                                 CODE OF VIRGINIA

PROHIBITED PRACTICES (§ 38.2-5806)

A. No MCHIP licensee may cancel or refuse to renew the coverage of a covered
person for basic health care services on the basis of the status of the covered
person&#8217;s health.

B. The following provisions shall apply whenever an MCHIP provides a covered
person who is also a resident of a continuing care facility with coverage for
Medicare benefits and the covered person&#8217;s primary care physician
determines that it is medically necessary for the covered person to be referred
to a skilled nursing unit:

   1. The health carrier shall not require that the covered person relocate to a
   skilled nursing unit outside the continuing care facility if (i) the
   continuing care facility&#8217;s skilled nursing unit is certified as a
   Medicare skilled nursing facility and (ii) the continuing care facility
   agrees, as to such skilled nursing unit, to become a contracting provider in
   accordance with the health carrier&#8217;s standard terms and conditions for
   its participating providers.

   2. A continuing care facility that satisfies clauses (i) and (ii) of
   subdivision 1 shall not be obligated to accept as a skilled nursing unit
   patient any one other than a resident of the continuing care facility; and
   neither the health carrier nor the continuing care facility shall be allowed
   to include the skilled nursing unit or facilities on the list required by
   &#xA7; 38.2-5802 or to advertise in any other way that the facility&#8217;s
   skilled nursing unit is a participating provider with respect to coverage
   offered by the MCHIP for Medicare benefits or skilled nursing unit facilities
   for other than the continuing care facility&#8217;s residents.
   				As used in this subsection, &#8220;Medicare benefits&#8221; means medical
   and health products, benefits and services offered in accordance with Title
   XVIII of the United States Social Security Act (42 U.S.C. &#xA7; 1395 et seq.)
   and &#8220;continuing care facility&#8221; means a continuing care retirement
   community regulated pursuant to Chapter 49 (&#xA7; 38.2-4900 et seq.) of this
   title.

C. The following shall apply in accordance with provisions in Title 32.1 or
regulations promulgated thereunder:

   1. Where complaints of a covered person may be resolved through a specified
   arbitration agreement, the covered person shall be advised in writing of his
   rights and duties under the agreement at the time the complaint is registered.

   2. No contract or evidence of coverage that entitles covered persons to
   resolve complaints through an arbitration agreement shall limit or prohibit
   such arbitration for any claims asserted having a monetary value of $250 or
   more.

   3. If the covered person agrees to binding arbitration, his written acceptance
   of the arbitration agreement shall not be executed prior to the time the
   complaint is registered nor subsequent to the time an initial resolution is
   made, and the agreement shall be accompanied by a statement setting forth in
   writing the terms and conditions of binding arbitration.

HISTORY: 1998, c. 891.