12 Va. Admin. Code § 35-225-420

Current through Register Vol. 41, No. 6, November 4, 2024

Section 12VAC35-225-420 - Appeal to the Department of Medical Assistance Services

A. In addition to the dispute resolution options described in this chapter, Medicaid or FAMIS recipients seeking to contest service decisions shall have the right to file an appeal with the Department of Medical Assistance Services pursuant to federal and state Medicaid law. If the individual is enrolled in a Medicaid managed care organization or "MCO," the internal appeal process for the Medicaid MCO must be exhausted or deemed exhausted before appealing to the Department of Medical Assistance Services. Appeals to the Department of Medical Assistance Services are separate from the dispute resolution options available under this chapter and shall comply with applicable Department of Medical Assistance Services' regulations.

B. A notice of action meeting federal and state requirements must be issued to the individual explaining the basis for the action and the right to appeal.

C. Families shall follow all applicable Department of Medical Assistance Services requirements when filing an appeal.

12 Va. Admin. Code § 35-225-420

Derived From Virginia Register Volume 32, Issue 10, eff. 2/27/2016; Amended, Virginia Register Volume 37, Issue 17, eff. 5/28/2021.

Statutory Authority: § 2.2-5304 of the Code of Virginia.