Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 150. Uninsured Medical Catastrophe Fund
10/19/2020

12VAC30-150-100. Appeals.

A. Except as otherwise provided in this section, a UMCF applicant may appeal an adverse determination regarding eligibility and the treatment plan. UMCF will follow the procedures established under 12VAC30-110, Eligibility and Appeals, except that applicants have no right to appeal a denial of benefits because of a lack of funds.

B. An applicant who wishes to appeal an adverse determination must follow an expedited appeal process to maintain a position on the waiting list if sufficient funds are not available. The expedited appeal has no impact on appeal rights granted under 12VAC30-110.

1. An expedited appeal must be made within 15 days of receiving an adverse determination.

2. The expedited appeal can be filed by facsimile, e-mail, or by regular mail or courier, but it must be in writing.

3. The agency's expedited appeal decision shall be rendered by a DMAS hearing officer.

4. The agency must make an expedited appeal decision within 15 days of receiving an appeal.

5. The agency shall advise the appellant within one day of its decision.

Statutory Authority

§§ 32.1-324.3 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from Volume 18, Issue 17, eff. June 6, 2002.

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