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This document contains the findings and decision related to a Medicaid Long-Term Care benefits denial case, including details of eligibility criteria and conclusions from a hearing held for the claimant.
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How to fill out State of West Virginia Department of Health and Human Resources Office of Inspector General Board of Review

01
Obtain the application form from the State of West Virginia Department of Health and Human Resources Office of Inspector General's website or office.
02
Carefully read the instructions provided with the form to understand the requirements.
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Fill out your personal information, including name, address, and contact details.
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Provide any required identification documents as specified in the form.
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Include details about the specific issue or case you are appealing or seeking review for.
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Review the filled application for accuracy and completeness.
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Sign and date the application where indicated.
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Submit the completed application form along with any required documentation to the appropriate office address provided in the instructions.

Who needs State of West Virginia Department of Health and Human Resources Office of Inspector General Board of Review?

01
Individuals who have received a decision regarding Medicaid eligibility or services and wish to appeal.
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Providers or organizations that need to contest decisions made about their services or reimbursement.
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Anyone seeking clarification or review of actions taken by the West Virginia Department of Health and Human Resources.
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The State of West Virginia Department of Health and Human Resources Office of Inspector General Board of Review is a body that provides oversight and ensures accountability within the state's health and human services programs. It conducts reviews and hearings related to actions taken by the Department of Health and Human Resources.
Individuals or entities that have received adverse actions or decisions from the West Virginia Department of Health and Human Resources are typically required to file with the Board of Review, including providers of health and human services.
To fill out the Board of Review application, applicants must obtain the necessary form, provide detailed information regarding the adverse action, include relevant documentation, and submit it to the Office of Inspector General within the specified timeframe.
The purpose of the Board of Review is to provide a fair and impartial review process for individuals and entities contesting adverse actions taken by the Department of Health and Human Resources, ensuring due process and accountability.
The information that must be reported includes the applicant's details, a description of the adverse action being contested, any supporting documentation, and the reasons for requesting a review.
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