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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2021 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.112 27

a. Hospital staff shall simultaneously send: • the Medicaid application and a cover sheet, available on Fusion at to the LDSS or the hospital outstationed eligibility worker

• the medical documentation (disability report, authorizations to release information and medical records) and cover sheet to the DDS. b. LDSS shall immediately upon receipt of the Medicaid application: • fax a completed DDS Referral Form (#032-03-0095, #032-03-0096, #032-03-0097, or #032-03-0098) available at https://fusion.dss.virginia.gov/bp/BP-Home/Medical-Assistance/Forms, to the DDS Central Regional Office at 804- 527-4518 to verify receipt of the Medicaid application unless it is known to the agency that the individual already has a pending disability claim with DDS. If the individual already has a pending disability claim with DDS, the claim cannot be treated as an expedited referral. • give priority to processing the applications and immediately request any verifications needed; and

• process the application as soon as the DDS disability determination and all necessary verifications are received; and

• notify the hospital contact identified on the cover sheet of the action on the application and provide the Medicaid enrollee number, if eligible.

c. DDS shall make a disability determination within seven (7) working days and fax the result of the disability decision to the LDSS. DDS is not responsible for notifying either the applicant or the hospital of the outcome of the disability determination. If DDS is unable to render a decision within 7 working days, DDS will send a communication to the LDSS advising that the disability determination has been delayed. 3. Application Processing When DDS Referral is Pending If the completed forms are not returned by the applicant within 45 calendar days from the date of application, the applicant is considered not to meet the covered group and the application must be denied. Individuals who require a disability determination must meet all non-financial requirements other than covered group, within 45 calendar days or the application must be denied. If these requirements are met, the application timeframe may be extended to 90 days while DDS is making the disability determination. If any non-financial requirement other than covered group is not met by the 45th calendar day, his application must be denied and DDS must be notified of the denial. DDS does NOT stop the disability determination process when the individual meets all non-financial requirements, but has excess resources (see M0130.100 B.4) because he might reduce his resources while the