                                 CODE OF VIRGINIA

PROVIDER CONTRACTS (§ 38.2-5805)

A. Each health carrier subject to subsection B of &#xA7; 38.2-5801 shall file
with the Commission a list of the current providers who have executed a contract
directly with the health carrier or indirectly through an intermediary
organization for the purpose of providing health care services pursuant to an
MCHIP or for the benefit of a covered person of an MCHIP. The list shall include
the names and localities of the providers. The list shall be updated by the
health carrier at least annually and more frequently as required by the
Commission in accordance with provisions in this title or by the State Health
Commissioner in accordance with provisions in Title 32.1.

B. Every contract with a provider of health care services enabling an MCHIP to
provide health care services shall be in writing.

C. When the health carrier is a health maintenance organization, the contracts
with providers enabling the MCHIP to provide health care services to the covered
persons shall contain a &#8220;hold harmless&#8221; clause setting forth that,
in the event such health carrier fails to pay for health care services as set
forth in the contract, the covered persons shall not be liable to the provider
for any sums owed by the health carrier. The following requirements shall apply
to such contracts:

   1. Such contracts shall require that if the provider terminates the agreement,
   the provider shall give the health carrier at least sixty days&#8217; advance
   notice of termination.

   2. No provider party to such a contract, or agent, trustee or assignee
   thereof, may maintain any action at law against a covered person to collect
   sums owed by the health carrier.

   3. If there is an intermediary organization enabling a health carrier subject
   to subsection B of &#xA7; 38.2-5801 to provide health care services by means
   of the intermediary organization&#8217;s own contracts with health care
   providers, the contracts between the intermediary organization and its
   providers shall be in writing.

   4. The contracts shall set forth that, in the event either the health carrier
   or the intermediary organization fails to pay for health care services as set
   forth in the contracts between the intermediary organization and its
   providers, or in the contract between the intermediary organization and the
   health carrier, the covered person shall not be liable to the provider for any
   sums owed by either the intermediary organization or the health carrier.

   5. No provider party to such a contract, or agent, trustee or assignee
   thereof, may maintain any action at law against a covered person to collect
   sums owed by the health carrier or the intermediary organization.

   6. An agreement to provide health care services between an intermediary
   organization and a health carrier subject to subsection B of &#xA7; 38.2-5801
   shall require that if the intermediary organization terminates the agreement,
   the intermediary organization shall give the health carrier at least sixty
   days&#8217; advance notice of termination.

   7. An agreement to provide health care services between an intermediary
   organization and a provider shall require that if the provider terminates the
   agreement, the provider shall give the intermediary organization at least
   sixty days&#8217; advance notice of termination.

   8. Each such health carrier and intermediary organization shall be responsible
   for maintaining its executed contracts enabling it to provide health care
   services. These contracts shall be available for the Commission&#8217;s review
   and examination for a period of five years after the expiration of any such
   contract.

   9. The &#8220;hold harmless&#8221; clause required by this section shall read
   essentially as set forth in this subdivision. The health carrier may use a
   corresponding provision of different wording approved by the Commission that
   is not less favorable in any respect to the covered persons.
   				Hold Harmless Clause
   				[Provider] hereby agrees that in no event, including, but not limited to
   nonpayment by the MCHIP or its health carrier, the insolvency of the [health
   carrier], or breach of this agreement, shall [Provider] bill, charge, collect
   a deposit from; seek compensation, remuneration or reimbursement from; or have
   any recourse against subscribers or persons other than the health carrier for
   services provided pursuant to this Agreement. This provision shall not
   prohibit collection of any applicable copayments or deductibles billed in
   accordance with the terms of the subscriber agreement for the MCHIP.
   				[Provider] further agrees that (i) this provision shall survive the
   termination of this Agreement regardless of the cause giving rise to such
   termination and shall be construed to be for the benefit of the plan&#8217;s
   subscribers and (ii) this provision supersedes any oral or written agreement
   to the contrary now existing or hereafter entered into between [Provider] and
   the subscriber or persons acting on the subscriber&#8217;s behalf.

   10. If there is an intermediary organization between the health carrier and
   the health care providers, the hold harmless clause set forth in subdivision 5
   shall be amended to include nonpayment by the plan, the health carrier, and
   the intermediary organization and shall be included in any contract between
   the intermediary organization and health care providers and in any contract
   between the health carrier on behalf of the MCHIP and the intermediary
   organization.

D. The Commission may specify for each type of health carrier other than a
health maintenance organization the circumstances, if any, under which a health
carrier for an MCHIP shall contract with a provider with the &#8220;hold
harmless&#8221; clause described in subsection C. The Commission may specify
also the extent to which certain accounting treatment, reserves, net worth or
surplus shall be required for liabilities arising from provider contracts
without the &#8220;hold harmless&#8221; clause.

HISTORY: 1998, c. 891.