Virginia Code 38.2-5809: Suspension or revocation of license
The Commission may suspend or revoke any license issued to a health carrier if it finds that any of the following conditions exist:
Terms Used In Virginia Code 38.2-5809
- Commission: means the State Corporation Commission. See Virginia Code 38.2-100
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Health care services: means the furnishing of services to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability. See Virginia Code 38.2-5800
- Health carrier: means an entity subject to Title 38. See Virginia Code 38.2-5800
- MCHIP: means an arrangement for the delivery of health care in which a health carrier undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. See Virginia Code 38.2-5800
- State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
1. The State Health Commissioner certifies to the Commission pursuant to § 32.1-137.5 that the health carrier or its MCHIP is unable to fulfill its obligations to furnish quality health care services as set forth in Article 1.1 (§ 32.1-137.1 et seq.) of Chapter 5 of Title 32.1. The suspension of a certificate of quality assurance shall not be deemed such a certification by the State Health Commissioner.
2. The State Health Commissioner notifies the Commission that the health carrier has failed to implement the complaint system required by Title 32.1 and § 38.2-5804 to resolve valid complaints reasonably.
3. The Commission determines that a certificate of quality assurance issued to the health carrier has been revoked by the State Health Commissioner, or a request for renewal of such certificate has been denied or disapproved by the State Health Commissioner.
1998, c. 891.