Medical Assistance Services, Department of; appeals of agency determinations.

Document formatting and layout changes including spacing, line breaks, and header information between Reenrolled and Governor Substitute versions.

Contractors must now exhaust both internal reconsideration and internal appeal processes before appealing to the Department, expanding the exhaustion requirement.

Contractors including managed care organizations are explicitly prohibited from filing petitions for reconsideration or court appeals of the Department's final agency decisions.

Settlement agreements now require review and approval in accordance with § 2.2-514, adding a specific statutory reference for the approval process.

Minor formatting changes including session designation updates from 'Enrolled' to 'Reenrolled' and page numbering adjustments.

Established specific timeframes for agency decisions (180 days for initial determination, 120 days for hearing officer recommendation, 60 days for final decision) with automatic provider-favorable outcomes if deadlines are missed.

Added requirement that agencies must reimburse providers for reasonable attorney fees and costs if providers substantially prevail on appeal, unless special circumstances make the award unjust.

Clarified that agencies cannot recover overpayments through offset or other means until a final agency case decision is issued, and that interest accrues from the date the determination becomes final.

Added provision allowing Department and provider to jointly agree to extend appeal deadlines up to 60 days for settlement discussions.

Changed section lettering from A, B, C, D, E, F, D to A, B, B.C, C.D, D.E, E.F, D.G, which appears to be a formatting error rather than a substantive policy change.