TITLE 12. HEALTH
Title of Regulation: 12VAC30-20. Administration of Medical
Assistance Services (adding 12VAC30-20-570).
Statutory Authority: § 2.2-4023.1 of the Code of
Effective Dates: December 6, 2016, through June 5, 2018.
Agency Contact: Emily McClellan, Regulatory Supervisor,
Policy Division, Department of Medical Assistance Services, 600 East Broad
Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804)
786-1680, or email email@example.com.
Section 2.2-4011 of the Code of Virginia states that
agencies may adopt emergency regulations in situations in which Virginia
statutory law or the appropriation act or federal law or federal regulation
requires that a regulation be effective in 280 days or less from its enactment,
and the regulation is not exempt under the provisions of § 2.2-4006 A 4 of
the Code of Virginia. Chapter 694 of the 2016 Acts of Assembly, which enacted §
2.2-4023.1 of the Code of Virginia, establishes a reconsideration process by
which appellants may petition the agency director to reconsider the final
agency decision made pursuant to the § 2.2-4020 of the Code of Virginia.
Chapter 694 specifically authorizes the agency to promulgate emergency
regulations to specify the scope of the reconsideration review. This emergency
regulation adding 12VAC30-20-570 is needed to accomplish the goal of
establishing and defining the scope of review for reconsiderations conducted in
accordance with § 2.2-4023.1 of the Code of Virginia. The reconsideration shall
not authorize the reopening of the formal administrative hearing or acceptance
of evidence or testimony not part of the record of the case in accordance with
1st Stop Health Services v. DMAS, 63 Va. App. 266, 756 S.E.2d 183 (2014).
This regulatory action is essential to protect the health,
safety, and welfare of citizens by ensuring the integrity of the Department of
Medical Assistance Services appeals process by ensuring that it is in accordance
with the Code of Virginia so that individuals and providers may challenge
health care determinations made by the state Medicaid agency.
Prior to the enactment of § 2.2-4023.1 of the Code of
Virginia, there was no process by which an appellant could petition the agency
director to reconsider a final agency case decision made pursuant to
§ 2.2-4020 of the Code of Virginia.
12VAC30-20-570. Reconsideration of final agency decision.
A. Reconsiderations of a DMAS final appeal decision issued
on a formal appeal conducted pursuant to § 2.2-4020 of the Code of
Virginia shall be conducted in accordance with § 2.2-4023.1 of the Code of
B. The DMAS director's review shall be made upon the case
record of the formal appeal. Testimony or documentary submissions that were not
part of the formal appeal case record prior to issuance of the final agency
decision shall not be considered.
VA.R. Doc. No. R17-4817; Filed December 6, 2016, 2:46 p.m.