                                 CODE OF VIRGINIA

PATIENT ACCESS TO EMERGENCY SERVICES (§ 38.2-3445)

A. Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other
section of this title to the contrary, if a health carrier providing individual
or group health insurance coverage provides any benefits with respect to
services in an emergency department of a hospital, the health carrier shall
provide coverage for emergency services:

   1. Without the need for any prior authorization determination, regardless of
   whether the emergency services are provided on an in-network or out-of-network
   basis;

   2. Without regard to the final diagnosis rendered to the covered person or
   whether the health care provider furnishing the emergency services is a
   participating health care provider with respect to such services;

   3. If such services are provided out-of-network, without imposing any
   administrative requirement or limitation on coverage that is more restrictive
   than the requirements or limitations that apply to such services received from
   an in-network provider;

   4. If such services are provided out-of-network, the health carrier shall pay
   the out-of-network provider in accordance with &#xA7; 38.2-3445.01 less any
   cost-sharing requirement. Any such cost-sharing requirement shall not exceed
   the cost-sharing requirement that would apply if such services were provided
   in-network as provided in &#xA7; 38.2-3445.01; and

   5. Without regard to any term or condition of such coverage other than the
   exclusion of or coordination of benefits or an affiliation or waiting period.

B. Coverage for emergency services that are related to mental health services or
substance abuse services, as those terms are defined in &#xA7; 38.2-3412.1,
shall be provided in accordance with the federal Mental Health Parity and
Addiction Equity Act of 2008, P.L. 110-343, even where those requirements would
not otherwise apply directly. Such emergency services may be rendered at a
location other than the emergency department of a hospital, such as a behavioral
health crisis service provider, as required.

HISTORY: 2011, c. 882; 2020, cc. 1080, 1081; 2024, cc. 199, 360.