38.2-5806 - Prohibited practices.
§ 38.2-5806. Prohibited practices.
A. No MCHIP licensee may cancel or refuse to renew the coverage of a coveredperson for basic health care services on the basis of the status of thecovered person's health.
B. The following provisions shall apply whenever an MCHIP provides a coveredperson who is also a resident of a continuing care facility with coverage forMedicare benefits and the covered person's primary care physician determinesthat it is medically necessary for the covered person to be referred to askilled nursing unit:
1. The health carrier shall not require that the covered person relocate to askilled nursing unit outside the continuing care facility if (i) thecontinuing care facility's skilled nursing unit is certified as a Medicareskilled nursing facility and (ii) the continuing care facility agrees, as tosuch skilled nursing unit, to become a contracting provider in accordancewith the health carrier's standard terms and conditions for its participatingproviders.
2. A continuing care facility that satisfies clauses (i) and (ii) ofsubdivision 1 shall not be obligated to accept as a skilled nursing unitpatient any one other than a resident of the continuing care facility; andneither the health carrier nor the continuing care facility shall be allowedto include the skilled nursing unit or facilities on the list required by §38.2-5802 or to advertise in any other way that the facility's skillednursing unit is a participating provider with respect to coverage offered bythe MCHIP for Medicare benefits or skilled nursing unit facilities for otherthan the continuing care facility's residents.
As used in this subsection, "Medicare benefits" means medical and healthproducts, benefits and services offered in accordance with Title XVIII of theUnited States Social Security Act (42 U.S.C. § 1395 et seq.) and "continuingcare facility" means a continuing care retirement community regulatedpursuant to Chapter 49 (§ 38.2-4900 et seq.) of this title.
C. The following shall apply in accordance with provisions in Title 32.1 orregulations promulgated thereunder:
1. Where complaints of a covered person may be resolved through a specifiedarbitration agreement, the covered person shall be advised in writing of hisrights and duties under the agreement at the time the complaint is registered.
2. No contract or evidence of coverage that entitles covered persons toresolve complaints through an arbitration agreement shall limit or prohibitsuch arbitration for any claims asserted having a monetary value of $250 ormore.
3. If the covered person agrees to binding arbitration, his writtenacceptance of the arbitration agreement shall not be executed prior to thetime the complaint is registered nor subsequent to the time an initialresolution is made, and the agreement shall be accompanied by a statementsetting forth in writing the terms and conditions of binding arbitration.
(1998, c. 891.)