Virginia Code 38.2-3407.10:2: Credentialing of private mental health agencies.
A. As used in this section, “carrier,” “covered person,” and “health benefit plan,” have the same meaning ascribed thereto in § 38.2-3407.10:1.
Terms Used In Virginia Code 38.2-3407.10:2
- Commission: means the State Corporation Commission. See Virginia Code 38.2-100
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
“Mental health professional” means a person who by education and experience is professionally qualified to provide counseling interventions designed to facilitate an individual’s achievement of human development goals and remediate mental, emotional, or behavioral disorders and associated distresses that interfere with mental health and development.
“Network” means a group of participating mental health professionals who provide mental health services under the carrier’s health benefit plan that requires or creates incentives for a covered person to use the participating mental health professionals.
“Private mental health agency” means a practice group of mental health professionals at least one of whom is licensed under Chapter 24 of Title 54.1.
B. A carrier that credentials the mental health professionals in its network may establish reasonable protocols and procedures for credentialing private mental health agencies. Upon approval by a carrier of a credentialing application made by a private mental health agency, any mental health professional employed or engaged by such agency shall be deemed credentialed pursuant to the approved credentialing application of the private mental health agency. If a carrier opts to credential a private mental health agency, at a minimum the protocols and procedures established by the carrier shall:
1. Apply only if the private mental health agency’s credentialing application is approved by the carrier; and
2. Require a private mental health agency to maintain minimum audit report requirements, as determined by the Department of Behavioral Health and Developmental Services.
C. The Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.
2019, c. 689.