                                 CODE OF VIRGINIA

EXPLANATION OF BENEFITS FOR HEALTH MAINTENANCE ORGANIZATION ENROLLEES WHO ARE
RECIPIENTS OF MEDICAL ASSISTANCE SERVICES OR COVERED BY THE FAMILY ACCESS TO
MEDICAL INSURANCE SECURITY (FAMIS) PLAN (§ 38.2-4320.1)

In the case of any health maintenance organization that has contracted with the
Virginia Department of Medical Assistance Services to provide health care
services to recipients of medical assistance services pursuant to Title XIX of
the Social Security Act, as amended, or to individuals who are covered by the
Family Access to Medical Insurance Security (FAMIS) Plan developed pursuant to
Title XXI of the Social Security Act, as amended, the requirements for
furnishing an explanation of benefits to current or former members and their
respective health care providers shall be as authorized and directed in the
standards prescribed in the state plan for medical assistance services pursuant
to Chapter 10 (§ 32.1-323 et seq.) of Title 32.1 and the FAMIS Plan pursuant to
Chapter 13 (§ 32.1-351 et seq.) of Title 32.1. The requirements for an
explanation of benefits otherwise addressed in this title shall not apply to
such health maintenance organization when contracting to deliver such services
to the extent that the statutory requirements differ from the standards of the
Department of Medical Assistance Services.

HISTORY: 2004, c. 185.