Administrative Code

Virginia Administrative Code
8/9/2022

Part XII. Health Insurance Premium Payment Program (Hipp)

12VAC30-130-740. General.

The requirements of this part shall operate in concert with the HIPP program requirements as contained in the State Plan for Medical Assistance, specifically Attachment 4.22-C (VR 460-02-4.2230).

Statutory Authority

§ 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-4.2230 § 1, eff. April 1, 1993.

12VAC30-130-750. Time frames for determining cost effectiveness.

A. The department (DMAS) shall determine eligibility for the program and shall provide notice to the recipient within 45 calendar days from the date of receiving an application that contains all information and verifications necessary to determine eligibility.

B. Incomplete applications shall be held for a period of 30 calendar days to enable applicants to provide outstanding information needed for an eligibility determination. Any applicant who fails to provide information or verifications necessary to determine eligibility within 30 calendar days of the receipt of the initial application shall have his application denied.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-4.2230 § 2, eff. April 1, 1993; amended, Virginia Register Volume 25, Issue 20, eff. July 23, 2009.

12VAC30-130-760. Notices.

An adequate notice consistent with 42 CFR 431.210 shall be provided to the recipient, person carrying the group health plan policy or responsible person in the case under the following circumstances:

1. To inform the household of the decision on cost effectiveness and premium payment.

2. To inform the household that premium payments are being discontinued because Medicaid eligibility has been lost by all persons covered under the group health plan.

3. To inform the household that premium payments are being discontinued because the group health plan is no longer available to the family (e.g., the employer drops insurance coverage or the plan is terminated by the insurance company).

4. To inform the household that premium payments are being discontinued because DMAS has determined it is no longer cost effective to pay the premiums.

Statutory Authority

§ 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-4.2230 § 3, eff. April 1, 1993.

12VAC30-130-770. [Reserved]. (Reserved)

12VAC30-130-780. (Repealed.)

Historical Notes

Derived from VR460-04-4.2230 § 5, eff. April 1, 1993; repealed, Virginia Register Volume 25, Issue 20, eff. July 23, 2009.

12VAC30-130-790. Information required of applicants and recipients.

All applicants and recipients shall be required to provide the information required on the prescribed DMAS HIPP applications forms and all requested information to determine eligibility and cost effectiveness.

Statutory Authority

§§32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-4.2230 § 6, eff. April 1, 1993; amended, Virginia Register Volume 25, Issue 20, eff. July 23, 2009.

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