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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 October 2016 Subchapter Subject Page ending with Page M0110.000 GENERAL INFORMATION M0110.110 3

C. Use of System Searches Searches of online information systems, including but not limited to the State Online Query-Internet (SOLQ-I),the State Verification Exchange System (SVES), and the Federal Data Hub, are permitted only for applicants and family members whose income and/or resource information is required to determine eligibility for the applicant or patient pay for an enrollee. This includes spouses of applicants and parents of child applicants. Searches of the Asset Verification System (AVS) are permitted only for applicants with a resource test. The Federal Data Hub and AVS are to be accessed only for information necessary to determine eligibility for MA cases processed in the Virginia Case Management System (VaCMS). They may not be used for other public assistance programs. D. Release of Information to Medical Providers Although certain individuals are authorized to receive information about an applicant’s/recipient’s case, only the minimum data necessary to respond to the request is to be released. Federal regulations stipulate that the disclosure of information about an applicant or recipient can only be for purposes related to administration of the Medicaid State Plan. Information in the case record related to an individual’s medical treatment, or method of reimbursement for services may be released to Virginia MA providers by DMAS without the applicant’s/enrollee’s consent. Enrollee consent is not needed for the DSS agency to provide confirmation of an individual’s eligibility, the dates of eligibility, and any patient pay responsibility if the medical provider is unable to obtain that information from the member verification system or from DMAS staff. The provider is not entitled to specific information about an applicant’s/recipient’s income or resources because the provider does not need that information for medical treatment or payment. Provider contractors, such as application assistance companies, operate under the authority of the provider. A patient’s consent is not required for the agency to provide the contractor with information related to reimbursement for services rendered or medical treatment. Providers and their contractors are not entitled to receive detailed financial or income information contained in an applicant’s or recipient’s case record. Information should not be provided from case records unless the release of such information is for purposes directly related to the administration of the MA programs. Local agencies may release MA enrollee identification numbers to medical providers by telephone if the provider cannot contact the DMAS provider/recipient verification telephone number. This procedure does not conflict with federal or State confidentiality regulations, if the local agency is satisfied that the number is being released to an identifiable provider. E. Release to Authorized Representatives and Other Application Assistants