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2008 SESSION
080034664Be it enacted by the General Assembly of Virginia:
1. That §§ 38.2-5801 and 38.2-5802 of the Code of Virginia are amended and reenacted as follows:
§ 38.2-5801. General provisions.
A. No person shall operate an MCHIP in this Commonwealth unless the health carrier who directly or indirectly manages, owns, contracts with, or employs the providers for the plan is licensed in accordance with provisions in this title as an insurance company, a health maintenance organization, or a nonstock corporation organized in accordance with provisions in Chapter 42 (§ 38.2-4200 et seq.) or Chapter 45 (§ 38.2-4500 et seq.) of this title. Such health carrier shall be deemed responsible for the MCHIP and its compliance with this chapter and the provisions of Title 32.1 concerning quality assurance of MCHIPs. A health carrier may be responsible for more than one MCHIP; however, no MCHIP shall have more than one responsible health carrier.
B. Except as provided in subsection C, no person shall operate an MCHIP in this Commonwealth unless the health carrier responsible for the MCHIP holds an active or temporarily suspended certificate of quality assurance issued by the Department of Health.
C. 1. A health maintenance organization
applying for licensure under this title on or after July 1, 1998, or
whose application for such licensure is pending before the Commission on July
1, 1998, shall request its initial certificate of quality
assurance prior to licensing and a copy of its request shall be included with
and made a part of the licensing application and material filed with the
Commission pursuant to § 38.2-4301 and subsection B of § 38.2-5802. Until
July 1, 2000, (i) issuance Issuance
of a license under § 38.2-4302 shall be contingent upon receipt of notice from
the State Health Commissioner that the health maintenance organization's
description of its complaint system has been reviewed and approved by the State
Health Commissioner and (ii) upon.
Upon issuance of the license under § 38.2-4302, such
health maintenance organization shall be deemed in compliance with subsection B
provided no the State Health
Commissioner has not revoked or failed to renew a
certificate of quality assurance that has
been issued to the health maintenance organization which
has been revoked or not renewed by the State Health Commissioner.
Effective July 1, 2000, issuance of a license under § 38.2-4302 shall be
contingent upon the Department of Health's issuance of a certificate of quality
assurance.
2. Until July 1, 2000, a health maintenance
organization licensed under this title on and before July 1, 1998, shall be
deemed in compliance with the provisions of this section if (i) a request for
initial certification has been filed with the Department of Health on or before
December 1, 1998, and is pending before the State Health Commissioner and (ii)
no certificate has been issued to the health maintenance organization which has
been revoked or not renewed by the State Health Commissioner.
3. D. A
health carrier, other than a health maintenance organization, responsible for
an MCHIP pursuant to this chapter, shall request its initial certificate of
quality assurance from the Department of Health on or before December 1, 1998,
or becoming responsible for a MCHIP under this title. Until July 1, 2000,
such health carrier shall be deemed in compliance with the provisions of this
section if (i) a request for initial certification is pending before the
Department of Health and (ii) no certificate has been issued to the health
carrier which has been revoked or not renewed by the State Health Commissioner.
D E. The
provisions of this chapter shall apply to all health carriers and all MCHIPs
operating in this Commonwealth unless an exemption is recognized in accordance
with § 38.2-3420; and, except as otherwise provided in this chapter, the
provisions of this chapter shall be supplemental and in addition to those
otherwise applicable under this title or Title 32.1.
§ 38.2-5802. Establishment of an MCHIP.
A. A health carrier, when applying for initial licensing under
this title and with each request for renewal that is to be
effective on or after July 1, 1999, shall describe and categorize
generally its existing or planned transactions and
operations in this the
Commonwealth, as
applicable, that may influence the cost or level of
health care services between the health carrier and one or more providers with
respect to the delivery of health care services through its MCHIPs.
Descriptions and categorization shall identify generally the arrangements that
the health carrier has with providers with respect to the delivery of health
care services. Descriptions of incentive arrangements shall include
compensation methodology and incentives. The descriptions of incentive
arrangements shall not include amounts of compensation and values of
incentives. Renewal filings shall clearly identify new matter and material
changes of information disclosed in the preceding filing.
B. A health carrier applying to the Department of Health for initial certification of quality assurance shall simultaneously file a copy of its request for certification with the Commission and shall include the list of providers required by § 38.2-5805. Such filings shall be assessed by the Department of Health.
C. In addition to items specified in subsection B, the initial filing under this chapter by a health carrier subject to subsection B of § 38.2-5801 shall include any forms of contracts, including any amendments thereto, made with health care providers enabling the health carrier to provide health care services through its MCHIPs to covered persons. Individual provider contracts and contracts with persons outside this Commonwealth shall not be filed with the Commission unless requested by the Commission or necessary to explain or fully disclose pursuant to subsection D operational changes that are materially at variance with the information currently on file with the Commission. The health carrier shall maintain a complete file of all contracts made with health care providers which shall be subject to examination by the Commission. The contracts shall be retained in the file for a period of at least five years after their expiration. Notwithstanding the provisions of Chapter 37 (§ 2.2-3700 et seq.) of Title 2.2 of the Code of Virginia, such contracts shall be confidential and shall not be subject to discovery upon subpoena.
D. No MCHIP shall be operated in a manner that is materially
at variance with the information submitted pursuant to this section. Any change
in such information which would result in operational changes that are
materially at variance with the information currently on file with the
Commission shall be subject to the Commission's prior approval. The
requirements of this subsection apply when a health carrier proposes material
changes to information of the type described in this section that previously had been filed with the Commission pursuant to provisions of Chapter
43 (§ 38.2-4300 et seq.). If the Commission fails to act on a
notice of material change within thirty 30
days of its filing, the proposed changes shall be deemed approved. A material
change in the MCHIP's health care delivery system shall be deemed to result in
operational changes that are materially at variance with the information on
file with the Commission. The Commission may determine that other changes are
material and may require disclosure to secure full and accurate knowledge of
the affairs and condition of the health carrier.
E. A health carrier shall give notice to the State Health
Commissioner of the any
filings it makes with the Commission pursuant to this section.
F. The provisions of this section are applicable
generally for all health carriers subject to licensure under this title. The
provisions of this section shall be applied specifically as follows: (i)
the provisions of subsection A are applicable for each health carrier
requesting renewal of a license on or after July 1, 1998, and also for each
health carrier applying for initial licensing on or after July 1, 1998; (ii)
the provisions of subsection B shall be applied to any health carrier that
files an application with the Department of Health for initial certification of
quality assurance; (iii) the provisions of subsection C become applicable
as soon as a health carrier makes a filing pursuant to this section; (iv) the
filing requirements described in subsection D are applicable for all material
filed with the Commission pursuant to this section, and shall be applied also
when a health carrier proposes material changes to information of the type
described in this section which previously had been filed with the Commission
pursuant to provisions of Chapter 43 (§ 38.2-4300 et seq.) of this title; and
(v) the provisions of subsection E are applicable whenever a health carrier
makes a filing pursuant to this section.