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The form used for this purpose is State Form 35937 Medicaid Recipients Claim to Defray Burial Costs. Effective July 1, 2014, any claim under this section must be submitted with the signed claim form and all necessary supporting documentation to the FSSA office within ninety (90) days of the date of death. Failure to submit all documents within 90 days of the date of death may result in denial of such claim by the FSSA. 4815.05.00 SUBMISSION OF CEMETERY CLAIM BY FUNERAL DIRECTOR (MED 1) A funeral director may file and receive payment for cemetery expenses if they attach proof to the claim that either (1) They are a cemetery representative, or (2) they have been designated such by the cemetery representative. In addition, the funeral director must attach a signed receipt verifying the cemetery expenses have been paid. If there was no charge for opening and closing the grave, a notation to this effect must be entered on the claim by the funeral director. If the funeral director is designated as the cemetery representative, cemetery claims submitted by any other party will not be paid. 4820.00.00 CONSIDERATION OF BURIAL CLAIMS BY FSSA (MED 1) The payment of funeral and cemetery expenses is based upon the charges for burial expenses, the existence of other funds to meet such expenses, and the legal maximum payments from public funds. If other resources are determined to be available a summary of those resources should be listed. Amounts paid by all other sources toward burial expenses should be verified by the FSSA before a recommendation for payment is made. If resources are determined post payment, then reimbursement back to the FSSA will be requested. If the FSSA determines that payments made toward burial expenses are insufficient to cover the costs, and payment of the claim is to be approved by the FSSA, the FSSA Authorized Designee shall: • Certify that State Form 35937 is in proper form and that the amount being recommended for payment is correct based on information submitted by the funeral director or the cemetery representative. • Sign the form, file the original copy, and submit a copy to Accounts Payable. 4825.00.00 VERIFICATION BY FSSA OF BURIAL CONTRIBUTIONS (MED 1) In the event inaccurate information was recorded on the funeral and/or cemetery claim regarding the amount of the individual contribution, the FSSA will follow up. If it is determined that there was collusion, misrepresentation, or apparent fraud on the part of the funeral director and/or the cemetery representative to obtain more payment, the FSSA will refer the case for prosecution.