38.2-3418.11 - Coverage for hospice care. - Virginia Statutes

§ 38.2-3418.11. Coverage for hospice care.

A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for hospice services under such policy, contract or plandelivered, issued for delivery or renewed in this Commonwealth on and afterJuly 1, 1999.

B. As used in this section:

"Hospice services" shall mean a coordinated program of home and inpatientcare provided directly or under the direction of a hospice licensed underArticle 7 (§ 32.1-162.1 et seq.) of Chapter 5 of Title 32.1, and shallinclude palliative and supportive physical, psychological, psychosocial andother health services to individuals with a terminal illness utilizing amedically directed interdisciplinary team.

"Individuals with a terminal illness" shall mean individuals whosecondition has been diagnosed as terminal by a licensed physician, whosemedical prognosis is death within six months, and who elect to receivepalliative rather than curative care.

"Medicare" shall mean Title XVIII of the Social Security Act.

"Palliative care" shall mean treatment directed at controlling pain,relieving other symptoms, and focusing on the special needs of the patient ashe experiences the stress of the dying process, rather than treatment aimedat investigation and intervention for the purpose of cure or prolongation oflife.

C. For the purposes of this section, documentation requirements shall be nogreater than those required for the same services under Medicare.

D. Nothing in this section shall prohibit an insurer, corporation, or healthmaintenance organization from offering or providing coverage for hospiceservices when it cannot be demonstrated that the illness is terminal or forindividuals with life expectancies of longer than six months.

E. The provisions of this section shall not apply to short-term travel,accident only, short-term nonrenewable policies of not more than six months'duration, or to policies or contracts designed for issuance to personseligible for coverage under Title XVIII of the Social Security Act, known asMedicare, or any other similar coverage under state or federal governmentalplans.

(1999, c. 858.)