12 Va. Admin. Code § 30-150-90 - Application procedures and waiting list
A. An application for assistance under the
Uninsured Medical Catastrophe Fund must be on a form prescribed by DMAS and
signed by the applicant. Funds will be committed on behalf of eligible
individuals on a first-come, first-served basis based on the date and time the
original signed application is received by DMAS or its agent.
B. Applicants must:
(i) provide a statement signed by a physician
licensed in the state in which he practices who has examined the individual
certifying that the individual has a life-threatening illness or injury as
defined in this regulation and
(ii)
submit a treatment plan developed by a potential contracting provider and
signed by a physician licensed in the state in which he practices.
C. It is the responsibility of the
applicant to provide financial and medical information necessary to determine
eligibility and approve the treatment plan. Failure to complete the
application, submit the items in subsection B of this section, or provide
requested information within 30 days of the date of the original signed
application is grounds for denial.
D. Eligibility for Uninsured Medical
Catastrophe Funds and approval of the treatment plan shall be determined by
DMAS within 45 days of the date the original signed application was received.
DMAS will not fully evaluate an application if it has determined that there is
at least one cause for disqualification. DMAS shall advise in writing all
applicants within 45 days of its determination about their
applications.
E. DMAS may establish
a waiting list if funds are insufficient to make commitments for all
applicants. Applicants will be placed on the waiting list in the order that the
original signed application was received by DMAS or its agent. An applicant
will be taken off the waiting list if (i) there is an adverse determination
regarding eligibility and no expedited appeal has been requested, (ii) the
treatment plan is denied, (iii) the applicant requests to be taken off the
waiting list, or (iv) the applicant dies. An applicant who prevails on appeal
or in circuit court will be restored to the waiting list based on the date of
the original signed application, but this action does not affect any contracts
signed in the interim.
F. If more
than 60 days have elapsed between the date that DMAS initially determines an
applicant eligible and approves the treatment plan and the date that funds
become available, DMAS may review and revise the eligibility and treatment plan
decisions. DMAS may require applicants to update the information provided in
the original application.
G. An
application may be denied if no provider is willing to contract with DMAS
pursuant to
12VAC30-150-70 within 30 days of a
favorable determination of eligibility, approval of the treatment plan, and the
availability of funds.
H. DMAS may
establish additional application procedures as necessary.
Notes
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of Virginia.
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