38.2-5802 - Establishment of an MCHIP.
§ 38.2-5802. Establishment of an MCHIP.
A. A health carrier, when applying for initial licensing under this title andwith each request for renewal that is to be effective on or after July 1,1999, shall describe and categorize generally its transactions and operationsin this Commonwealth that influence the cost or level of health care servicesbetween the health carrier and one or more providers with respect to thedelivery of health care services through its MCHIPs. Descriptions andcategorization shall identify generally the arrangements that the healthcarrier has with providers with respect to the delivery of health careservices. Descriptions of incentive arrangements shall include compensationmethodology and incentives. The descriptions of incentive arrangements shallnot include amounts of compensation and values of incentives. Renewal filingsshall clearly identify new matter and material changes of informationdisclosed in the preceding filing.
B. A health carrier applying to the Department of Health for initialcertification of quality assurance shall simultaneously file a copy of itsrequest for certification with the Commission and shall include the list ofproviders required by § 38.2-5805. Such filings shall be assessed by theDepartment of Health.
C. In addition to items specified in subsection B, the initial filing underthis chapter by a health carrier subject to subsection B of § 38.2-5801 shallinclude any forms of contracts, including any amendments thereto, made withhealth care providers enabling the health carrier to provide health careservices through its MCHIPs to covered persons. Individual provider contractsand contracts with persons outside this Commonwealth shall not be filed withthe Commission unless requested by the Commission or necessary to explain orfully disclose pursuant to subsection D operational changes that arematerially at variance with the information currently on file with theCommission. The health carrier shall maintain a complete file of allcontracts made with health care providers which shall be subject toexamination by the Commission. The contracts shall be retained in the filefor a period of at least five years after their expiration. Notwithstandingthe provisions of Chapter 37 (§ 2.2-3700 et seq.) of Title 2.2 of the Code ofVirginia, such contracts shall be confidential and shall not be subject todiscovery upon subpoena.
D. No MCHIP shall be operated in a manner that is materially at variance withthe information submitted pursuant to this section. Any change in suchinformation which would result in operational changes that are materially atvariance with the information currently on file with the Commission shall besubject to the Commission's prior approval. If the Commission fails to act ona notice of material change within thirty days of its filing, the proposedchanges shall be deemed approved. A material change in the MCHIP's healthcare delivery system shall be deemed to result in operational changes thatare materially at variance with the information on file with the Commission.The Commission may determine that other changes are material and may requiredisclosure to secure full and accurate knowledge of the affairs and conditionof the health carrier.
E. A health carrier shall give notice to the State Health Commissioner of thefilings it makes with the Commission pursuant to this section.
F. The provisions of this section are applicable generally for all healthcarriers subject to licensure under this title. The provisions of thissection shall be applied specifically as follows: (i) the provisions ofsubsection A are applicable for each health carrier requesting renewal of alicense on or after July 1, 1998, and also for each health carrier applyingfor initial licensing on or after July 1, 1998; (ii) the provisions ofsubsection B shall be applied to any health carrier that files an applicationwith the Department of Health for initial certification of quality assurance;(iii) the provisions of subsection C become applicable as soon as a healthcarrier makes a filing pursuant to this section; (iv) the filing requirementsdescribed in subsection D are applicable for all material filed with theCommission pursuant to this section, and shall be applied also when a healthcarrier proposes material changes to information of the type described inthis section which previously had been filed with the Commission pursuant toprovisions of Chapter 43 (§ 38.2-4300 et seq.) of this title; and (v) theprovisions of subsection E are applicable whenever a health carrier makes afiling pursuant to this section.
(1998, c. 891; 1999, c. 20.)