THE TEXT OF THIS REGULATION IS IN DRAFT FORM AND SHOULD NOT BE RELIED UPON FOR LEGAL INTERPRETATION.

12VAC30-110-1370. Applicant's signature.

A.   The applicant must sign a state-approved official application form, even if another person fills out the form, unless the application is filed and signed by the applicant's parent, caretaker relative, legal guardian or conservator, attorney-in-fact or authorized representative. If the applicant cannot sign his name, but can make a mark, the mark must be correctly designated and witnessed by one person.

B.   The director of the Department of Corrections, or his designee, shall be permitted to sign the Medicaid application form for any inmate who refuses to sign, or is unable for any reason to sign, for purposes of Medicaid reimbursement of services provided to Medicaid-eligible offenders.