12VAC30-40 Eligibility Conditions and Requirements

REGULATIONS

Vol. 29 Iss. 7 - December 03, 2012

TITLE 12. HEALTH

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Chapter 40

Final Regulation

REGISTRAR'S NOTICE: The following regulatory action is exempt from the Administrative Process Act in accordance with § 2.2-4006 A 4 c of the Code of Virginia, which excludes regulations that are necessary to meet the requirements of federal law or regulations, provided such regulations do not differ materially from those required by federal law or regulation. The Department of Medical Assistance Services will receive, consider, and respond to petitions by any interested person at any time with respect to reconsideration or revision.

Title of Regulation: 12VAC30-40. Eligibility Conditions and Requirements (adding 12VAC30-40-347).

Statutory Authority: § 32.1-325 of the Code of Virginia.

Effective Date: January 3, 2013.

Agency Contact: Brian McCormick, Regulatory Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone [phone], FAX [phone], or email [e-mail].

Summary:

This regulatory action complies with a federal mandate requiring states to implement the use of an asset verification system to electronically verify through financial institutions the ownership and amount of resources held by elderly or disabled Virginia Medicaid applicants or recipients. Individuals applying for medical assistance on the basis of being elderly or disabled are required to disclose and provide information regarding resources held by them or any other person whose resources are required as part of the eligibility determination. Currently, the process is performed manually and involves a written request for the information, submission of paper documentation by the applicant/recipient, and copying and review by staff in the local department of social services.

12VAC30-40-347. Asset verification system.

A. The agency is providing for the verification of assets for purposes of determining or redetermining Medicaid eligibility for aged, blind, and disabled Medicaid applicants and recipients using an asset verification system (AVS) that meets the following minimum requirements:

1. The request and response system is electronic.

a. Verification inquiries are sent electronically via the Internet or similar means from the agency to the financial institution.

b. The system is not based on mailing paper-based requests.

c. The system has the capability to accept responses electronically.

2. The system is secure, based on a recognized industry standard of security (e.g., as defined by the U.S. Commerce Department's National Institute of Standards and Technology (NIST)).

3. The system establishes and maintains a database of financial institutions that participate in the agency's AVS.

4. Verification requests are also sent to financial institutions other than those identified by applicants and recipients, based on some logic such as geographic proximity to the applicant's home address, or other reasonable factors whenever the agency determines that such requests are needed to determine or redetermine the individual's eligibility.

5. The verification request must include a request for information on both open and closed accounts, going back for a period up to five years, as determined by the Department of Medical Assistance Services.

B. System development.

a. The agency is hiring a contractor to develop an AVS.

b. AVS implementation information: Virginia is implementing a web-based asset verification system (AVS) as part of its Eligibility Modernization Project for implementing the mandatory provisions of health care reform. The selected contractors will provide an AVS that meets all requirements of the Centers for Medicare and Medicaid Services and § 1940 of the Social Security Act. It will be secure and meet all Medicaid Information Technology Architecture (MITA) standards.

VA.R. Doc. No. R13-3166; Filed November 1, 2012, 2:35 p.m.