Legal Help For Medicaid Members of Commonwealth Coordinated Care Plus (CCC + or CCC Plus)
Your Child Advocate and Attorney when CCC Plus benefits are denied!
On January 1, 2018, Virginia fully transitioned to a new way of managing its Medicaid program providing long term services and supports. The Virginia Department of Medical Assistance Services (DMAS) no longer directly manages the program. Medicaid is now being managed by private companies operating under a contract with DMAS. The program is now called Commonwealth Coordinated Care Plus (CCC + or CCC Plus).
This is a significant policy change with pros and cons for the approximately 214,000 individuals with complex care needs receiving these services. On the one hand, the DMAS contract provides some guarantees not otherwise provided by law. For instance, under the new arrangement, a letter denying benefits (called the adverse benefits determination notice or ABD Notice) have to provide the titles and qualifications, including specialties, of individuals participating in the review of the request for benefits. See DMAS Contract §§ 6.2.12 and 15.3. This is useful information to ensure qualified individuals are deciding what benefits are medical necessary in your case. Unfortunately, with the change, there may not be as much direct supervision by DMAS over the program, which could impact the quality of the service provided, the transparency in the administration of the program, and compliance with the law and regulations.
APPEAL RIGHTS – WHEN CCC PLUS BENEFITS DENIED
It can be difficult to navigate the appeals process when you are denied Medicaid benefits. It is important for you to know your rights in the process.
If you or a loved one has been denied Medicaid benefits under CCC +, Virginia’s long term services and supports program, you typically have a right to appeal the decision, but you should exercise that right wisely. The DMAS Contract ensures that, in most cases, you have up to 60 days to file your appeal. This gives you time to collect additional materials to support your request for benefits. The information you submit for the appeal has to be given equal consideration with the information you initially submitted.
- You have a right to present evidence in person to the decision-maker, not merely orally or in writing.
- You have a right to examine the case file before or during the appeals process.
- You have a right to know the law or policy used as the basis for denying benefits.
Child Advocate and Attorney Andrew T. Bodoh of Thomas H. Roberts & Associates, P.C. has experience fighting for long term services and supports under the CCC Plus program. He can assist you in your time of need. This may be as simple as a consultation—meeting with him in person to discuss your situation and obtaining advice about the steps you can take to secure your rights. In more serious case, he can even represent the Medicaid member and present the case to the Medicaid provider.
804-783-2000 x 110
Andrew T. Bodoh, Esq.
Thomas H. Roberts & Associates, PC
105 S 1st Street
Richmond, VA 23219
804-783-2000 x 110
Mr. Bodoh provides in person and telephonic consultations. The fees that he charges for these consults are reasonable. To obtain a consult, you may email him at firstname.lastname@example.org or call at 804-783-2000 x 110. Payment may be made by credit card or Paypal using the Make Payment Tab.