{"law_id":"769288","section_number":"38.2-5806","catch_line":"Prohibited practices","history":"1998, c. 891.","order_by":null,"metadata":false,"court_decisions":{},"official_url":"http:\/\/law.lis.virginia.gov\/vacode\/38.2-5806\/","refers_to":false,"url":"\/38.2-5806\/","token":"38.2\/58\/38.2-5806","structure":{"1":{"id":"1843","name":"Managed Care Health Insurance Plans","identifier":"58","label":"chapter","url":"\/38.2\/58\/"},"2":{"id":"7","name":"Insurance","identifier":"38.2","label":"title","url":"\/38.2\/"}},"referred_to_by":[{"id":"785071","section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","url":"\/38.2-5802\/"}],"edition_id":"11","section_id":"769288","structure_id":"1843","full_text":"A No MCHIP licensee may cancel or refuse to renew the coverage of a covered person for basic health care services on the basis of the status of the covered person’s health.\r\rB The following provisions shall apply whenever an MCHIP provides a covered person who is also a resident of a continuing care facility with coverage for Medicare benefits and the covered person’s primary care physician determines that it is medically necessary for the covered person to be referred to a skilled nursing unit:\r\rC The following shall apply in accordance with provisions in Title 32.1 or regulations promulgated thereunder:\r\r","text":{"0":{"id":"2479657","text":"No MCHIP licensee may cancel or refuse to renew the coverage of a covered person for basic health care services on the basis of the status of the covered person’s health.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1},"1":{"id":"2479658","text":"The following provisions shall apply whenever an MCHIP provides a covered person who is also a resident of a continuing care facility with coverage for Medicare benefits and the covered person’s primary care physician determines that it is medically necessary for the covered person to be referred to a skilled nursing unit:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1},"2":{"id":"2479659","text":" The health carrier shall not require that the covered person relocate to a skilled nursing unit outside the continuing care facility if (i) the continuing care facility’s skilled nursing unit is certified as a Medicare skilled nursing facility and (ii) the continuing care facility agrees, as to such skilled nursing unit, to become a contracting provider in accordance with the health carrier’s standard terms and conditions for its participating providers.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2},"3":{"id":"2479660","text":" A continuing care facility that satisfies clauses (i) and (ii) of subdivision 1 shall not be obligated to accept as a skilled nursing unit patient any one other than a resident of the continuing care facility; and neither the health carrier nor the continuing care facility shall be allowed to include the skilled nursing unit or facilities on the list required by \u00a7 38.2-5802 or to advertise in any other way that the facility’s skilled nursing unit is a participating provider with respect to coverage offered by the MCHIP for Medicare benefits or skilled nursing unit facilities for other than the continuing care facility’s residents.As used in this subsection, “Medicare benefits” means medical and health products, benefits and services offered in accordance with Title XVIII of the United States Social Security Act (42 U.S.C. \u00a7 1395 et seq.) and “continuing care facility” means a continuing care retirement community regulated pursuant to Chapter 49 (\u00a7 38.2-4900 et seq.) of this title.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2},"4":{"id":"2479661","text":"The following shall apply in accordance with provisions in Title 32.1 or regulations promulgated thereunder:","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1},"5":{"id":"2479662","text":" Where complaints of a covered person may be resolved through a specified arbitration agreement, the covered person shall be advised in writing of his rights and duties under the agreement at the time the complaint is registered.","type":"section","prefixes":["C","1"],"prefix":"1","entire_prefix":"C1","prefix_anchor":"C1","level":2},"6":{"id":"2479663","text":" No contract or evidence of coverage that entitles covered persons to resolve complaints through an arbitration agreement shall limit or prohibit such arbitration for any claims asserted having a monetary value of $ 250 or more.","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2},"7":{"id":"2479664","text":" If the covered person agrees to binding arbitration, his written acceptance of the arbitration agreement shall not be executed prior to the time the complaint is registered nor subsequent to the time an initial resolution is made, and the agreement shall be accompanied by a statement setting forth in writing the terms and conditions of binding arbitration.","type":"section","prefixes":["C","3"],"prefix":"3","entire_prefix":"C3","prefix_anchor":"C3","level":2}},"ancestry":{"1":{"id":"1843","name":"Managed Care Health Insurance Plans","identifier":"58","label":"chapter","url":"\/38.2\/58\/"},"2":{"id":"7","name":"Insurance","identifier":"38.2","label":"title","url":"\/38.2\/"}},"structure_contents":{"0":{"id":"788087","structure_id":"1843","section_number":"38.2-5800","catch_line":"Definitions","url":"\/38.2-5800\/","token":"38.2\/58\/38.2-5800"},"1":{"id":"769891","structure_id":"1843","section_number":"38.2-5801","catch_line":"General provisions","url":"\/38.2-5801\/","token":"38.2\/58\/38.2-5801"},"2":{"id":"785071","structure_id":"1843","section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","url":"\/38.2-5802\/","token":"38.2\/58\/38.2-5802"},"3":{"id":"781280","structure_id":"1843","section_number":"38.2-5803","catch_line":"Disclosures and representations to enrollees","url":"\/38.2-5803\/","token":"38.2\/58\/38.2-5803"},"4":{"id":"792762","structure_id":"1843","section_number":"38.2-5804","catch_line":"Complaint system","url":"\/38.2-5804\/","token":"38.2\/58\/38.2-5804"},"5":{"id":"773456","structure_id":"1843","section_number":"38.2-5805","catch_line":"Provider contracts","url":"\/38.2-5805\/","token":"38.2\/58\/38.2-5805"},"6":{"id":"769288","structure_id":"1843","section_number":"38.2-5806","catch_line":"Prohibited practices","url":"\/38.2-5806\/","token":"38.2\/58\/38.2-5806"},"7":{"id":"780912","structure_id":"1843","section_number":"38.2-5807","catch_line":"Access to care","url":"\/38.2-5807\/","token":"38.2\/58\/38.2-5807"},"8":{"id":"776595","structure_id":"1843","section_number":"38.2-5808","catch_line":"Examinations","url":"\/38.2-5808\/","token":"38.2\/58\/38.2-5808"},"9":{"id":"767187","structure_id":"1843","section_number":"38.2-5809","catch_line":"Suspension or revocation of license","url":"\/38.2-5809\/","token":"38.2\/58\/38.2-5809"},"10":{"id":"780860","structure_id":"1843","section_number":"38.2-5810","catch_line":"Statutory construction and relationship to other laws","url":"\/38.2-5810\/","token":"38.2\/58\/38.2-5810"},"11":{"id":"777561","structure_id":"1843","section_number":"38.2-5811","catch_line":"Controversies involving contracts","url":"\/38.2-5811\/","token":"38.2\/58\/38.2-5811"}},"previous_section":{"id":"773456","structure_id":"1843","section_number":"38.2-5805","catch_line":"Provider contracts","url":"\/38.2-5805\/","token":"38.2\/58\/38.2-5805"},"next_section":{"id":"780912","structure_id":"1843","section_number":"38.2-5807","catch_line":"Access to care","url":"\/38.2-5807\/","token":"38.2\/58\/38.2-5807"},"references":false,"formats":{"txt":"\/38.2-5806.txt","json":"\/38.2-5806.json","xml":"\/38.2-5806.xml"},"dublin_core":{"Title":"Prohibited practices","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-5806","Relation":"Code of Virginia"},"plain_text":"                                 CODE OF VIRGINIA\n\nPROHIBITED PRACTICES (\u00a7 38.2-5806)\n\nA. No MCHIP licensee may cancel or refuse to renew the coverage of a covered\nperson for basic health care services on the basis of the status of the covered\nperson’s health.\n\nB. The following provisions shall apply whenever an MCHIP provides a covered\nperson who is also a resident of a continuing care facility with coverage for\nMedicare benefits and the covered person’s primary care physician\ndetermines that it is medically necessary for the covered person to be referred\nto a skilled nursing unit:\n\n   1.  The health carrier shall not require that the covered person relocate to a\n   skilled nursing unit outside the continuing care facility if (i) the\n   continuing care facility’s skilled nursing unit is certified as a\n   Medicare skilled nursing facility and (ii) the continuing care facility\n   agrees, as to such skilled nursing unit, to become a contracting provider in\n   accordance with the health carrier’s standard terms and conditions for\n   its participating providers.\n\n   2.  A continuing care facility that satisfies clauses (i) and (ii) of\n   subdivision 1 shall not be obligated to accept as a skilled nursing unit\n   patient any one other than a resident of the continuing care facility; and\n   neither the health carrier nor the continuing care facility shall be allowed\n   to include the skilled nursing unit or facilities on the list required by \u00a7\n   38.2-5802 or to advertise in any other way that the facility’s skilled\n   nursing unit is a participating provider with respect to coverage offered by\n   the MCHIP for Medicare benefits or skilled nursing unit facilities for other\n   than the continuing care facility’s residents.As used in this\n   subsection, “Medicare benefits” means medical and health products,\n   benefits and services offered in accordance with Title XVIII of the United\n   States Social Security Act (42 U.S.C. \u00a7 1395 et seq.) and “continuing\n   care facility” means a continuing care retirement community regulated\n   pursuant to Chapter 49 (\u00a7 38.2-4900 et seq.) of this title.\n\nC. The following shall apply in accordance with provisions in Title 32.1 or\nregulations promulgated thereunder:\n\n   1.  Where complaints of a covered person may be resolved through a specified\n   arbitration agreement, the covered person shall be advised in writing of his\n   rights and duties under the agreement at the time the complaint is registered.\n\n   2.  No contract or evidence of coverage that entitles covered persons to\n   resolve complaints through an arbitration agreement shall limit or prohibit\n   such arbitration for any claims asserted having a monetary value of $ 250 or\n   more.\n\n   3.  If the covered person agrees to binding arbitration, his written\n   acceptance of the arbitration agreement shall not be executed prior to the\n   time the complaint is registered nor subsequent to the time an initial\n   resolution is made, and the agreement shall be accompanied by a statement\n   setting forth in writing the terms and conditions of binding arbitration.\n\nHISTORY: 1998, c. 891."}