Bill > HB2082

This bill modifies the appeals process for health care providers when challenging determinations made by the Department of Medical Assistance Services (DMAS) or its contractors. The bill expands providers' ability to appeal any adverse action, not just overpayment determinations, and requires providers to first exhaust a contractor's internal appeal processes before appealing to DMAS. The bill introduces a provision allowing DMAS and a provider to jointly stay (pause) appeal deadlines for up to 60 days to facilitate settlement discussions. It also mandates that DMAS contractors must represent themselves during appeal proceedings and cannot file appeals of the Department's final decisions. The legislation maintains existing timelines for appeal determinations, such as requiring an initial determination within 180 days, and provides that if DMAS does not issue a decision within the specified timeframe, the decision is deemed in the provider's favor. Additionally, the bill allows providers to recover attorney fees and costs if they substantially prevail in an appeal and specifies that DMAS must reimburse a provider within 30 days if a judicial proceeding reverses an overpayment determination. These changes aim to create a more transparent and fair appeals process for health care providers interacting with DMAS.

Health and Social Services

https://lis.virginia.gov/bill-details/20251/HB2082