CODE OF VIRGINIA

COVERAGE FOR HOSPICE CARE (§ 38.2-3418.11)

A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to
issue individual or group accident and sickness insurance policies providing
hospital, medical and surgical, or major medical coverage on an expense-incurred
basis; each corporation providing individual or group accident and sickness
subscription contracts; and each health maintenance organization providing a
health care plan for health care services shall provide coverage for hospice
services under such policy, contract or plan delivered, issued for delivery or
renewed in this Commonwealth on and after July 1, 1999.

B. As used in this section:”Hospice services” shall mean a
coordinated program of home and inpatient care provided directly or under the
direction of a hospice licensed under Article 7 (§ 32.1-162.1 et seq.) of
Chapter 5 of Title 32.1, and shall include palliative and supportive physical,
psychological, psychosocial and other health services to individuals with a
terminal illness utilizing a medically directed interdisciplinary
team.”Individuals with a terminal illness” shall mean individuals
whose condition has been diagnosed as terminal by a licensed physician, whose
medical prognosis is death within six months, and who elect to receive
palliative rather than curative care.”Medicare” shall mean Title
XVIII of the Social Security Act.”Palliative care” shall mean
treatment directed at controlling pain, relieving other symptoms, and focusing
on the special needs of the patient as he experiences the stress of the dying
process, rather than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life.

C. For the purposes of this section, documentation requirements shall be no
greater than those required for the same services under Medicare.

D. Nothing in this section shall prohibit an insurer, corporation, or health
maintenance organization from offering or providing coverage for hospice
services when it cannot be demonstrated that the illness is terminal or for
individuals with life expectancies of longer than six months.

E. The provisions of this section shall not apply to short-term travel, accident
only, short-term nonrenewable policies of not more than six months’
duration, or to policies or contracts designed for issuance to persons eligible
for coverage under Title XVIII of the Social Security Act, known as Medicare, or
any other similar coverage under state or federal governmental plans.

HISTORY: 1999, c. 858.