38.2-4320.1 - Explanation of benefits for health maintenance organization enrollees who are recipients of medical assistance services or covered by the Family Access to Medical Insurance Security (FAM
§ 38.2-4320.1. Explanation of benefits for health maintenance organizationenrollees who are recipients of medical assistance services or covered by theFamily Access to Medical Insurance Security (FAMIS) Plan.
In the case of any health maintenance organization that has contracted withthe Virginia Department of Medical Assistance Services to provide health careservices to recipients of medical assistance services pursuant to Title XIXof the Social Security Act, as amended, or to individuals who are covered bythe Family Access to Medical Insurance Security (FAMIS) Plan developedpursuant to Title XXI of the Social Security Act, as amended, therequirements for furnishing an explanation of benefits to current or formermembers and their respective health care providers shall be as authorized anddirected in the standards prescribed in the state plan for medical assistanceservices pursuant to Chapter 10 (§ 32.1-323 et seq.) of Title 32.1 and theFAMIS Plan pursuant to Chapter 13 (§ 32.1-351 et seq.) of Title 32.1. Therequirements for an explanation of benefits otherwise addressed in this titleshall not apply to such health maintenance organization when contracting todeliver such services to the extent that the statutory requirements differfrom the standards of the Department of Medical Assistance Services.
(2004, c. 185.)