Common use of Supplementation Clause in Contracts

Supplementation. a. Before a Contractor may request supplemental payments for items not covered in the Medicaid rate, the Contractor must have a supplemental payment policy that has been given to all applicants for admittance and current residents. The policy must be in accordance with WAC 388-105-0050 and 388-105-0055 and must follow the Contract per WAC 000-00-00000. The Contractor may not request supplemental payment of a Medicaid recipient's daily rate for services, items not covered by the Medicaid daily rate, move-in fees, and/or refundable or non-refundable deposits, in accordance with chapter 388-76 WAC, RCW 70.129.030(4), RCW 74.39A.901, this Contract, and the Client’s NCP. b. The Contractor must disclose in the Admission Agreement per WAC 000-00-00000 and the Policy on accepting Medicaid as a payment source WAC 000-00-00000, any changes that could occur if a resident becomes eligible for Medicaid funding. The Contractor shall refund to the Client, on a prorated basis, the amount prepaid for care of that Client in the event that the Client becomes eligible for Medicaid funding or moves out of the home before the end of the month. c. If a family member or friend purchases additional items or services through the Contractor that are not provided for under the Medicaid contract, he or she must pay the Contractor directly to avoid jeopardizing the Client’s financial eligibility. In all cases of supplementation, the Contractor is required to notify the DSHS Case Manager of the additional charges, what they are for, and who is paying them. Violations of the supplementation WACs will be reported to the RCS Complaint Resolution Unit. CRU will investigate and refer to the Medicaid Fraud Unit if appropriate.