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1999 SESSION

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HB 2567 Medical assistance services; coverage for leukemia.

Introduced by: Mary T. Christian | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED: (all summaries)

Medical assistance services. Requires Virginia Medicaid to cover high-dose chemotherapy and bone marrow transplant when this treatment is the appropriate treatment for individuals over the age of 21 who have been diagnosed with leukemia. Present law requires payment for this treatment for only lymphoma and breast cancer. The patient must have a performance status sufficient to proceed with the high-dose chemotherapy and bone marrow transplant.

This bill also provides for an appeal of the initial determination concerning provider reimbursement by the Director of the Department of Medical Assistance Services directly to court in lieu of an administrative process review. The appellant will be entitled to recover from the Department (a) reasonable costs and attorney fees, up to $25,000, if he substantially prevails on the merits of the case and the agency’s position is not substantially justified, unless special circumstances would make an award unjust, and (b) interest at the legal rate on any claim against the Department from the date the court finds payment by the Department was justly due. Emergency regulations to implement this bill are required by the second enactment. Technical amendments are made to improve the organization of this long statute and to provide accurate cross references in related statutes.


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