Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Board of Medical Assistance Services intends to consider amending 12VAC30-60, Standards Established and Methods Used to Assure High Quality Care, and 12VAC30-141, Family Access to Medical Insurance Security Plan. The purpose of the proposed action is to consider standardizing (i) the utilization review process for all provider types, including the deadlines for providers to submit documentation, (ii) documentation deadlines for the cost settlement process, and (iii) the audit process, including what letters are sent to providers, what documentation may be submitted and when it may be submitted, and what deadlines apply. The proposed action is intended to conform the Medicaid and Family Access to Medical Insurance Security Plan utilization review regulations to decisions of the Virginia Court of Appeals in 1st Stop Health Services, Inc. vs. DMAS, 63 Va. App. 266, 756 S.E.2d 183 (2014) and DMAS v. Ablix Corporation, 2015 Va. App. LEXIS 82 (March 17, 2015).

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Public Comment Deadline: February 10, 2016.

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 emily.mcclellan@dmas.virginia.gov.