{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.14_1.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.14_1.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.14_1.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.14_1.html"}],"law_id":82945,"edition_id":1,"section_id":82945,"structure_id":12994,"section_number":"38.2-3407.14:1","catch_line":"Standard of clinical evidence for decisions on coverage for proton radiation therapy","history":"2017, c. 287; 2024, c. 538.","full_text":"A\n\nAs used in this section, unless the context requires a different meaning:\n\t\t\t“Carrier” means an insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; a corporation providing individual or group accident and sickness subscription contracts; or a health maintenance organization providing a health care plan for health care services.\n\t\t\t“Proton radiation therapy” means the advanced form of radiation therapy treatment that utilizes protons as an alternative radiation delivery method for the treatment of tumors.\n\t\t\t“Radiation therapy treatment” means a cancer treatment through which a dose of radiation to induce tumor cell death is delivered by means of proton radiation therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation.B\n\nNotwithstanding the provisions of \u00a7 38.2-3419, each policy, contract, or plan issued or provided by a carrier that provides coverage for cancer therapy shall not hold proton radiation therapy to a higher standard of clinical evidence for decisions regarding coverage under the policy, contract, or plan than is applied for decisions regarding coverage of other types of radiation therapy treatment, and each carrier may consider at least one of the following a sufficient standard of clinical evidence to justify coverage of proton radiation therapy:1\n\nThat a proton radiation therapy treatment is covered by Medicare, Medicaid, or any other governmental health care coverage for any type of cancer.2\n\nThat a patient’s treating physician or radiation oncologist recommends proton radiation therapy for such patient’s cancer treatment.C\n\nNothing in this section shall be construed to mandate the coverage of proton radiation therapy under any policy, contract, or plan issued or provided by a carrier.D\n\nThe requirements of this section shall apply to all insurance policies, subscription contracts, and health care plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2018, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.E\n\nThis section shall not apply to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans.","order_by":null,"text":{"0":{"id":297293,"text":"As used in this section, unless the context requires a different meaning:\n\t\t\t“Carrier” means an insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; a corporation providing individual or group accident and sickness subscription contracts; or a health maintenance organization providing a health care plan for health care services.\n\t\t\t“Proton radiation therapy” means the advanced form of radiation therapy treatment that utilizes protons as an alternative radiation delivery method for the treatment of tumors.\n\t\t\t“Radiation therapy treatment” means a cancer treatment through which a dose of radiation to induce tumor cell death is delivered by means of proton radiation therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":297294,"text":"Notwithstanding the provisions of \u00a7 38.2-3419, each policy, contract, or plan issued or provided by a carrier that provides coverage for cancer therapy shall not hold proton radiation therapy to a higher standard of clinical evidence for decisions regarding coverage under the policy, contract, or plan than is applied for decisions regarding coverage of other types of radiation therapy treatment, and each carrier may consider at least one of the following a sufficient standard of clinical evidence to justify coverage of proton radiation therapy:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":297295,"text":"That a proton radiation therapy treatment is covered by Medicare, Medicaid, or any other governmental health care coverage for any type of cancer.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":297296,"text":"That a patient’s treating physician or radiation oncologist recommends proton radiation therapy for such patient’s cancer treatment.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"C"},"4":{"id":297297,"text":"Nothing in this section shall be construed to mandate the coverage of proton radiation therapy under any policy, contract, or plan issued or provided by a carrier.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B2","next_prefix":"D"},"5":{"id":297298,"text":"The requirements of this section shall apply to all insurance policies, subscription contracts, and health care plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2018, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"6":{"id":297299,"text":"This section shall not apply to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance 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This law was first created in 2017. The record of its establishment is cataloged in chapter 287<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 2024, chapter 538<\/a>.<\/p>","references":false,"refers_to":[{"id":66144,"section_number":"38.2-3419","catch_line":"Additional mandated coverage made optional to group policy or contract holder","order_by":null,"url":"\/38.2-3419\/"}],"permalink":{"id":214995,"object_type":"law","relational_id":82945,"identifier":"38.2-3407.14:1","token":"38.2\/34\/1\/38.2-3407.14_1","url":"\/38.2-3407.14_1\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.14_1\/","token":"38.2\/34\/1\/38.2-3407.14_1","dublin_core":{"Title":"Standard of clinical evidence for decisions on coverage for proton radiation therapy","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.14:1","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section, unless the context requires a different meaning:\n\t\t\t“Carrier<\/span>” means an insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; a corporation providing individual or group accident and sickness subscription contracts<\/span>; or a health maintenance organization providing a health care plan for health care services.\n\t\t\t“Proton radiation therapy<\/span>” means the advanced form of radiation therapy treatment<\/span> that utilizes protons as an alternative radiation delivery method for the treatment of tumors.\n\t\t\t“Radiation therapy treatment<\/span>” means a cancer treatment through which a dose of radiation to induce tumor cell death is delivered by means of proton radiation therapy<\/span>, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Notwithstanding the provisions of \u00a7 38.2-3419<\/a>, each policy, contract<\/span>, or plan issued or provided by a carrier<\/span> that provides coverage for cancer therapy shall not hold proton radiation therapy<\/span> to a higher standard of clinical evidence<\/span> for decisions regarding coverage under the policy, contract<\/span>, or plan than is applied for decisions regarding coverage of other types of radiation therapy treatment<\/span>, and each carrier<\/span> may consider at least one of the following a sufficient standard of clinical evidence<\/span> to justify coverage of proton radiation therapy<\/span>: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> That a proton radiation therapy treatment<\/span> is covered by Medicare<\/span>, Medicaid, or any other governmental health care coverage for any type of cancer. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> That a patient’s treating physician or radiation oncologist recommends proton radiation therapy<\/span> for such patient’s cancer treatment. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Nothing in this section shall be construed to mandate<\/span> the coverage of proton radiation therapy<\/span> under any policy, contract<\/span>, or plan issued or provided by a carrier<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The requirements of this section shall apply to all insurance policies<\/span>, subscription contracts<\/span>, and health care plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2018, or at any time thereafter when any term of the policy, contract<\/span>, or plan is changed or any premium adjustment is made. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> This section shall not apply to policies or contracts<\/span> designed for issuance to persons<\/span> eligible for coverage under Title XVIII of the Social Security Act, known as Medicare<\/span>, or any other similar coverage under state<\/span> or federal governmental plans. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSTANDARD OF CLINICAL EVIDENCE FOR DECISIONS ON COVERAGE FOR PROTON RADIATION\nTHERAPY (\u00a7 38.2-3407.14:1)\n\nA. As used in this section, unless the context requires a different meaning:\n\t\t\t“Carrier” means an insurer proposing to issue individual or group\naccident and sickness insurance policies providing hospital, medical and\nsurgical, or major medical coverage on an expense-incurred basis; a corporation\nproviding individual or group accident and sickness subscription contracts; or a\nhealth maintenance organization providing a health care plan for health care\nservices.\n\t\t\t“Proton radiation therapy” means the advanced form of radiation\ntherapy treatment that utilizes protons as an alternative radiation delivery\nmethod for the treatment of tumors.\n\t\t\t“Radiation therapy treatment” means a cancer treatment through\nwhich a dose of radiation to induce tumor cell death is delivered by means of\nproton radiation therapy, intensity modulated radiation therapy, brachytherapy,\nstereotactic body radiation therapy, three-dimensional conformal radiation\ntherapy, or other forms of therapy using radiation.\n\nB. Notwithstanding the provisions of \u00a7 38.2-3419, each policy, contract, or\nplan issued or provided by a carrier that provides coverage for cancer therapy\nshall not hold proton radiation therapy to a higher standard of clinical\nevidence for decisions regarding coverage under the policy, contract, or plan\nthan is applied for decisions regarding coverage of other types of radiation\ntherapy treatment, and each carrier may consider at least one of the following a\nsufficient standard of clinical evidence to justify coverage of proton radiation\ntherapy:\n\n 1. That a proton radiation therapy treatment is covered by Medicare, Medicaid,\n or any other governmental health care coverage for any type of cancer.\n\n 2. That a patient’s treating physician or radiation oncologist\n recommends proton radiation therapy for such patient’s cancer treatment.\n\nC. Nothing in this section shall be construed to mandate the coverage of proton\nradiation therapy under any policy, contract, or plan issued or provided by a\ncarrier.\n\nD. The requirements of this section shall apply to all insurance policies,\nsubscription contracts, and health care plans delivered, issued for delivery,\nreissued, or extended in the Commonwealth on and after January 1, 2018, or at\nany time thereafter when any term of the policy, contract, or plan is changed or\nany premium adjustment is made.\n\nE. This section shall not apply to policies or contracts designed for issuance\nto persons eligible for coverage under Title XVIII of the Social Security Act,\nknown as Medicare, or any other similar coverage under state or federal\ngovernmental plans.\n\nHISTORY: 2017, c. 287; 2024, c. 538.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}