In the case of any health maintenance organization that has contracted with the Virginia Department of Medical Assistance Services to provide health care services to recipients of medical assistance services pursuant to Title XIX of the Social Security Act, as amended, or to individuals who are covered by the Family Access to Medical Insurance Security (FAMIS) Plan developed pursuant to Title XXI of the Social Security Act, as amended, the requirements for furnishing an explanation of benefits to current or former members and their respective health care providers shall be as authorized and directed in the standards prescribed in the state plan for medical assistance services pursuant to Chapter 10 (§ 32.1-323 et seq.) of Title 32.1 and the FAMIS Plan pursuant to Chapter 13 (§ 32.1-351 et seq.) of Title 32.1. The requirements for an explanation of benefits otherwise addressed in this title shall not apply to such health maintenance organization when contracting to deliver such services to the extent that the statutory requirements differ from the standards of the Department of Medical Assistance Services.
2004, c. 185.
Structure Code of Virginia
Chapter 43 - Health Maintenance Organizations
§ 38.2-4301. Establishment of health maintenance organizations
§ 38.2-4302. Issuance of license; fee; minimum net worth; impairment
§ 38.2-4305. Fiduciary responsibilities
§ 38.2-4306. Evidence of coverage and charges for health care services
§ 38.2-4306.1. Interest on claim proceeds
§ 38.2-4307.1. Additional reports
§ 38.2-4310. Protection against insolvency
§ 38.2-4312. Prohibited practices
§ 38.2-4312.1. Pharmacies; freedom of choice
§ 38.2-4312.3. Patient access to emergency services
§ 38.2-4313. Licensing of agents
§ 38.2-4314. Powers of insurers and health services plans
§ 38.2-4316. Suspension or revocation of license
§ 38.2-4320. Authority of Commonwealth to contract with health maintenance organizations
§ 38.2-4321. Health maintenance organization affected by chapter