reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 2 - Prehearing Review › Section 12VAC30-110-200 - Medical assessment

Current through Register Vol. 40, No. 24, July 15, 2024
A. A
						hearing officer may order an independent medical assessment when:
1. The hearing involves medical issues such
						as a diagnosis, an examining physician's report, or a medical review team's
						decision; and
2. The hearing
						officer determines it necessary to have an assessment by someone other than the
						person or team who made the original decision, for example, to obtain more
						detailed medical findings about the impairments, to obtain technical or
						specialized medical information, or to resolve conflicts or differences in
						medical findings or assessments in the existing evidence.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 2 - Prehearing Review › Section 12VAC30-110-210 - Prehearing action

Current through Register Vol. 40, No. 24, July 15, 2024
A. Invalidation.
						A Request for Appeal may be invalidated if it was not filed within the time
						limit imposed by
						12VAC30-110-160 or extended
						pursuant to 12VAC30-110-170.
1. If the
						hearing officer determines that the appellant has failed to file a timely
						appeal, the hearing officer shall notify the appellant and the appellant's
						representative of the opportunity to show good cause for the late
						appeal.
2. If a factual dispute
						exists about the timeliness of the Request for Appeal, the hearing officer
						shall receive evidence or testimony on those matters before taking final
						action.
3. If the individual filing
						the appeal is not the appellant or an authorized representative of the
						appellant under the provisions of
						12VAC30-110-60 A, the appeal shall
						be determined invalid.
4. If a
						Request for Appeal is invalidated, the hearing officer shall issue a decision
						pursuant to
						12VAC30-110-370.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-220 - Evidentiary hearings

Current through Register Vol. 40, No. 24, July 15, 2024
A. General.
						The hearing officer shall review all agency determinations that are properly
						appealed; conduct informal, fact-gathering hearings; evaluate evidence
						presented; and issue a written final decision that is based on the evidence and
						policy relevant to the appeal.
B.
						De novo hearing. All hearings shall be considered "de novo," meaning that the
						department's hearing officer will consider all relevant evidence submitted
						during the appeal in order to make a determination on the issues on appeal,
						even if the evidence was not previously received by the agency. The hearing
						officer shall consider testimony and evidence that explains, supports, or is
						probative to the issues on appeal.
C. Burden of proof. The burden of proof shall
						be assigned to the party who is attempting to change the status quo. If an
						individual is seeking initial Medicaid eligibility, an increase in the Medicaid
						eligibility level, or the initial approval of a medical service, the individual
						has the burden of proof. Conversely, when an already-eligible individual is
						facing a proposed termination or reduction in Medicaid eligibility or medical
						services, the burden of proof shall be assigned to the entity that has proposed
						the change to an individual's coverage. To prevail in the appeal, the party
						with the assigned burden of proof shall establish its position to the
						satisfaction of the hearing officer by a preponderance of the
						evidence.
D. Submission of
						evidence. The appellant's appeal request should include all documents the
						appellant would like considered during the appeal. The appellant can also
						submit additional documents leading up to and during the appeal hearing. The
						hearing officer has the discretion to reschedule or delay a hearing in order to
						allow the hearing officer and agency time to review documents submitted close
						to or at the scheduled hearing. Post-hearing supplementation of the record is
						addressed in
						12VAC30-110-360.
						Failure to submit information with the appeal so that it can be moved forward
						will add delay to the appeal decision due date per
						42 CFR
						431.244.
Statutory Authority: § 32.1-325 of the Code of
							 Virginia;
							 42 USC §
															1396 et
							 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-230 - Scheduling and rescheduling

Current through Register Vol. 40, No. 24, July 15, 2024
A. To
						the extent possible, hearings will be scheduled at the appellant's convenience,
						with consideration of the travel distance required.
B. A hearing shall be rescheduled at the
						claimant's request no more than twice unless compelling reasons
						exist.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-250 - Notification

Current through Register Vol. 40, No. 24, July 15, 2024
When a hearing is scheduled, the appellant and his
						  representative shall be notified in writing of its time and
						  place.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-260 - Postponement

Current through Register Vol. 40, No. 24, July 15, 2024
A hearing may be postponed for good cause shown. No
						  postponement will be granted beyond 30 days after the date of the Request for
						  Appeal was filed unless the appellant or his representative waives in writing
						  the 90-day deadline for the final decision.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-270 - Location

Current through Register Vol. 40, No. 24, July 15, 2024
The hearing location shall be determined by the
						  division. If for medical reasons the appellant is unable to travel, the hearing
						  may be conducted at his residence.
The agency may respond to a series of individual
						  requests for hearings by conducting a single group hearing:
1. Only in cases in which the sole issue
						involved is one of federal or state law or policy; and
2. Each person must be permitted to present
						his own case or be represented by his authorized representative.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-280 - Client access to records

Current through Register Vol. 40, No. 24, July 15, 2024
Upon the request of the appellant or his
						  representative, at a reasonable time before the date of the hearing, as well as
						  during the hearing, the appellant and his representative may examine the
						  content of appellant's case file and all documents and records the agency will
						  rely on at the hearing.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-285 - Appeals Division access to agency records

Current through Register Vol. 40, No. 24, July 15, 2024
A hearing officer shall have access to agency
						  information necessary to issue a proper hearing decision that is sound and
						  legally supportable, including information concerning state policies and
						  regulations.
Statutory Authority: § 32.1-325 of the Code of
							 Virginia; 42 USC § 1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-290 - Subpoenas

Current through Register Vol. 40, No. 24, July 15, 2024
Appellants who require the attendance of witnesses or
						  the production of records, memoranda, papers, and other documents at the
						  hearing may request issuance of a subpoena in writing. The request must be
						  received by the division at least five business days before the hearing is
						  scheduled. Such request must include the witness' name, home and work address,
						  county or city of work and residence, and identify the sheriff's office which
						  will serve the subpoena.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-300 - Role of the hearing officer

Current through Register Vol. 40, No. 24, July 15, 2024
The hearing officer shall conduct the hearing, decide
						  on questions of evidence, procedure and law, question witnesses, and assure
						  that the hearing remains relevant to the issue or issues being appealed. The
						  hearing officer shall control the conduct of the hearing and decide who may
						  participate in or observe the hearing.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-310 - Informality of hearings

Current through Register Vol. 40, No. 24, July 15, 2024
Hearings shall be conducted in an informal,
						  nonadversarial manner. The appellant or his representative has the right to
						  bring witnesses, establish all pertinent facts and circumstances; present an
						  argument without undue interference, and question or refute the testimony or
						  evidence, including the opportunity to confront and cross-examine adverse
						  witnesses.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-320 - Evidence

Current through Register Vol. 40, No. 24, July 15, 2024
The rules of evidence shall not strictly apply. All
						  relevant, nonrepetitive evidence may be admitted, but the probative weight of
						  the evidence will be evaluated by the hearing officer.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-330 - Record of hearing

Current through Register Vol. 40, No. 24, July 15, 2024
All hearings shall be recorded either by court
						  reporter, tape recorders, or whatever other means the agency deems appropriate.
						  All exhibits accepted or rejected shall become part of the hearing
						  record.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-340 - Oath or affirmation

Current through Register Vol. 40, No. 24, July 15, 2024
All witnesses shall testify under oath which shall be
						  administered by the court reporter or the hearing officer, as delegated by the
						  department's director.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-350 - Dismissal of Request for Appeal

Current through Register Vol. 40, No. 24, July 15, 2024
A Request for Appeal may be dismissed if:
1. The appellant or his representative
						withdraws the request in writing; or
2. The appellant or his representative fails
						to appear at the scheduled hearing without good cause and does not reply within
						10 days after the hearing officer sends an inquiry as to whether the appellant
						wishes further action on the appeal.
Statutory Authority: § 32.1-325 of the Code of
							 Virginia; 42 USC § 1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-360 - Post-hearing supplementation of the record

Current through Register Vol. 40, No. 24, July 15, 2024
A. Medical assessment. Following a hearing, a
						hearing officer may order an independent medical assessment as described in
						12VAC30-110-200.
B. Additional evidence. The hearing officer
						may leave the hearing record opened for a specified period of time in order to
						receive additional evidence or argument from the appellant. If the record
						indicates that evidence exists which was not presented by either party, with
						the appellant's permission, the hearing officer may attempt to secure such
						evidence.
C. Appellant's right to
						reconvene hearing or comment. If the hearing officer receives additional
						evidence from a person other than the appellant or his representative, the
						hearing officer shall send a copy of such evidence to the appellant and his
						representative and give the appellant the opportunity to comment on such
						evidence in writing or to reconvene the hearing to respond to such
						evidence.
D. Any additional
						evidence received will become a part of the hearing record, but the hearing
						officer must determine whether or not it will be used in making the
						decision.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-370 - Final decision and transmission of the hearing record

Current through Register Vol. 40, No. 24, July 15, 2024
A. After
						conducting the hearing, reviewing the record, and deciding questions of law,
						the hearing officer shall issue a written final decision based upon the
						evidence and testimony presented. The hearing officer's final decision shall be
						considered as the agency's final administrative action pursuant to
						42 CFR
						431.244(f). The final
						decision shall include:
1. A description of
						the procedural development of the case;
2. Findings of fact that identify supporting
						evidence;
3. Conclusions of law
						that identify supporting regulations and law;
4. Conclusions and reasoning;
5. The specific action to be taken by the
						agency to implement the decision;
6. The deadline date by which further action
						must be taken; and
7. A cover
						letter stating that the hearing officer's decision is final, and stating that
						the final decision may be appealed directly to circuit court as provided in
						12VAC30-110-40.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-370 - Final decision and transmission of the hearing record

Current through Register Vol. 40, No. 24, July 15, 2024
A. After conducting
						the hearing, reviewing the record, and deciding questions of law, the hearing
						officer shall issue a written final decision based upon the evidence and
						testimony presented. The hearing officer's final decision shall be considered
						as the agency's final administrative action pursuant to
						42 CFR
						431.244(f). The final
						decision shall include:
1. A description of
						the procedural development of the case;
2. Findings of fact that identify supporting
						evidence;
3. Conclusions of law
						that identify supporting regulations and law;
4. Conclusions and reasoning;
5. The specific action to be taken by the
						agency to implement the decision;
6. The deadline date by which further action
						must be taken; and
7. A cover
						letter stating that the hearing officer's decision is final, and stating that
						the final decision may be appealed directly to circuit court as provided in
						12VAC30-110-40.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part I - Client Appeals › Subpart II - Hearing Officer Review › Article 3 - Hearing › Section 12VAC30-110-390 to 12VAC30-110-600

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-610 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
For those medically needy persons whose eligibility for
					 medical assistance is required by federal law to be dependent on the budget
					 methodology for Aid to Dependent Children, a home means the house and lot used
					 as the principal residence and all contiguous property.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-620 - Availability of real or personal property

Current through Register Vol. 40, No. 24, July 15, 2024
Real or personal property of a spouse is considered
					 available to a spouse if they are living together. Real or personal property of
					 a parent living in the home is considered available to his child or children,
					 except property owned by an SSI recipient is not considered available to his
					 children in determining their eligibility for Medicaid.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-630 - Income-producing real property other than the home for aged, blind and disabled individuals

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Income-producing real property other than the home does not affect eligibility
				  if:
1. It is used in a trade or business or
				  is otherwise income producing;
2.
				  The equity value (current market value less the.balance of any recorded liens
				  against the property) of the property does not exceed $6,000; and
3. The property produces a net annual income
				  to the individual of at least 6.0% of the property's equity value.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-640 - Income

Current through Register Vol. 40, No. 24, July 15, 2024
For the purposes of determining eligibility, income is
					 defined as the receipt of any property or services which an individual can
					 apply, either directly or by sale or conversion, to meet the individual's basic
					 needs for food, shelter, and clothing. Income is either earned (payment
					 received by the individual for services performed as an employee, or as a
					 result of being self-employed) or unearned (includes pensions, benefits,
					 prizes, inheritances, gifts, dividends, support and
					 maintenance).
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-650 - Deeming of income and resources; responsibility of spouses

Current through Register Vol. 40, No. 24, July 15, 2024
A. If an individual
				  and the spouse apply or are eligible for Medicaid as aged, blind, or disabled,
				  and they cease to live together (separate), their income and resources are
				  considered available (deemed) to each other for the time periods specified in
				  this section. After the appropriate time period, income or resources actually
				  contributed by the separated spouse to the individual are counted in
				  determining the individual's eligibility.
B. Reserved.
C. If spouses separate for any reason other
				  than institutionalization, their income and resources are deemed to each other
				  during the month in which they cease to live together. When spouses cease to
				  live together, their income and resources cease to be deemed to each other
				  beginning the first month following the month the couple ceases to live
				  together.
D. If only one spouse in
				  a couple applies for Medicaid or only one meets the aged, blind, or disabled
				  requirement, or if both spouses apply and are not eligible as a couple and they
				  separate, only the income and resources of the separated spouse that are
				  actually contributed to the individual are counted as available to the
				  individual beginning with the month after the month in which they cease to live
				  together.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-660 - Deeming of income and resources; responsibility of parents for blind or disabled children

Current through Register Vol. 40, No. 24, July 15, 2024
A. If the
				  blind or disabled child is living in the same household with a parent and is
				  (i) under age 18 or (ii) under age 21 and regularly attending a school,
				  college, university or is receiving technical training designed to prepare him
				  for gainful employment, the parents' income and resources are deemed available
				  to the child.
B. Only the parent's
				  income and resources which remain, after deducting appropriate disregards and
				  amounts for the maintenance needs of the parents and other dependents in the
				  household, are deemed as resources and unearned income available to the blind
				  or disabled child.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-670 - Aid to Dependent Children (ADC) Related Medically Needy Individuals

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Reserved.
B. Personal property.
1. Automobiles. The policy in § 4 of
				  Supplement 8b (was Supplement 12) to Attachment 2.6-A of the State Plan
				  (12VAC30-40-290 )
				  applies.
2. Life insurance. The
				  policy in § 5 of Supplement 8b (was Supplement 12) to Attachment 2.6-A of
				  the State Plan (12VAC30-40-290 )
				  applies.
3. Burial plots. The
				  market value of burial plots owned by any member of the family unit are not
				  counted toward the medical resource limit for the family.
4. Prepaid burial plans are counted as
				  resources, except for the amounts of such funeral agreements that are
				  disregarded under the Virginia ADC cash assistance program.
5. Assets which can be liquidated such as
				  cash, bank accounts, stocks, bonds, and securities, are counted as
				  resources.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-680 - SSI

Current through Register Vol. 40, No. 24, July 15, 2024
A SSI recipient who has transferred or given away property
					 to become or remain eligible for SSI or Medicaid and who has not received
					 compensation in return for the property approximating the tax assessed value of
					 the property is ineligible for long-term care (see
					 12VAC30-40-300
					 ).
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part II - Related Cash Assistance Property Rules › Section 12VAC30-110-690 - Imposition of lien

Current through Register Vol. 40, No. 24, July 15, 2024
No lien may be imposed or any encumbrance placed upon any
					 property, real or personal, owned by a recipient of medical assistance except
					 pursuant to a court judgment on account of benefits incorrectly
					 paid.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part IV - Transfer of Resources › Section 12VAC30-110-710 - Undue hardship; transfer of resources

Current through Register Vol. 40, No. 24, July 15, 2024
A. Undue hardship exists when the department
				  determines that the application of the transfer of assets provisions would
				  deprive the individual of medical care such that his health or his life would
				  be endangered or would deprive the individual of food, clothing, shelter or
				  other necessities of life.
B. When
				  determining the eligibility of an individual who has transferred resources
				  without receiving adequate compensation, the individual must be notified:
1. That an undue hardship can be claimed, the
				  process for seeking an exception from the transfer of assets provisions and the
				  time frame making determinations of whether an undue hardship exists;
a. That written documentation must be
				  provided to substantiate the circumstances of the transfer and the claim of
				  undue hardship.
b. That written
				  documentation must be provided to document that the resources transferred
				  without adequate compensation cannot be recovered.
c. That written documentation must clearly
				  substantiate the immediate adverse impact of the denial of Medicaid coverage of
				  long-term care services due to the uncompensated transfer and would result in
				  the individual being removed from the institution or unable to receive life
				  sustaining medical care, food, clothing, shelter or other necessities of
				  life.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 1 - General › Section 12VAC30-110-730 - Applicability

Current through Register Vol. 40, No. 24, July 15, 2024
Subpart II
Resource Assessments And Eligibility
A. These income and resource regulations
						shall apply to a married institutionalized individual who:
1. Was admitted to a medical institution,
						medical assistance community-based waiver service or hospice service on or
						after September 30, 1989, and has been continuously institutionalized since
						admission; and
2. Has a community
						spouse.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 1 - General › Section 12VAC30-110-740

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-741 - Resource assessment required

Current through Register Vol. 40, No. 24, July 15, 2024
A resource assessment shall be completed by the entity
						  determining medical assistance eligibility on all medical assistance
						  applications for married institutionalized individuals who have a community
						  spouse. If an applicant alleges that his marital status is unknown, it shall be
						  his responsibility to establish his marital status. It shall be the applicant's
						  responsibility to locate his community spouse. If attempts to establish marital
						  status or locate the separated spouse are unsuccessful or the community spouse
						  does not provide the required information necessary to complete the resource
						  assessment, the medical assistance eligibility application will be denied due
						  to inability to complete the required resource assessment, unless undue
						  hardship, as defined in
						  12VAC30-110-831, is
						  met.
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
							 Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-744 - Resource assessment initiated

Current through Register Vol. 40, No. 24, July 15, 2024
A resource assessment shall be initiated by an entity
						  determining medical assistance eligibility:
1. Upon request by either spouse of a couple,
						or a representative acting on behalf of either spouse, at the beginning of the
						first continuous period of institutionalization when (i) all relevant
						documentation of resources has been received and (ii) upon payment of a fee, if
						any, the amount of which is determined by the entity determining medical
						assistance eligibility, if the institutionalized spouse has not applied for
						medical assistance; or
2. Upon
						application for medical assistance by or on behalf of a married
						institutionalized individual who has a community spouse.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-747 - Total resources

Current through Register Vol. 40, No. 24, July 15, 2024
There shall be computed as of the beginning of the
						  first continuous period of institutionalization of the institutional spouse,
						  the total value of the couple's resources to the extent either the
						  institutionalized spouse or the community spouse has an ownership
						  interest.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-750 - Notification of documentation required

Current through Register Vol. 40, No. 24, July 15, 2024
When a resource assessment is initiated, the
						  Department of Social Services shall notify the applicant of all relevant
						  documentation required to be submitted for the assessment.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-751 - Spousal share

Current through Register Vol. 40, No. 24, July 15, 2024
The total value of the couple's combined resources
						  shall be divided by two to determine the spousal share.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-760 - Failure to provide documentation

Current through Register Vol. 40, No. 24, July 15, 2024
If an applicant fails to provide requested
						  documentation necessary to complete the required resource assessment within 45
						  days of receipt of notification sent pursuant to
						  12VAC30-110-750, the department
						  shall notify him that the assessment cannot be completed.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-770 - Notification of assessment and appeal rights

Current through Register Vol. 40, No. 24, July 15, 2024
The department shall provide each member of a couple
						  with copies of the completed resource assessment and the documentation used to
						  produce it. The department shall notify the couple of the procedure by which to
						  appeal the resource assessment.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 2 - Assessments of Couple's Resources › Section 12VAC30-110-780 - Appeal of resource assessment

Current through Register Vol. 40, No. 24, July 15, 2024
A. Not accompanied by a medical assistance
						application. If the resource assessment was conducted without a concurrent
						medical assistance application, an ineligible spouse may not appeal the
						assessment pursuant to the existing Client Appeals regulations (Part I
						(12VAC30-110-10 et seq.) of this
						chapter); however, an ineligible spouse will have an opportunity to appeal
						assessment findings if and when his institutionalized spouse applies for
						medical assistance.
B. Medical
						assistance application. A resource assessment which was conducted pursuant to a
						medical assistance application submitted by the institutionalized spouse may be
						appealed by either spouse pursuant to existing Client Appeals regulations (Part
						I (12VAC30-110-10 et seq.) of this
						chapter).
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-790 - Applicability

Current through Register Vol. 40, No. 24, July 15, 2024
This article shall be used to determine a married
						  institutionalized individual's initial and continuing medical assistance
						  eligibility for his current continuous period of
						  institutionalization.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-800 - Initial eligibility determinations

Current through Register Vol. 40, No. 24, July 15, 2024
An institutionalized spouse meets the medical
						  assistance resource eligibility requirements if the difference between the
						  couple's total countable resources at the time of application and the spousal
						  protected resource amount, as defined in
						  12VAC30-110-720, is equal to or
						  less than the appropriate medical assistance resource limit for one
						  person.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-810 - Initial determinations of ineligibility

Current through Register Vol. 40, No. 24, July 15, 2024
When the institutionalized spouse has countable
						  resources in excess of the medical assistance resource limit for one person,
						  the application for medical assistance shall be denied.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-813 - Attribution of resources at the time of initial eligibility determination

Current through Register Vol. 40, No. 24, July 15, 2024
In determining the countable resources of an
						  institutionalized spouse at the time of application, regardless of any state
						  laws relating to community property or division of marital property, all
						  resources held by either the institutionalized spouse, community spouse, or
						  both, shall be considered available to the institutionalized spouse but only to
						  the extent that the amount of such resources exceeds the spousal protected
						  resource amount calculated in accordance with § 1924(f)(2)(A) of the
						  Act.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-815 - Spousal protected resource amounts

Current through Register Vol. 40, No. 24, July 15, 2024
In the initial determination of eligibility, there
						  shall be deducted from the couple's total combined countable resources in the
						  application month a spousal protected resource amount.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-820

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-830 - Additional resource exclusions

Current through Register Vol. 40, No. 24, July 15, 2024
If an institutionalized spouse has resources exceeding
						  the appropriate medical assistance resource limit for one person, the following
						  are deducted from his resources for the purpose of establishing eligibility, as
						  appropriate:
1. The amount of
						resources which the institutionalized spouse has transferred to the community
						spouse or to other dependents pursuant to a court support order;
2. An amount necessary to make the individual
						eligible if the department determines that the denial of medical assistance
						would create undue hardship as defined in
						12VAC30-110-720.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-831 - Undue hardship

Current through Register Vol. 40, No. 24, July 15, 2024
A. Undue
						hardship can be claimed when the value of resources owned on the first day of
						the first month of the first continuous period of institutionalization cannot
						be verified after both spouses have exhausted all avenues to document the value
						of the resources owned on that day. When hardship is claimed, the spousal
						resource standard shall be used as a substitute for the spousal share when
						calculating the spousal protected resource amount.
B. Undue hardship can also be claimed if each
						of the following criteria are met:
1. The
						applicant establishes by affidavit specific facts sufficient to demonstrate:
a. That he has taken all steps reasonable
						under the circumstances to locate the spouse, to obtain relevant information
						about the resources of the spouse, and to obtain financial support from the
						spouse; and
b. That he has been
						unsuccessful in doing so.
Absent extraordinary circumstances, determined by DMAS,
						  the requirements of subdivision 1 a of this subsection cannot be met unless the
						  applicant and spouse have lived separate and apart without cohabitation and
						  without interruption for at least 36 months.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-840 - Separate treatment of resources after eligibility for benefits established

Current through Register Vol. 40, No. 24, July 15, 2024
Beginning with the first calendar month following the
						  date of the initial determination of eligibility, unless
						  12VAC30-110-900 applies, the
						  institutional spouse's continuing eligibility shall be determined based solely
						  on resources held in his name. The resources owned by the community spouse
						  shall not be deemed available to the institutional spouse in the month
						  following the initial month of ongoing eligibility.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-850 - Post-eligibility resource transfers

Current through Register Vol. 40, No. 24, July 15, 2024
After an initial determination of eligibility and
						  during the protected period specified in
						  12VAC30-110-860, an
						  institutionalized spouse may transfer to his community spouse resources equal
						  to the community spouse resource allowance which are not already titled to the
						  community spouse. Any resource owned by the institutionalized spouse which is
						  not transferred pursuant to this section and which the institutionalized spouse
						  does not actually make available to meet the community spouse's needs shall be
						  deemed available to the institutional spouse for the purpose of determining
						  continuing eligibility.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 110 - ELIGIBILITY AND APPEALS › Part V - Married Institutionalized Individuals' Eligibility and Patient Pay › Subpart II - Resource Assessments And Eligibility › Article 3 - Resource Eligibility Determinations for Institutionalized Spouses › Section 12VAC30-110-853 - Community spouse resource allowance

Current through Register Vol. 40, No. 24, July 15, 2024
The community spouse resource allowance shall be
						  calculated by determining the amount by which the greatest of:
1. The spousal resource standard;
2. The spousal share not to exceed the
						maximum spousal resource standard;
3. An amount established by a department
						hearing officer; or
4. An amount
						actually transferred from the institutionalized spouse to the community spouse
						under a court spousal support order exceeds the amount of resources otherwise
						available to the community spouse (determined without regard to such an
						allowance). If the community spouse has title to resources equal to or
						exceeding his spousal protected resource amount, he shall not be entitled to a
						community spouse resource allowance.
Statutory Authority
§ 32.1-325 of the Code of Virginia.