                                 CODE OF VIRGINIA

SERVICES OF CERTAIN PRACTITIONERS OTHER THAN PHYSICIANS TO BE COVERED (§
38.2-4221)

A. A nonstock corporation shall not fail or refuse, either directly or
indirectly, to allow or to pay to a subscriber for all or any part of the health
services rendered by any doctor of podiatry, doctor of chiropody, optometrist,
optician, chiropractor, professional counselor, psychologist, physical
therapist, clinical social worker, clinical nurse specialist, audiologist,
speech pathologist, certified nurse midwife or other advanced practice
registered nurse, licensed certified midwife, licensed midwife, marriage and
family therapist, athletic trainer, or licensed acupuncturist licensed to
practice in Virginia, if the services rendered (i) are services provided for by
the subscription contract; (ii) are services which the doctor of podiatry,
doctor of chiropody, optometrist, optician, chiropractor, professional
counselor, psychologist, physical therapist, clinical social worker, clinical
nurse specialist, audiologist, speech pathologist, certified nurse midwife or
other advanced practice registered nurse, licensed certified midwife, licensed
midwife, marriage and family therapist, athletic trainer, or licensed
acupuncturist is licensed to render in this Commonwealth; and (iii) are, for any
services rendered by an athletic trainer, rendered in an office setting.

B. If a subscription contract provides reimbursement for a service that may be
legally performed by a licensed pharmacist, reimbursement under the subscription
contract by the nonstock corporation shall not be denied because the service is
rendered by the licensed pharmacist provided that (i) the service is performed
for a subscriber for a condition under the terms of a collaborative agreement,
as defined in &#xA7; 54.1-3300, between a pharmacist and the physician with whom
the subscriber is undergoing a course of treatment or (ii) the service is for
the administration of vaccines for immunization. Notwithstanding the provisions
of &#xA7; 38.2-4209, the nonstock corporation may require the pharmacist, any
pharmacy or provider that may employ such pharmacist, or the collaborating
physician to enter into a written agreement with the nonstock corporation as a
condition for reimbursement for such services. In addition, reimbursement to
pharmacists acting under the terms of a collaborative agreement under this
subsection shall not be subject to the provisions of &#xA7; 38.2-4209.1.

C. The payment for a service provided by a licensed certified midwife or
licensed midwife shall be in the same amount as the payment paid under the
subscription contract for a certified nurse midwife performing such service in
the area served, provided that the claim is submitted using (i) the diagnoses
and procedure codes applicable to the service; (ii) such licensed certified
midwife&#8217;s or licensed midwife&#8217;s name; (iii) the national provider
identifier for the licensed certified midwife or licensed midwife providing the
service; and (iv) if required by the nonstock corporation, the facility in which
the service is provided.

D. No nonstock corporation shall reduce the reimbursement paid to a certified
nurse midwife in order to comply with the provisions of this section.

HISTORY: Code 1950, § 32-195.10:1; 1966, c. 276, § 38.1-824; 1973, c. 428;
1979, cc. 13, 721; 1980, c. 682; 1986, c. 562; 1987, cc. 549, 551, 557; 1988, c.
522; 1989, cc. 7, 201; 1997, c. 203; 1998, c. 146; 2001, cc. 102, 475; 2019, cc.
332, 333; 2020, c. 726; 2022, cc. 440, 441; 2023, c. 183; 2025, c. 695.