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.  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.