2025 SESSION
ENROLLED
VIRGINIA ACTS OF ASSEMBLY -- CHAPTER
An Act to amend and reenact 38.2-3408 and 38.2-4221 of the Code of Virginia, relating to health insurance; reimbursement for services rendered by certain practitioners other than physicians.
[H 1923]
Approved
Be it enacted by the General Assembly of Virginia:
1. That 38.2-3408 and 38.2-4221 of the Code of Virginia are amended and reenacted as follows:
38.2-3408. Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians.
A. If an accident and sickness insurance policy provides reimbursement for any service that may be legally performed by a person licensed in this Commonwealth as a chiropractor, optometrist, optician, professional counselor, psychologist, clinical social worker, podiatrist, physical therapist, chiropodist, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, licensed certified midwife, licensed midwife, marriage and family therapist, athletic trainer, or licensed acupuncturist, reimbursement under the policy shall not be denied because the service is rendered by the licensed practitioner, provided that, for services performed by an athletic trainer, such service is performed in an office setting.
B. If an accident and sickness insurance policy provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the policy shall not be denied because the service is rendered by the licensed pharmacist, provided that (i) the service is performed for an insured for a condition under the terms of a collaborative agreement, as defined in 54.1-3300, (ii) the service is for the administration of vaccines for immunization, or (iii) the service is provided in accordance with 54.1-3303.1.
C. The reimbursement for a service provided by a licensed certified midwife or licensed midwife shall be in the same amount as the reimbursement paid under the policy to a certified nurse midwife for performing such service in the area served, provided that the claim is submitted using (i) the diagnoses and procedure codes applicable to the service; (ii) such licensed certified midwife's or licensed midwife's name; (iii) the national provider identifier for the licensed certified midwife or licensed midwife providing the service; and (iv) if required by the insurer, the facility in which the service is provided.
D. No insurer shall reduce the reimbursement paid to a certified nurse midwife in order to comply with the provisions of this section.
E. This section shall not apply to Medicaid, or any state fund.
38.2-4221. Services of certain practitioners other than physicians to be covered.
A. A nonstock corporation shall not fail or refuse, either directly or indirectly, to allow or to pay to a subscriber for all or any part of the health services rendered by any doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, licensed certified midwife, licensed midwife, marriage and family therapist, athletic trainer, or licensed acupuncturist licensed to practice in Virginia, if the services rendered (i) are services provided for by the subscription contract; (ii) are services which the doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, licensed certified midwife, licensed midwife, marriage and family therapist, athletic trainer, or licensed acupuncturist is licensed to render in this Commonwealth; and (iii) are, for any services rendered by an athletic trainer, rendered in an office setting.
B. If a subscription contract provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the subscription contract by the nonstock corporation shall not be denied because the service is rendered by the licensed pharmacist provided that (i) the service is performed for a subscriber for a condition under the terms of a collaborative agreement, as defined in 54.1-3300, between a pharmacist and the physician with whom the subscriber is undergoing a course of treatment or (ii) the service is for the administration of vaccines for immunization. Notwithstanding the provisions of 38.2-4209, the nonstock corporation may require the pharmacist, any pharmacy or provider that may employ such pharmacist, or the collaborating physician to enter into a written agreement with the nonstock corporation as a condition for reimbursement for such services. In addition, reimbursement to pharmacists acting under the terms of a collaborative agreement under this subsection shall not be subject to the provisions of 38.2-4209.1.
C. The payment for a service provided by a licensed certified midwife or licensed midwife shall be in the same amount as the payment paid under the subscription contract for a certified nurse midwife performing such service in the area served, provided that the claim is submitted using (i) the diagnoses and procedure codes applicable to the service; (ii) such licensed certified midwife's or licensed midwife's name; (iii) the national provider identifier for the licensed certified midwife or licensed midwife providing the service; and (iv) if required by the nonstock corporation, the facility in which the service is provided.
D. No nonstock corporation shall reduce the reimbursement paid to a certified nurse midwife in order to comply with the provisions of this section.