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.