Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part XII - Provider Appeals › Section 12VAC30-20-550 - Settlement agreements

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Providers who have filed an administrative appeal under
				  12VAC30-20-540
				  or
				  12VAC30-20-560
				  may submit a proposal to DMAS to settle the appeal.
B. A proposal for a settlement shall be
				  submitted in writing by the provider or the provider's counsel to the DMAS
				  Appeals Division Director. The proposal shall include the justification for the
				  settlement and the terms proposed to settle the case. The Appeals Division
				  Director shall refer the proposal to a DMAS appeal representative authorized by
				  the Office of the Attorney General under §
										2.2-509
				  of the Code of Virginia to represent DMAS in administrative
				  proceedings.
C. Stay of decision
				  deadlines.
1. Receipt of a settlement
				  proposal from a provider in accordance with subsection B of this section shall
				  not require the DMAS appeal representative to engage in settlement negotiations
				  or agree to stay the deadline for the informal appeal decision or for the
				  formal appeal recommended decision of the hearing officer (collectively, the
				  decision deadline). The DMAS appeal representative and the provider may jointly
				  agree in writing to stay the decision deadline for a period of up to 60 days to
				  facilitate settlement discussions. The date of the written agreement of the
				  parties to stay the decision deadline shall be the start date for calculating
				  the length of the stay. Written notice of the agreement to stay the decision
				  deadline and the length of stay shall be provided to the Appeals Division
				  Director on the start date. During the stay, the time period to issue the
				  informal appeal decision or the formal appeal recommended decision shall not
				  run; however, all other interim deadlines remain applicable.
2. If the parties mutually agree in writing
				  to a proposed resolution within the agreed upon stay period described in
				  subdivision C 1 of this section, then the stay shall be extended for such
				  additional time as may be necessary for review and approval of the settlement
				  in accordance with §
											2.2-514
				  of the Code of Virginia.
3. A stay
				  may be removed by a party to the appeal for any reason, including the
				  following:
a. The parties do not agree to a
				  full settlement within the agreed upon stay period described in subdivision C 1
				  of this section;
b. One party
				  advises the other and the Appeals Division Director in writing that it no
				  longer agrees for the stay to continue; or
c. The parties reach a proposed settlement,
				  but the proposed settlement is not approved in accordance with §
												2.2-514
				  of the Code of Virginia.
If the stay is removed, the stay shall be communicated in
					 writing between the parties and written notice provided to the Appeals Division
					 Director. The time period to issue the informal appeal decision or the formal
					 appeal recommended decision shall resume on the day the notice is provided to
					 the Appeals Division Director.