1997 Session

Budget Amendments - HB1600 (Committee Approved)

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Medicaid Appeals for Service Denials (language only)

Item 322 #12h

Item 322 #12h

Health And Human Resources
Medical Assistance Services, Department of

Page 229, following line 50, insert:
"R.  Notwithstanding the provisions of §32.1-324.1, Code of Virginia, for Medicaid-eligible persons who have been denied preauthorization for a medical treatment, service, or medication, the Department of Medical Assistance Services shall make case decisions on the appeal for benefits within 30 days of receipt of the appeal provided that the treating physician provides medical certification that the person has a progressive disease which requires immediate treatment, service, or medication."

(This amendment provides an expedited Medicaid appeals process for certain Medicaid recipients when that person is denied services which require preauthorization and who may have a medical condition which requires immediate treatment and for whom an expedited appeal decision is needed.)