Title of Regulation: 14VAC10-10. Virginia Birth-Related Neurological Injury Compensation Program.

Statutory Authority: § 38.2-5002.1 of the Code of Virginia.

Public Comment Deadline: August 26, 2017.

Agency Contact: George Deebo, Executive Director, Virginia Birth-Related Neurological Injury Compensation Program, 7501 Boulders View Drive, Suite 210, Richmond, VA 23225, telephone (804) 330-2417, ext. 3041, FAX (804) 330-3054.

Notice is hereby given that the Virginia Birth-Related Neurological Injury Compensation Program seeks comment on proposed changes to the program's guidelines. This amendment is required to conform the guidelines to the Governor's amendments that were included in Item 4-5.01 of Chapter 836 of the 2017 Acts of the Assembly and requires each admitted claimant's parent or legal guardian to purchase private health insurance to provide coverage for the expenses set forth in § 38.2-5009 A 1 of the Code of Virginia. The act further requires the program to reimburse, upon receipt of proof of payment, solely the portion of the premiums that is attributable to the admitted claimant's post-admission coverage from the effective date of the Governor's amendment forward and paid for by the admitted claimant's parent or legal guardian.

The proposed changes are shown below and may be viewed on the program's website at www.vabirthinjury.com on the "News & Information" page. A copy of the proposed changes is available for inspection during normal business hours at the program's office located at 7501 Boulders View Drive, Suite 210, Richmond, VA 23225. The program will provide a copy in response to written requests. All comments must be submitted in written form and be directed to the Board of Directors at the above address. Comments also may be emailed to admasst@vabirthinjury.com. All comments must include the name, address, and telephone number of the submitting party. This 60-day comment period ends August 26, 2017.

14VAC10-XX. Other Procedures - Insurance.

Because the Program generally is the payer of last resort, it 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 § 38.2-5009 A 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 Program's facilitator's assistance in obtaining a suitable health insurance policy for the admitted claimant if he or she has no pre-existing 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, if one exists, or a complete description of applicable coverage, 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's 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.

Claimants must utilize the primary insurer's in-network providers and facilities unless otherwise authorized by the Program. Utilizing non-network or non-participating providers or facilities may result in reduced payment or non-payment/non-reimbursement of incurred expenses.