Terms Used In Virginia Code > Title 1 > Chapter 2.1 - Common Law and Rules of Construction

• Accident and sickness insurance: means insurance against loss resulting from sickness, or from bodily injury or death by accident or accidental means, or from a combination of any or all of these perils. See Virginia Code 38.2-109
• Adverse determination: means a determination by a health carrier or its designee utilization review entity that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness, and the requested service or payment for the service is therefore denied, reduced, or terminated. See Virginia Code 38.2-3556
• Ambulatory review: means utilization review of health care services performed or provided in an outpatient setting. See Virginia Code 38.2-3556
• Assessment: as used in this subtitle , shall include an assessment made pursuant to notice by the Department of Taxation and self-assessments made by a taxpayer upon the filing of a return or otherwise not pursuant to notice. See Virginia Code 58.1-1820
• Authorized insurer: means , in the case of an interstate motor carrier whose operations may or may not include intrastate activity, an insurer authorized to transact business in any one state, or, in the case of a solely intrastate motor carrier, an insurer authorized to transact business in the Commonwealth. See Virginia Code 46.2-2000
• Authorized representative: means (i) a person to whom a covered person has given express written consent to represent the covered person in an external review, (ii) a person authorized by law to provide substituted consent for a covered person, or (iii) a family member of the covered person or the covered person's treating health care professional only when the covered person is unable to provide consent. See Virginia Code 38.2-3556
• benefits: means those health care services to which a covered person is entitled under the terms of a health benefit plan. See Virginia Code 38.2-3556
• Best evidence: means evidence based on (i) randomized clinical trials; if randomized clinical trials are not available, then (ii) cohort studies or case-control studies; if clauses (i) and (ii) are not available, then (iii) case-series; or if clauses (i), (ii), and (iii) are not available, then (iv) expert opinion. See Virginia Code 38.2-3556
• Blighted property: means any property that endangers the public health or safety in its condition at the time of the filing of the petition for condemnation and is (i) a public nuisance or (ii) an individual commercial, industrial, or residential structure or improvement that is beyond repair or unfit for human occupancy or use. See Virginia Code 1-219.1
• Board of supervisors: means the governing body of a county. See Virginia Code 15.2-102
• Broker: means any person not included in the term "motor carrier" and not a bona fide employee or agent of any such carrier, who, as principal or agent, sells or offers for sale any transportation subject to this chapter except for transportation pursuant to Article 15 (§ Virginia Code 46.2-2000
• Case management: means a coordinated set of activities conducted for individual patient management of serious, complicated, protracted, or other health conditions. See Virginia Code 38.2-3556
• Case-series: means an evaluation of a series of patients with a particular outcome, without the use of a control group. See Virginia Code 38.2-3556
• Certificate: means a certificate of public convenience and necessity or a certificate of fitness. See Virginia Code 46.2-2000
• Certificate of fitness: means a certificate issued by the Department to a contract passenger carrier, a sight-seeing carrier, a transportation network company, or a nonemergency medical transportation carrier. See Virginia Code 46.2-2000
• Certificate of public convenience and necessity: means a certificate issued by the Department of Motor Vehicles to certain common carriers, but nothing contained in this chapter shall be construed to mean that the Department can issue any such certificate authorizing intracity transportation. See Virginia Code 46.2-2000
• Certification: means a determination by a health carrier or its designee utilization review entity that an admission, availability of care, continued stay, or other health care service has been reviewed and, based on the information provided, satisfies the health carrier's requirements for medical necessity, appropriateness, health care setting, level of care, and effectiveness. See Virginia Code 38.2-3556
• Chief judge: The judge who has primary responsibility for the administration of a court but also decides cases; chief judges are determined by seniority.
• Clinical review criteria: means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services. See Virginia Code 38.2-3556
• Commission: means the State Corporation Commission. See Virginia Code 38.2-100
• Common carrier: means any person who undertakes, whether directly or by a lease or any other arrangement, to transport passengers for the general public by motor vehicle for compensation over the highways of the Commonwealth, whether over regular or irregular routes, including such motor vehicle operations of carriers by rail or water under this chapter. See Virginia Code 46.2-2000
• Company: means any association, aggregate of individuals, business, 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
• Concurrent review: means utilization review conducted during a patient's hospital stay or course of treatment. See Virginia Code 38.2-3556
• Constitutional officer: means an officer provided for pursuant to Article VII, § 4 of the Constitution. See Virginia Code 15.2-102
• Contract passenger carrier: means a motor carrier that transports groups of passengers under a single contract made with one person for an agreed charge for such transportation, regardless of the number of passengers transported, and for which transportation no individual or separate fares are solicited, charged, collected, or received by the carrier. See Virginia Code 46.2-2000
• Covered person: means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. See Virginia Code 38.2-3556
• creditor: means the holder, payee, or obligee of a judgment lien and includes the lien creditor as noted on the recorded judgment or abstract of judgment and his successor in interest, including any assignee noted on a recorded assignment or notice of assignment. See Virginia Code 55.1-3100
• Department: means the Department of Motor Vehicles. See Virginia Code 46.2-2000
• Department: means the Department of Taxation. See Virginia Code 58.1-1
• Discharge planning: means the formal process for determining, prior to discharge from a facility, the coordination and management of the care that a patient receives following discharge from a facility. See Virginia Code 38.2-3556
• Emergency medical condition: means the sudden and, at the time, unexpected onset of a health condition or illness that requires immediate medical attention, where failure to provide medical attention would result in a serious impairment to bodily functions or a serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy. See Virginia Code 38.2-3556
• Emergency services: means health care items and services furnished or required to evaluate and treat an emergency medical condition. See Virginia Code 38.2-3556
• Employee hauler: means a motor carrier operating for compensation and exclusively transporting only bona fide employees directly to and from the factories, plants, office or other places of like nature where the employees are employed and accustomed to work. See Virginia Code 46.2-2000
• Evidence-based standard: means the conscientious, explicit, and judicious use of the current best evidence based on the overall systematic review of the research in making decisions about the care of individual patients. See Virginia Code 38.2-3556
• Excursion train: means any steam-powered train that carries passengers for which the primary purpose of the operation of such train is the passengers' experience and enjoyment of this means of transportation, and does not, in the course of operation, carry (i) freight other than the personal luggage of the passengers or crew or supplies and equipment necessary to serve the needs of the passengers and crew, (ii) passengers who are commuting to work, or (iii) passengers who are traveling to their final destination solely for business or commercial purposes. See Virginia Code 46.2-2000
• Expert opinion: means a belief or an interpretation by specialists with experience in a specific area about the scientific evidence pertaining to a particular service, intervention, or therapy. See Virginia Code 38.2-3556
• Facility: means an institution providing health care services or a health care setting, including hospitals and other licensed inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings. See Virginia Code 38.2-3556
• Final adverse determination: means an adverse determination involving a covered benefit that has been upheld by a health carrier, or its designee utilization review entity, at the completion of the health carrier's internal appeal process. See Virginia Code 38.2-3556
• Financial responsibility: means the ability to respond in damages for liability thereafter incurred arising out of the ownership, maintenance, use, or operation of a motor vehicle, in the amounts provided for in this chapter. See Virginia Code 46.2-2000
• Government utility corporation: means any county or municipality, or entity or agency thereof, which provides or operates one or more of the following authorized utility services: gas, pipeline, electric light, heat, power, water supply, sewer, telephone, or telegraph. See Virginia Code 1-219.1
• Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Virginia Code 38.2-3556
• Health care professional: means a physician or other health care practitioner licensed, accredited, or certified to perform specified health care services consistent with the laws of the Commonwealth. See Virginia Code 38.2-3556
• Health care services: means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Virginia Code 38.2-3556
• Health carrier: means an entity, subject to the insurance laws and regulations of the Commonwealth or subject to the jurisdiction of the Commission, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an accident and sickness insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or a nonstock corporation offering or administering a health services plan, a hospital services plan, or a medical or surgical services plan, or any other entity providing a plan of health insurance, health benefits, or health care services except as excluded under § Virginia Code 38.2-3556
• Health services plan: means any arrangement for offering or administering health services or similar or related services by a corporation licensed under Virginia Code 38.2-100
• Highway: means every public highway or place of whatever nature open to the use of the public for purposes of vehicular travel in the Commonwealth, including the streets and alleys in towns and cities. See Virginia Code 46.2-2000
• Identification marker: means a decal or other visible identification issued by the Department to show one or more of the following: (i) that the operator of the vehicle has registered with the Department for the payment of the road tax imposed under Chapter 27 of Virginia Code 46.2-2000
• Independent review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations. See Virginia Code 38.2-3556
• Interstate: means transportation of passengers between states. See Virginia Code 46.2-2000
• Intrastate: means transportation of passengers solely within a state. See Virginia Code 46.2-2000
• Joint activity: means a governmental function which is carried out by, performed on behalf of, or contracted for two or more localities within a region and includes present and future activities. See Virginia Code 15.2-1307
• Joint resolution: A legislative measure which requires the approval of both chambers.
• Judgment lien: includes a judgment lien pursuant to § Virginia Code 55.1-3100
• lane: means that portion of a roadway designed or designated to accommodate the forward movement of a single line of vehicles. See Virginia Code 46.2-100
• License: means a license issued by the Department to a broker or a TNC broker. See Virginia Code 46.2-2000
• local government: shall be construed to mean a county, city, or town as the context may require. See Virginia Code 15.2-102
• Locality: means all counties, cities and towns within a regional partnership. See Virginia Code 15.2-1307
• Medical or scientific evidence: means evidence found in (i) peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff; (ii) peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia, and other medical literature that meet the criteria of the National Institutes of Health's Library of Medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. See Virginia Code 38.2-3556
• Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the Social Security Amendment of 1965, as amended. See Virginia Code 38.2-100
• Motor carrier: means any person who undertakes, whether directly or by lease, to transport passengers for compensation over the highways of the Commonwealth. See Virginia Code 46.2-2000
• NAIC: means the National Association of Insurance Commissioners. See Virginia Code 38.2-3556
• operations: includes the operation of all motor vehicles, whether loaded or empty, whether for compensation or not, and whether owned by or leased to the motor carrier who operates them or causes them to be operated. See Virginia Code 46.2-2000
• Operator: means the employer or person actually driving a motor vehicle or combination of vehicles. See Virginia Code 46.2-2000
• Permit: means a permit issued by the Department to carriers operating as employee haulers or nonprofit/tax-exempt passenger carriers or to operators of taxicabs or other vehicles performing taxicab service under this chapter. See Virginia Code 46.2-2000
• 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
• Person: means any individual, firm, copartnership, corporation, company, association, or joint-stock association, and includes any trustee, receiver, assignee, or personal representative thereof. See Virginia Code 46.2-2000
• Property: means the piece or pieces of real property that are the subject of the settlement and cited on the notice and release. See Virginia Code 55.1-3100
• Prospective review: means utilization review conducted prior to an admission or a course of treatment. See Virginia Code 38.2-3556
• provider: means a health care professional or a facility. See Virginia Code 38.2-3556
• Region: means a planning district; however, by agreement of the localities of the planning district, localities which are not part of a planning district may be added to the region if the locality's governing body by vote agrees to become part of the region. See Virginia Code 15.2-1307
• Regional partnership: means an organization composed of government, business, education and civic leaders approved by the local governing bodies of the region to carry out the provisions of this chapter. See Virginia Code 15.2-1307
• reproduction: shall be deemed to include photographs, microphotographs, microfilm, microcard, printouts, optical imaging or other reproductions of electronically stored data, or any other reproduction of an original from a process which forms a durable medium for its recording, storing, and reproducing. See Virginia Code 58.1-106
• Restricted common carrier: means any person who undertakes, whether directly or by a lease or other arrangement, to transport passengers for compensation, whereby such transportation service has been restricted. See Virginia Code 46.2-2000
• Retrospective review: means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment. See Virginia Code 38.2-3556
• revocation: means that the document or privilege revoked is not subject to renewal or restoration except through reapplication after the expiration of the period of revocation. See Virginia Code 46.2-100
• Route: when used in connection with or with respect to a certificate of public convenience and necessity, means the road or highway, or segment thereof, operated over by the holder of a certificate of public convenience and necessity or proposed to be operated over by an applicant therefor, whether such road or highway is designated by one or more highway numbers. See Virginia Code 46.2-2000
• Second opinion: means an opportunity or requirement to obtain a clinical evaluation by a provider other than the one originally making a recommendation for a proposed health care service to assess the clinical necessity and appropriateness of the initial proposed health care service. See Virginia Code 38.2-3556
• Settlement agent: means the same as it is defined in § Virginia Code 55.1-3100
• Sight-seeing carrier: means a restricted common carrier authorized to transport passengers under the provisions of this chapter, whereby the primary purpose of the operation is the passengers' experience and enjoyment or the promotion of tourism. See Virginia Code 46.2-2000
• State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
• Subscriber: means a person obligated under a reciprocal insurance agreement. See Virginia Code 38.2-1201
• suspension: means that the document or privilege suspended has been temporarily withdrawn, but may be reinstated following the period of suspension unless it has expired prior to the end of the period of suspension. See Virginia Code 46.2-100
• Tier-city: means an incorporated community within a consolidated county that (i) has within defined boundaries a population of 5,000 or more, (ii) has been designated as a tier-city by the General Assembly, and (iii) has both the powers of a town and such additional powers as may be granted tier-cities by the General Assembly. See Virginia Code 1-252
• TNC broker: means any person who (i) is not a transportation network company or TNC partner and (ii) is not a bona fide employee or agent of a transportation network company or TNC partner, and who contracts or enters into an agreement or arrangement, with a transportation network company and who, in accordance with such contract, agreement or arrangement, arranges any transportation subject to Article 15 (§ Virginia Code 46.2-2000
• TNC partner: means a person authorized by a transportation network company to use a TNC partner vehicle to provide prearranged rides on an intrastate basis in the Commonwealth. See Virginia Code 46.2-2000
• Town: means any existing town or an incorporated community within one or more counties which became a town before noon, July one, nineteen hundred seventy-one, as provided by law or which has within defined boundaries a population of 1,000 or more and which has become a town as provided by law. See Virginia Code 15.2-102
• transportation: include the service of, and all transportation by, all vehicles operated by, for, or in the interest of any motor carrier irrespective of ownership or contract, expressed or implied, together with all facilities and property operated or controlled by any such carrier or carriers and used in the transportation of passengers or the performance of any service in connection therewith. See Virginia Code 46.2-2000
• Transportation network company: means a person who provides prearranged rides using a digital platform that connects passengers with TNC partners. See Virginia Code 46.2-2000
• Uphold: The decision of an appellate court not to reverse a lower court decision.
• Utilization review: means a set of formal techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings. See Virginia Code 38.2-3556
• Utilization review entity: means an individual or entity that conducts utilization review. See Virginia Code 38.2-3556
• Vehicle: means every device in, on or by which any person or property is or may be transported or drawn on a highway, except personal delivery devices and devices moved by human power or used exclusively on stationary rails or tracks. See Virginia Code 46.2-100