Part VII. Appeal Process
12VAC5-200-270. Rights.
A. If an applicant for or recipient of medical care services is denied services, has services terminated, wishes to contest the determined income level, or is denied a waiver as defined in Part VI (12VAC5-200-220 et seq.) of this chapter, the applicant or recipient is entitled to appeal that action as set forth under this part.
B. The district director shall notify the applicant or recipient in writing of the appeal process, including time limits, and the right to receive a written statement of the reasons for denial. If a person already receiving services is denied those services, a written notice of termination shall be given 30 days in advance of discontinuing services. The applicant or recipient has the right to confront any witnesses who may have testified against him.
C. An individual or the individual's representative may make a written or oral appeal to the district or program director within 30 days of the denial of service.
D. Upon receipt of the appeal, the district director shall review and make written recommendations to the commissioner or commissioner's designee within 15 days. Within 45 days following the date on which an appeal is filed, the commissioner or commissioner's designee shall make a final decision and notify the district director of the decision in writing.
E. The district director or the program director shall notify the individual or the individual's representative in writing of the final decision.
F. The department shall continue to provide medical care services to the applicant or recipient during the appeal process.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Historical Notes
Derived from VR355-39-100 § 7.1, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004; Volume 42, Issue 9, eff. January 29, 2026.
