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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maintenance organization which has been revoked or not renewed by the State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 [ . 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.