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

The document formatting changed from a clean legislative text format to include page numbers, line numbers, and layout markers typical of a Governor's Substitute amendment document.

Formatting and spacing adjustments throughout the document to correct layout issues from the enrolled version.

Corrected minor text inconsistencies such as 'attorneys' attorney fees' to 'attorneys' fees' and standardized section lettering.

Clarified that contractors must exhaust internal reconsideration and internal appeal processes before appealing to the Department.

Added language preventing contractors from filing petitions for reconsideration or court appeals of the Department's final decisions.

Updated settlement provisions to reference specific administrative code section 2.2-514 for settlement agreement review and approval.

Established specific deadlines for appeal decisions: 180 days for initial determinations and 120 days for hearing officer recommendations, with deemed favorable decisions if deadlines are missed.

Added settlement stay provisions allowing up to 60 days to pause appeal deadlines for settlement discussions.

Added provisions requiring the agency to reimburse providers for reasonable attorney fees and costs when the provider substantially prevails on appeal.

Strengthened court review procedures requiring reimbursement within 30 days if overpayment determinations are reversed in judicial proceedings.

Clarified that providers must exhaust contractor internal reconsideration processes before appealing to the Department for actions stemming from contractors.