Page 78

STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 12-1

Effective Date: 07/01/05

78 Approval Date: _____________/06 d. Receive continued coverage if the enrollee requests a review prior to the effective date of the reduction or termination of services or payment for services.

8. Unless an expedited review decision is mandated, the external review process shall be completed and a written decision shall be issued within ninety (90) calendar days of the date an enrollee requests an external review, unless the applicant, enrollee, or authorized representative requests or causes a delay. If the enrollee’s physician or health plan determines that operating under the standard time frame could seriously jeopardize the enrollee’s life or health or ability to attain, maintain, or regain maximum function, then the external review process must be completed and a written decision must be issued within seventy-two (72) hours of the time an enrollee requests external review, unless the applicant, enrollee, or authorized representative requests or causes a delay.

Premium Assistance Programs

12.3 If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, please describe how the state will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.

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Page 78

Official source

STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 12-1

Effective Date: 07/01/05

78 Approval Date: _____________/06 d. Receive continued coverage if the enrollee requests a review prior to the effective date of the reduction or termination of services or payment for services.

8. Unless an expedited review decision is mandated, the external review process shall be completed and a written decision shall be issued within ninety (90) calendar days of the date an enrollee requests an external review, unless the applicant, enrollee, or authorized representative requests or causes a delay. If the enrollee’s physician or health plan determines that operating under the standard time frame could seriously jeopardize the enrollee’s life or health or ability to attain, maintain, or regain maximum function, then the external review process must be completed and a written decision must be issued within seventy-two (72) hours of the time an enrollee requests external review, unless the applicant, enrollee, or authorized representative requests or causes a delay.

Premium Assistance Programs

12.3 If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, please describe how the state will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.