid Agency will accept direct reimbursement from the recipient/authorized representative or provider to satisfy the recoupment.

(2) Time Payment Plan

(a) Recipient Recoupment-Upon sufficient justification, the Alabama Medicaid Agency may allow a time payment plan. The recipient will be required to sign a promissory note not to exceed two years.

(b) Provider Recoupment-Upon sufficient justification, the Alabama Medicaid Agency may allow a time payment plan. The provider will be required to sign a promissory note not to exceed one year.

(3) Fiscal Agent Recoupment

(a) Recipient Recoupment-In the event the provider is the payee for the recipient and has received the monies to be recouped, the Agency's fiscal agent will recoup the excess payment from a future adjustment payroll.

(b) Provider Recoupment-Upon receipt of a recoupment letter, if the provider does not submit direct reimbursement or agree to a time payment plan or if the provider fails to submit a timely payment pursuant to a promissory note, the Agency's fiscal agent will recoup the amount from a future adjustment payroll.

(4) Civil Actions - Civil actions through the courts may be initiated on cases where the above procedures have not resulted in a satisfactory resolution.

Ala. Admin. Code r. 560-X-33-.04

Rule effective October 1, 1982. Amended effective April 15, 1983.

Amended by Alabama Administrative Monthly Volume XXXIV, Issue No. 03, December 31, 2015, eff. 1/25/2016.

Author: Keith Thompson, Director, Third Party Liability

Statutory Authority: Social Security Act; State Plan; U.S.C. §1396p; 42 C.F.R. Parts 431, 433, and 455; Code of Ala. 1975, §§ 22-1-11, 22-6-8.