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2000 SESSION

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HB 892 Medical assistance services; appeals of overpayment.

Introduced by: Clifton A. (Chip) Woodrum | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED: (all summaries)

Medical assistance services; appeals. Provides that, to the extent not prohibited by federal statute or regulation, the findings of the Commissioner of Health, with respect to periodic surveys, i.e., inspections of nursing homes conducted pursuant to federal regulations relating to certification for reimbursement through Medicare and Medicaid, will be case decisions under the Administrative Process Act and will be subject to administrative appeal. Further, not withstanding the current limitations concerning court review of inspection findings, the Commissioner's nursing home survey findings will be subject to court review. This bill also provides for an initial determination in cases of appeal as to whether an overpayment has been made by the Virginia Medicaid program to a provider of medical assistance services to be made within 180 days of receipt of the appeal request. If such initial determination is not made within 180 days, the decision is presumed to be in favor of the provider. A hearing officer is to make a ruling within 120 days, and the Director of the Department of Medical Assistance Services then has 60 days to adopt the recommendation of the hearing officer unless to do so would be in error of law or department policy. Rejection of the ruling by the hearing officer must be explained. No recovery can be made prior to the final decision, and interest will accrue on any amounts from the date of the final determination. The burden of proof is on the provider who shall receive reasonable attorney's fees on a one-time basis if he substantially prevails. The Board of Medical Assistance Services is required to promulgate emergency regulations. The Commissioner of Health must report to the Joint Commission on Health Care on the effects of the inspection findings being subject to administrative appeal, such as the kinds of survey deficiencies appealed, the reasons for the Department of Health's findings of deficiency, any federal actions taken as a result of the deficiencies, any effects on patient care, and the costs to the Commonwealth of the appeals.


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