Section 0720-19-.05 - REIMBURSEMENT(1)(a) The Department shall reimburse an approved and participating residential home for the aged for each day of care and services given to an approved and participating resident as permitted by allocated funding.(b) The Department will reimburse a participating home the current amount as defined in T.C.A. § 12-4-320(b) of thirteen dollars ($13.00) per eligible resident day, not to exceed the maximum allowable percentage rate based on the allotted contract amount for the current fiscal year.(c) Claims for reimbursement shall be submitted quarterly to the Department on forms approved by the Department. The authorized representative of the Residential Home for the Aged shall certify the participant's continued eligibility for services during the previous quarter, attesting that the representative has personally examined documents demonstrating that continued eligibility. In order to be reimbursed, all claims must be submitted no later that fifteen (15) days from the last full day upon which the service was rendered, except for claims occurring before the effective date and implementation of these regulations.(d) The Department may recoup or recover funds paid to any provider for services rendered to an ineligible recipient, or if the provider has accepted prohibited payments from any other individual on behalf of the resident.Tenn. Comp. R. & Regs. 0720-19-.05
Original rule filed June 7, 1974; effective July 7, 1974. Repeal and new rule filed January 13, 1987; effective February 27, 1987. Amendment filed June 20, 1988; effective September 28, 1988. Amendment filed April 1, 1992; effective May 16, 1992. Amendment filed December 4, 1992; effective January 19, 1993. Amendment filed June 19, 1995; effective September 2, 1995. Amendment filed August 23, 2006; effective November 6, 2006. Transferred from chapter 1200-08-07 pursuant to Public Chapter 1119 of 2022 effective 7/1/2022.Authority: T.C.A. §§ 4-5-202, 4-5-204, 12-4-320 (Public Acts of 1986, Chapter 927), and 68-11-209.