Page 962

West Virginia Income Maintenance Manual Chapter 9

West Virginia Income Maintenance Manual Page 18 Chapter 9 Client Notification

• The date the action is effective; • The reason for the action; • The IMM section on which the decision is based; and • Any other action taken. 9.3.2.C.3 Medicaid and WVCHIP The notice must include: • The specific action being taken; • The date that the action is effective; • The reason for the action; • The IMM section on which the decision is based; and • Any other action taken. The following must be included as appropriate: • For Closures: The fact that the Medicaid AG is being closed. • For Removal of a Client from the Medicaid AG: The name of the client being removed. • For a Change to a Spenddown AG: The fact that the eligibility status has changed, reason for and the effective date of the change, beginning and ending dates of the new Period of Certification (POC). 9.3.3 DFA-NL-C, NOTIFICATION LETTER: PENDING CHANGE IN THE BENEFITS YOU RECEIVED A DFA-NL-C, Notification Letter: Pending Change In The Benefits You Receive, is used to notify a client of an adverse action in situations requiring a 13-day advance notice period except as described above. Instructions for completion of the DFA-NL-B in the Adverse Actions Not Requiring Advance Notice section 9.3.2.C above also apply to the DFA-NL-C. NOTE: The Pre-Hearing Conference and/or a Fair Hearing Request Form, DFA-FH-1, must always be included with the DFA-NL-C and the appropriate computation forms.

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Page 962

Official source

West Virginia Income Maintenance Manual Chapter 9

West Virginia Income Maintenance Manual Page 18 Chapter 9 Client Notification

• The date the action is effective; • The reason for the action; • The IMM section on which the decision is based; and • Any other action taken. 9.3.2.C.3 Medicaid and WVCHIP The notice must include: • The specific action being taken; • The date that the action is effective; • The reason for the action; • The IMM section on which the decision is based; and • Any other action taken. The following must be included as appropriate: • For Closures: The fact that the Medicaid AG is being closed. • For Removal of a Client from the Medicaid AG: The name of the client being removed. • For a Change to a Spenddown AG: The fact that the eligibility status has changed, reason for and the effective date of the change, beginning and ending dates of the new Period of Certification (POC). 9.3.3 DFA-NL-C, NOTIFICATION LETTER: PENDING CHANGE IN THE BENEFITS YOU RECEIVED A DFA-NL-C, Notification Letter: Pending Change In The Benefits You Receive, is used to notify a client of an adverse action in situations requiring a 13-day advance notice period except as described above. Instructions for completion of the DFA-NL-B in the Adverse Actions Not Requiring Advance Notice section 9.3.2.C above also apply to the DFA-NL-C. NOTE: The Pre-Hearing Conference and/or a Fair Hearing Request Form, DFA-FH-1, must always be included with the DFA-NL-C and the appropriate computation forms.