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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 July 2019 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.100 3

If a decision cannot be made within 10 working days of receipt of the BCCPTA application, the worker must send a written notice on the 10th day stating why action has not been taken, specifying what information is needed, and a deadline for submitting the information. If all necessary verifications are not received, the application continues to pend until the 45-calendar-day processing time limit is reached. 2. 45/90 Day Requirement Applications for which information in addition to that provided on the application is required, including requests for retroactive coverage, must be processed within 45 calendar days for all applicants other than pregnant women, women in the BCCPTA covered group, or individuals needing a disability determination. For individuals who require a disability determination to meet the covered group requirement, the time standard for processing an application is 90 calendar days. Other non-financial requirements, however, must be met and verified by the 45th calendar day, or the application must be denied and DDS must be notified to stop action on the disability determination (see M0310.112 G.3). The time standard begins with the date of receipt of a signed application and ends with the date of enrollment or the date the notification of denial of MA is mailed to the applicant. The applicant must be informed of the agency's time standards. The eligibility worker must allow at least 10 calendar days to receive the necessary verifications. If all necessary verifications are not received, the application continues to pend until the 45-day processing time limit is reached. 3. Early Denial Before Deadline Date When the 45-day processing deadline date falls on a weekend or a holiday, the LDSS may deny an individual’s application on the last business day before the deadline date if all necessary verifications have not been received. If the early denial action is taken, however, the LDSS must re-open the application if the individual provides the necessary information on or before the 45th day deadline. If the individual’s application is re-opened and he is determined eligible, the LDSS must enroll the individual and send a notice to the individual notifying him of the approval and the begin date of coverage. 4. Processing Priority Application processing priority must be given to applicants who are in need of Medicaid coverage for nursing facility or community-based long-term care, hospice care, or who are in emergent need of other covered services. These applications must be processed as quickly as possible. 5. Time Standard Exceptions The specified time standards apply unless the agency cannot reach a decision within the time standard because of one of the following reasons: • the applicant's inability to furnish necessary information for a reason beyond his/her control, • a delay in receipt of information from an examining physician, • a delay in the disability determination process, • a delay in receiving DMAS decision on property transfer undue hardship claim, or • an administrative or other emergency beyond the agency's control.