reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-60 - Reporting cybersecurity events to the commissioner

Current through Register Vol. 40, No. 24, July 15, 2024
A. Reporting cybersecurity events to the
				commissioner.
1. Once a licensee has
				determined both that a cybersecurity event has occurred and that the licensee
				has a duty to report it to the commissioner pursuant to §
										38.2-625
				of the Code of Virginia, the licensee shall notify the commissioner within
				three business days that it has information to report, using the email address
				designated by the bureau. This notification should include the name, telephone
				number, and email address of the individual who is the licensee's designated
				contact for the cybersecurity event.
2. Instructions for communicating the
				information required by §
										38.2-625
				of the Code of Virginia to the commissioner through a secure portal will be
				provided by the bureau in response to the email.
3. The licensee shall update the commissioner
				on the progress of its investigation as information becomes known to the
				licensee until the licensee has provided as much of the information set forth
				in §
										38.2-625
				of the Code of Virginia as possible.
4. If also required to notify consumers,
				licensees shall (i) provide the commissioner with a copy of the notice template
				and any documentation provided to consumers and (ii) maintain a list of
				consumers notified and retain the list for the timeframe established by §
										38.2-624D
				of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-70 - Consumer notification provisions

Current through Register Vol. 40, No. 24, July 15, 2024
A. Licensees, except those exempted under
				subsection A 1 or A 2 of §
									38.2-629 of the Code
				of Virginia, that determine a cybersecurity event has occurred and has caused
				or has a reasonable likelihood of causing identity theft or other fraud to
				consumers whose information was accessed or acquired shall notify those
				consumers in accordance with §
									38.2-626 of
				the Code of Virginia, subject to any applicable numerical threshold.
B. Each licensee required to notify consumers
				of a cybersecurity event that does not intend to notify consumers based on a
				belief that the cybersecurity event does not have a reasonable likelihood of
				causing identity theft or other fraud to the consumers shall notify the
				commissioner, without unreasonable delay, of its position and provide an
				explanation supporting the licensee's position.
Statutory Authority: §§
											12.1-13
					 and
					 38.2-223
					 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section - DOCUMENTS INCORPORATED BY REFERENCE (14VAC5-430)

Current through Register Vol. 40, No. 24, July 15, 2024
National Institute of Standards and Technology, Computer
				  Security Division, Information Technology Laboratory, 100 Bureau Drive (Mail
				  Stop 8930), Gaithersburg, MD 20899-8930, sec-cert@nist.gov
NIST,
				  Special Publication, Guide for Conducting Risk Assessments, 800-30 (rev.
				  9/2012)
NIST,
				  Special Publication, Managing Information Security Risk Organization, Mission,
				  and Information System View, 800-39 (eff. 3/2011)
N
IST
,
				  Special Publication, Security and Privacy Controls for Federal Information
				  Systems and Organizations, 800-53 (rev. 9/2021)
NIST,
				  Special Publication, Protecting Controlled Unclassified Information, 800-171
				  (rev. 2/2020)
Statutory Authority: §§
											12.1-13
					 and
					 38.2-223
					 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-10 - Scope and purpose

Current through Register Vol. 40, No. 24, July 15, 2024
The purpose of this chapter is to establish standards for a
				  certified application counselor program by the Health Benefit Exchange in
				  accordance with §
									38.2-6514
				  of the Code of Virginia.
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-20 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter shall
				  have the following meanings unless the context clearly indicates
				  otherwise:
"Certified application counselor" means an individual
				  certified by a CDO to perform the duties described in in this chapter and
				  45 CFR
				  155.225(c).
"Certified application counselor designated organization" or
				  "CDO" means an organization designated by the exchange to certify its staff
				  members or volunteers to act as certified application counselors who perform
				  the duties and meet the standards and requirements for certified application
				  counselors set forth in this chapter and
				  45 CFR
				  155.225.
"CHIP" means the Children's Health Insurance Program under
				  Title XXI ( 42 USC 7 ) of the Social Security Act, including FAMIS.
"Exchange" means the Virginia Health Benefit Exchange
				  established pursuant to the provisions of Chapter 65 (§
									38.2-6500 et seq.) of
				  Title 38.2 of the Code of Virginia.
"FAMIS" means the Family Access to Medical Insurance Security
				  Plan, including the FAMIS Plus program, established pursuant to Chapter 13
				  (§
									32.1-351
				  et seq.) of Title 32.1 of the Code of Virginia.
"Navigator" means an individual or entity that is registered
				  pursuant to §
									38.2-3457
				  of the Code of Virginia.
"Personal information" has the same meaning assigned to the
				  term in §
									38.2-602 of the Code
				  of Virginia.
"Qualified dental plan" means a limited scope dental plan
				  that has been certified in accordance with §
									38.2-6506
				  of the Code of Virginia.
"Qualified health plan" means a health benefit plan that
				  meets the criteria for certification described in § 1311(c) of the Patient
				  Protection and Affordable Care Act,
				  P.L.
				  111-148, and has been certified in accordance with
				  §
									38.2-6506
				  of the Code of Virginia.
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-30 - Designation of organizations

Current through Register Vol. 40, No. 24, July 15, 2024
A. The exchange may designate an organization
				to certify its staff members or volunteers as certified application counselors.
				An organization seeking designation as a CDO shall:
1. Register with the exchange and provide any
				information required for registration purposes in the form and manner
				prescribed by the exchange;
2.
				Submit a compliance agreement with the exchange that outlines the standards and
				requirements in accordance with
				45 CFR
				155.225, including subdivisions (d)3 through
				(d)5; and
3. Attest to the
				organization's ability to carry out the required duties as set forth in
				14VAC7-10-40, and if requested by the exchange, provide documentation or other
				information evidencing compliance with these duties.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-40 - Duties of a certified application counselor designated organization

Current through Register Vol. 40, No. 24, July 15, 2024
A CDO shall perform the duties and meet the standards and
				  requirements to certify application counselors. The CDO shall:
1. Meet the terms of the compliance agreement
				executed with the exchange pursuant to 14VAC7-10-30 A 2;
2. Maintain a registration process and method
				to track the performance of certified application counselors;
3. Provide data and information to the
				exchange regarding (i) the identity, number, and performance of its certified
				application counselors; and (ii) the consumer assistance provided by its
				certified application counselors in the form and manner specified by the
				exchange. Beginning in the first quarter of calendar year 2021, each CDO shall
				submit quarterly reports that include, at a minimum, data regarding the number
				and identifying information of individuals who have been certified by the
				organization; the total number of consumers who received application and
				enrollment assistance from the organization; and of that number, the number of
				consumers who received assistance in applying for and selecting a qualified
				health plan or qualified dental plan, enrolling in a qualified health plan or
				qualified dental plan, or applying for Medicaid or CHIP;
4. Establish procedures to withdraw
				certification from or refuse to recertify any individual certified application
				counselor upon a finding of noncompliance with the requirements for
				certification or a failure to perform duties as required by this chapter; and
5. Establish consumer protection
				procedures to ensure that:
a. Consumers are
				informed prior to receiving assistance of the functions and responsibilities of
				a certified application counselor, including that a certified application
				counselor may not act as a tax adviser or attorney and cannot provide tax or
				legal advice when providing assistance in their capacity as a certified
				application counselor;
b.
				Consumers provide the CDO with a signed authorization on a form prescribed and
				furnished by the exchange prior to a certified application counselor obtaining
				access to a consumer's personal information. The CDO shall maintain a record of
				the authorization for a period of at least six years; and
c. Consumers understand that they may revoke
				at any time the authorization provided to the certified application
				counselor.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-50 - Certification of application counselors

Current through Register Vol. 40, No. 24, July 15, 2024
A. A CDO may certify an individual staff
				member or volunteer to perform the duties of a certified application counselor
				only if the individual staff member or volunteer:
1. Completes exchange-approved training
				regarding qualified health plan and qualified dental plan options, insurance
				affordability programs, eligibility, and benefits rules and regulations
				governing all insurance affordability programs operated in Virginia, as
				implemented in Virginia, and completes and achieves a passing score on all
				exchange-approved certification examinations, prior to functioning as a
				certified application counselor;
2. Discloses to the CDO and potential
				applicants any relationships the certified application counselor or sponsoring
				agency has with any qualified health plan, qualified dental plan, insurance
				affordability program, or other potential conflicts of interest;
3. Complies with the exchange's privacy and
				security standards adopted consistent with
				45 CFR
				155.260 and applicable authentication and
				data security standards;
4. Agrees
				to act in the best interest of the applicants assisted;
5. Provides, either directly or through an
				appropriate referral to a navigator or non-navigator assistance personnel
				authorized under
				45 CFR
				155.205(d) and (e) or 45 CFR
				155.210 or to the exchange call center, information in a manner that is
				accessible to individuals with disabilities, as defined by the Americans with
				Disabilities Act (
				42 USC §
											12101 et seq.) and § 504 of the
				Rehabilitation, Comprehensive Services, and Developmental Disabilities Act (
				29 USC §
											794 ); and
6. Enters into an agreement with the CDO
				regarding compliance with the standards specified in
				45 CFR
				155.225(d), (f), and (g).
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-60 - Duties of certified application counselors

Current through Register Vol. 40, No. 24, July 15, 2024
A certified application counselor certified by a CDO shall:
1. Provide information to individuals
				and employees about the full range of qualified health plan or qualified dental
				plan options and insurance affordability programs for which they are eligible,
				including providing fair, impartial, and accurate information that assists
				consumers with submitting the eligibility application; clarify the distinctions
				among health coverage options, including qualified health plans or qualified
				dental plans; and help consumers make informed decisions during the health
				coverage selection process;
2.
				Assist individuals and employees to apply for coverage in a qualified health
				plan or qualified dental plan through the exchange and for insurance
				affordability programs;
3. Help to
				facilitate enrollment of eligible individuals in a qualified health plan or
				qualified dental plan and any insurance affordability programs; and
4. Adhere to all the requirements and
				responsibilities set forth by the CDO or the exchange in the performance of the
				certified application counselor's duties under this chapter.
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-70 - Prohibitions on fees, consideration, solicitation, and marketing

Current through Register Vol. 40, No. 24, July 15, 2024
A CDO or a certified application counselor may not:
1. Impose any charge on a consumer, an
				applicant, or an enrollee for application or other assistance related to the
				exchange;
2. Act as an insurance
				agent or broker;
3. Receive any
				consideration directly or indirectly from any health insurance issuer or other
				insurance issuer in connection with the enrollment of any individual in a
				qualified health plan or qualified dental plan or a nonqualified health plan or
				nonqualified dental plan;
4.
				Provide compensation to any individual certified application counselor on a
				per-application, per-individual-assisted, or per-enrollment basis;
5. Provide to an applicant or potential
				enrollee a gift of any value as an inducement for enrollment. The value of a
				gift provided to an applicant and potential enrollee for purposes other than as
				an inducement for enrollment shall not exceed nominal value, either
				individually or in the aggregate, when provided to that individual during a
				single encounter. For purposes of this subdivision the term "gift" includes
				gift items, gift cards, cash cards, cash, or promotional items that market or
				promote the products or services of a third party but does not include the
				reimbursement of legitimate expenses incurred by a consumer in an effort to
				receive exchange application assistance, such as travel or postage expenses;
6. Solicit any consumer for
				application or enrollment assistance by going door-to-door or through other
				unsolicited means of direct contact with a consumer to provide application or
				enrollment assistance without the consumer initiating the contact, unless the
				individual has a preexisting relationship with the individual certified
				application counselor or CDO and other applicable state and federal laws are
				otherwise complied with; or
7.
				Initiate any telephone call to a consumer using an automatic telephone dialing
				system or an artificial or prerecorded voice, except in cases where the
				individual certified application counselor or CDO has a relationship with the
				consumer and so long as other applicable state and federal laws are otherwise
				complied with.
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Section 14VAC7-10-80 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or its application to any
				  person or circumstance is for any reason held to be invalid by a court, the
				  remainder of this chapter and the application of the provisions to other
				  persons or circumstances shall not be affected.
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 7 - STATE CORPORATION COMMISSION, HEALTH BENEFITS EXCHANGE DIVISION › Chapter 10 - RULES GOVERNING THE CERTIFIED APPLICATION COUNSELOR PROGRAM › Form - FORMS (14VAC7-10)

Current through Register Vol. 40, No. 24, July 15, 2024
Agreement
				  Between the Virginia Health Benefit Exchange and Certified Counselor Designated
				  Organization, Form 10-A (eff. 1/2021)
Health
				  Benefits Exchange Certified Account Counselor Authorization Form, Form 10-B
				  (eff. 3/2021)
Statutory Authority: 12.1-13, 38.2-223, and 38.2-6515 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part I - General Procedural Requirements › Section 14VAC10-10-10 - Payer of last resort

Current through Register Vol. 40, No. 24, July 15, 2024
The Virginia Birth-Related Neurological Injury Compensation
					 Program (Program) is a payer of last resort. Each admitted claimant's primary
					 insurance and other sources of coverage should be billed for covered services
					 before the Program is asked to pay for a service. An admitted claimant may not
					 receive reimbursement or compensation from the Program for expenses for items
					 or services, or for reimbursements, that he has received or is entitled to
					 receive by contract, state law, or federal law, or from another source, except
					 to the extent that it is prohibited by federal law.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part I - General Procedural Requirements › Section 14VAC10-10-20 - Primary insurance

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Medical services that are required to be precertified, preauthorized, or
				  authorized by the admitted claimant's primary insurance provider may not be
				  payable by the Virginia Birth-Related Neurological Injury Compensation Program
				  (Program) if the primary insurance carrier's certification or authorization
				  process has not been satisfied.
B.
				  Admitted claimants must utilize the primary insurer's in-network providers and
				  facilities unless otherwise authorized by the Program. Utilizing non-network or
				  nonparticipating providers or facilities may result in reduced payment or
				  nonpayment of incurred expenses.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part I - General Procedural Requirements › Section 14VAC10-10-30 - Medical review

Current through Register Vol. 40, No. 24, July 15, 2024
The Virginia Birth-Related Neurological Injury Compensation
					 Program reserves the right to submit requests for services or equipment for
					 independent medical review to determine medical necessity or appropriateness of
					 care prior to authorizing payment.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-40 - Counseling

Current through Register Vol. 40, No. 24, July 15, 2024
The Virginia Birth-Related Neurological Injury Compensation
					 Program will pay for counseling for family members related to the needs of an
					 admitted claimant. After primary insurance, a maximum of $1,500 per calendar
					 year will be paid for this service. Services must be provided by a licensed
					 clinical social worker, counselor, psychologist, or
					 psychiatrist.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-60 - Dental care

Current through Register Vol. 40, No. 24, July 15, 2024
The Virginia Birth-Related Neurological Injury Compensation
					 Program will pay for the admitted claimant's dental care costs if they are
					 medically necessary not cosmetic and are not covered by other
					 sources.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-70 - Therapy

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Virginia
				  Birth-Related Neurological Injury Compensation Program (Program) will pay for
				  therapy that is determined to be medically necessary and reasonable and for
				  which there is a letter of medical necessity provided by the admitted
				  claimant's primary care physician or appropriate treating specialist
				  physician.
B. The Program may
				  consult periodically with appropriate medical professionals regarding the
				  necessity for continuing various therapies including behavioral, physical,
				  horseback, and speech therapy.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-80 - Transportation; vans

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Virginia
				  Birth-Related Neurological Injury Compensation Program (Program) will fund the
				  purchase of a van when it becomes medically necessary for wheelchair
				  transportation. Van options for admitted claimants are available from the
				  Program. The Program will have the primary lien on the van's certificate of
				  title, although the van itself will be titled in the name of the admitted
				  claimant's parents or legal guardians. The Program will pay the personal
				  property taxes on and sales taxes resulting from the initial purchase of the
				  medically necessary van and also will pay an amount equal to the uninsured
				  motorist fee, or the insurance premium for the van, whichever is less. Other
				  operating costs, such as city or county decals and tags, maintenance, repairs,
				  and tires will be the responsibility of the parents or guardians. Mileage and
				  other transportation costs will be reimbursed as set out under 14VAC10-10-150.
				  The Program will reimburse the admitted claimant's family for the cost of
				  insuring the lift and tie downs if an additional cost is incurred for this and
				  a receipt is provided.
B. Vans will
				  be replaced at approximately 100,000 miles. Documentation of the vehicle's
				  service history and condition will be considered in determining the timing of
				  van replacement.
C. In the event a
				  van provided by the Program is no longer necessary for transportation of the
				  admitted claimant, the van must be returned, and the title must be transferred
				  to the Program within three months. The family may purchase the van if an
				  agreeable purchase price is agreed upon with the Executive Director of the
				  Program.
D. All vans returned to
				  the Program should be in good working order and be able to pass a Virginia
				  state inspection. If the van is not in good working order or cannot pass a
				  Virginia state inspection, the admitted claimant's parent or legal guardian
				  must have the defects repaired at his own cost if the expense is not covered by
				  insurance prior to returning the vehicle to the Program.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-90 - Equipment

Current through Register Vol. 40, No. 24, July 15, 2024
A. Equipment
				  documented as medically necessary by the admitted claimant's physician will be
				  provided by the Virginia Birth-Related Neurological Injury Compensation Program
				  (Program). Because there is a gamut of equipment that may be provided, no
				  attempt is made to list all such equipment in this section. Equipment provided
				  to date, however, includes oxygen concentrators, bipap machines, feeding pumps,
				  gait trainers, wheelchairs, Wizard strollers, suction machines, apnea monitors,
				  IV poles, pulse oximeters, therapy balls, therapy mats, Gorilla car seats,
				  wheelchair lifts, and wheelchair tie-downs.
B. All medically necessary equipment (except
				  vans) purchased entirely by the Program remains the property of the Program.
				  Depending upon the type of equipment and its condition, it is expected that
				  equipment will be returned to the Program when no longer required by the
				  admitted claimant. The family may purchase the equipment if a purchase price is
				  agreed upon with the Executive Director of the Program. If the equipment is not
				  purchased entirely by the Program it does not have to be returned to the
				  Program.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-100 - Augmentative communication technology

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Virginia Birth-Related Neurological
				  Injury Compensation Program (Program) will pay for devices, equipment, and
				  computer software for the purpose of aiding in communication of an admitted
				  claimant who otherwise is unable to communicate verbally. The Program may
				  require an evaluation be completed by a Program assigned augmentative
				  communication consultant to ensure the appropriate equipment is recommended or
				  purchased.
B. For all equipment
				  supplied by the Program, it is expected that the admitted claimant and those
				  involved in the care of the admitted claimant will utilize the equipment as
				  intended and invest the time and effort required for the equipment to be
				  utilized successfully.
C. In
				  accordance with the Program's general policy on purchasing medically necessary
				  equipment, all augmentative communication technology equipment remains the
				  property of the Program. If for any reason the equipment no longer is necessary
				  or not utilized by the admitted claimant, it should be returned to the Program.
				  Because the Program is a payer of last resort, all measures for obtaining
				  coverage through primary insurance or other sources must be exhausted before
				  the Program will cover augmentative technology services.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-110 - Privately owned housing assistance

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Virginia Birth-Related Neurological
				  Injury Compensation Program (Program) Board of Directors statutory authority
				  concerns awards for the medical needs of the admitted claimants it serves.
				  However, if an admitted claimant has medically necessary housing needs that can
				  be addressed in the nonrental home currently owned and occupied by the admitted
				  claimant's family or guardian, the board will provide one-time funding for
				  medically necessary modification to, or construction of, an accessible bedroom
				  and bathroom if such modification or construction is feasible and reasonable.
				  This modification or construction must be within the Program's allowable
				  standards for cost, space, and other factors before funding for an accessible
				  bedroom and bathroom will be authorized. The Program's construction manager or
				  other qualified professional will determine the feasibility of these
				  modifications or construction and whether the admitted claimant's needs will be
				  met in the contemplated project.
B.
				  The maximum lifetime housing benefit per admitted claimant for any one or
				  combination of housing benefits (rental or construction) is up to
				  $175,000.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-120 - Rental housing assistance

Current through Register Vol. 40, No. 24, July 15, 2024
A. If the admitted claimant resides in a
				  non-handicapped-accessible rental unit and moves to a handicapped accessible
				  rental unit, the Virginia Birth-Related Neurological Injury Compensation
				  Program (Program) will reimburse the difference between the former monthly
				  rental payment and the cost for the appropriate handicapped accessible rental
				  unit of similar size and quality based on cost per square foot. Any substantial
				  increases in the square footage of the handicapped accessible unit to be
				  reimbursed must be attributable to medically necessary requirements and not
				  exceed the overall guidelines utilized when the Program constructs additional
				  space for an admitted claimant.
B.
				  The handicapped accessible rental unit should meet all applicable regulations
				  of the Americans with Disabilities Act (ADA (
				  42 USC §
											1201 et seq.)). Exceptions to meeting the ADA
				  regulations must be approved by the Virginia Birth-Related Neurological Injury
				  Compensation Program's Board of Directors. Prior to providing reimbursement the
				  Program may require certification of the rental unit's suitability for the
				  admitted claimant or compliance with this policy.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-130 - Funeral expenses

Current through Register Vol. 40, No. 24, July 15, 2024
The Virginia Birth-Related Neurological Injury Compensation
					 Program will pay a maximum of $5,000 for the funeral and burial expenses of an
					 admitted claimant.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-140 - Attorney fees

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia law authorizes payment of reasonable attorney fees
					 incurred in the initial filing of a claim to enter the Virginia Birth-Related
					 Neurological Injury Compensation Program, subject to the approval and award of
					 the Virginia Workers' Compensation Commission.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-150 - Miscellaneous expenses

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Transportation. Upon submission of receipts, the Virginia Birth-Related
				  Neurological Injury Compensation Program (Program) will reimburse parking fees
				  associated with medically necessary travel. The Program will reimburse
				  documented mileage for medically necessary travel at the following rates:
1. Mileage will be reimbursed at 50% of the
				  U.S. Internal Revenue Service's mileage rate for vans provided by the Program.
				  Mileage reimbursement typically covers gasoline and other costs of operation.
				  Because the Program provides the van in this instance, the Program's mileage
				  reimbursement is intended only to cover the cost of gasoline associated with
				  medically necessary transportation. Mileage is based on the distance from the
				  home to the appointment location. Verification may be required by the
				  Program.
2. For use of personal
				  vehicles, reimbursement will be at the U.S. Internal Revenue Service's mileage
				  rate. In the event a van provided by the Program is unavailable, the mileage
				  reimbursement allowance provided would be that allowed for vans purchased by
				  the Program. Upon submission of receipts, the Program will reimburse other
				  medically necessary transportation expenses not otherwise reimbursed.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-160 - Insurance

Current through Register Vol. 40, No. 24, July 15, 2024
A. Because the
				  Virginia Birth-Related Neurological Injury Compensation Program (Program)
				  generally is a payer of last resort, each admitted claimant's parent or legal
				  guardian must purchase private health insurance to provide coverage for the
				  actual medically necessary and reasonable expenses as described in §
										38.2-5009A
				  1 of the Code of Virginia that were, or are, incurred as a result of the
				  admitted claimant's birth-related neurological injury and for the admitted
				  claimant's benefit. The admitted claimant's parent or legal guardian may
				  request the assistance of the Program facilitator in obtaining a suitable
				  health insurance policy for the admitted claimant if he has no preexisting
				  coverage for the admitted claimant upon the admitted claimant's admission into
				  the Program. The Program will reimburse, upon receipt of proof of payment,
				  solely the portion of the premiums that is attributable to the admitted
				  claimant's post-admission coverage and paid for by the admitted claimant's
				  parent or legal guardian. The Program must be provided with a copy of the
				  applicable health insurance policy before benefits are paid by the Program. It
				  is the responsibility of the parents or guardians to seek benefits for which an
				  admitted claimant is eligible by submitting requests to the Program third-party
				  administrator or other appropriate staff person, as indicated on the Program's
				  website. In addition, the parents or guardians of the admitted claimant must
				  identify a primary care physician.
B. Claimants must utilize the primary
				  insurer's in-network providers and facilities unless otherwise authorized by
				  the Program. Utilizing non-network or nonparticipating providers or facilities
				  may result in reduced payment, nonpayment, or nonreimbursement of incurred
				  expenses.
Statutory Authority: §
												38.2-5002.1
						of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-170 - Reimbursement

Current through Register Vol. 40, No. 24, July 15, 2024
Although an admitted claimant has been determined eligible
					 for benefits from the Virginia Birth-Related Injury Compensation Program
					 (Program), parents or caregivers must contact the Program before committing to
					 the purchase of equipment or incurring other expenses for which they may seek
					 reimbursement. Failure to do so may jeopardize reimbursement from the Program.
					 In the case of emergency care rendered or sought during nonbusiness hours, the
					 admitted claimant's family is responsible for contacting the Program the next
					 business day for authorization of services for which the Program is expected to
					 pay.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-180 - Claims for reimbursement

Current through Register Vol. 40, No. 24, July 15, 2024
Requests for reimbursement of expenses from medical
					 providers, pharmacies, equipment providers, medically necessary mileage, or
					 other expenses will not be honored if submitted after one year from the date
					 they are incurred. All reimbursement requests must be accompanied by
					 documentation of medical necessity and receipts from providers. This time limit
					 does not apply to expenses incurred prior to acceptance into the Virginia
					 Birth-Related Neurological Injury Compensation Program (Program). All requests
					 for reimbursement for expenses prior to entry into the Program must be
					 submitted within two years of entry into the Program.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-190 - Requests for authorization; services outside insurance plan covered area or network

Current through Register Vol. 40, No. 24, July 15, 2024
A. In
				  the event it is medically necessary to take an admitted claimant outside the
				  admitted claimant's applicable insurance plan's covered service area or the
				  primary insurance's provider network for evaluation, surgery, etc., it must be
				  ascertained if the primary insurance plan will pay for benefits and if so, what
				  amount it will pay. After this is determined, the Virginia Birth-Related
				  Neurological Injury Compensation Program (Program) must be contacted for
				  authorization prior to seeking services or the Program may determine not to pay
				  any balance remaining on the bill for these services.
B. If an in-network provider is available for
				  a service and an out-of-network provider is utilized, the Program will
				  reimburse or pay only an amount equal to what the Program would have paid if an
				  in-network provider had been utilized.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-200 - Medically necessary travel greater than 100 miles from primary residence

Current through Register Vol. 40, No. 24, July 15, 2024
In the event it is medically necessary to take an admitted
					 claimant outside the local service area (more than 100 miles from the admitted
					 claimant's primary residence) for evaluation, surgery, or other medically
					 necessary care, it must be ascertained prior to the travel if the
					 travel-related expenses will be reimbursed by the Virginia Birth-Related
					 Neurological Injury Compensation Program (Program). If preauthorization is not
					 obtained, the Program may not pay for these travel-related
					 expenses.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-210 - Request for benefits no specifically addressed

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter authorizes the Executive Director of the
					 Virginia Birth-Related Neurological Injury Compensation Program (Program) to
					 provide the benefits described without referral to the Board of Directors of
					 the Program except in exceptional circumstances, and in the executive
					 director's discretion. The board, however, realizes that there may be programs,
					 equipment, or other items, which may be of value to an admitted claimant that
					 this chapter does not address. If the parents or guardians feel a benefit not
					 described in this chapter would be of value to the admitted claimant (the
					 executive director is not authorized to provide those benefits without board
					 approval), the parents or guardians should write the board via the executive
					 director, who will bring these requests to the board at its next
					 meeting.
Statutory Authority: §
												38.2-5002.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part III - Other Procedure › Section 14VAC10-10-220 - Experimental treatment and therapy

Current through Register Vol. 40, No. 24, July 15, 2024
A. Experimental treatments or therapy not
				  typically covered by health insurance, including conductive education, may be
				  covered up to a maximum of $6,000 per year, combined, with written prior
				  authorization from the Executive Director of the Virginia Birth-Related
				  Neurological Injury Compensation Program (Program). The Board of Directors of
				  the Program recognizes that such therapies or treatments may be useful for some
				  admitted claimants and, therefore, grants this discretionary benefit on a
				  case-by-case basis. Because this benefit is not provided expressly by the
				  Virginia Birth-Related Neurological Injury Compensation Act (§
										38.2-5000 et seq. of the Code of
				  Virginia), however, there is no guarantee of coverage for experimental therapy
				  or treatment. This completely discretionary benefit may be rescinded at any
				  time; especially if such rescission is warranted by the Board of Directors
				  fiduciary obligations set forth in §
										38.2-5016F of
				  the Code of Virginia. Upon such rescission, benefits under this policy will
				  terminate immediately and no admitted claimant will have any further recourse
				  or any basis for a claim for further benefits under this policy.
B. A written request for authorization of
				  experimental treatment or therapy must be submitted to the Program in
				  accordance with the following process:
1. A
				  letter of medical necessity from the admitted claimant's physiatrist,
				  neurologist, or other appropriate treating specialist physician, who also
				  regularly treats other patients with cerebral palsy, must be received by the
				  Program. A letter of medical necessity from a physical therapist is not
				  acceptable.
2. The letter of
				  medical necessity must be received in the Program's offices at least 60 days
				  prior to the desired start of treatment.
3. Evidence as to whether the primary
				  insurers or other payers will cover any portion of the cost must be submitted
				  with the request.
4. At the
				  Program's discretion, all requests for experimental treatments or therapies may
				  be reviewed for medical necessity by an objective qualified
				  physician.