38.2-5801 - General provisions.
§ 38.2-5801. General provisions.
A. No person shall operate an MCHIP in this Commonwealth unless the healthcarrier who directly or indirectly manages, owns, contracts with, or employsthe providers for the plan is licensed in accordance with provisions in thistitle as an insurance company, a health maintenance organization, or anonstock corporation organized in accordance with provisions in Chapter 42 (§38.2-4200 et seq.) or Chapter 45 (§ 38.2-4500 et seq.) of this title. Suchhealth carrier shall be deemed responsible for the MCHIP and its compliancewith this chapter and the provisions of Title 32.1 concerning qualityassurance of MCHIPs. A health carrier may be responsible for more than oneMCHIP; however, no MCHIP shall have more than one responsible health carrier.
B. Except as provided in subsection C, no person shall operate an MCHIP inthis Commonwealth unless the health carrier responsible for the MCHIP holdsan active or temporarily suspended certificate of quality assurance issued bythe Department of Health.
C. 1. A health maintenance organization applying for licensure under thistitle on or after July 1, 1998, or whose application for such licensure ispending before the Commission on July 1, 1998, shall request its initialcertificate of quality assurance prior to licensing and a copy of its requestshall be included with and made a part of the licensing application andmaterial filed with the Commission pursuant to § 38.2-4301 and subsection Bof § 38.2-5802. Until July 1, 2000, (i) issuance of a license under §38.2-4302 shall be contingent upon receipt of notice from the State HealthCommissioner that the health maintenance organization's description of itscomplaint system has been reviewed and approved by the State HealthCommissioner and (ii) upon issuance of the license such health maintenanceorganization shall be deemed in compliance with subsection B provided nocertificate of quality assurance has been issued to the health maintenanceorganization which has been revoked or not renewed by the State HealthCommissioner. Effective July 1, 2000, issuance of a license under § 38.2-4302shall be contingent upon the Department of Health's issuance of a certificateof quality assurance.
2. Until July 1, 2000, a health maintenance organization licensed under thistitle on and before July 1, 1998, shall be deemed in compliance with theprovisions of this section if (i) a request for initial certification hasbeen filed with the Department of Health on or before December 1, 1998, andis pending before the State Health Commissioner and (ii) no certificate hasbeen issued to the health maintenance organization which has been revoked ornot renewed by the State Health Commissioner.
3. A health carrier, other than a health maintenance organization,responsible for an MCHIP pursuant to this chapter, shall request its initialcertificate of quality assurance from the Department of Health on or beforeDecember 1, 1998, or becoming responsible for a MCHIP under this title. UntilJuly 1, 2000, such health carrier shall be deemed in compliance with theprovisions of this section if (i) a request for initial certification ispending before the Department of Health and (ii) no certificate has beenissued to the health carrier which has been revoked or not renewed by theState Health Commissioner.
D. The provisions of this chapter shall apply to all health carriers and allMCHIPs operating in this Commonwealth unless an exemption is recognized inaccordance with § 38.2-3420; and, except as otherwise provided in thischapter, the provisions of this chapter shall be supplemental and in additionto those otherwise applicable under this title or Title 32.1.
(1998, c. 891.)