Access to Health Care & Insurance

Bills CommitteeLast actionDate
HB 39 - Samirah - Health benefit plans; enrollment by pregnant individuals. (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce02/06/20
notes: Requires health carriers to allow pregnant individuals to enroll in a health benefit plan at any time after the commencement of the pregnancy, with the pregnant individual's coverage being effective as of the first of the month in which the individual receives certification of the pregnancy. The measure applies to such agreements that are entered into, amended, extended, or renewed on or after January 1, 2021.
HB 58 - Ware - Health insurance; payment to out-of-network providers, emergency services. (H) Committee on Labor and Commerce(H) Incorporated by Labor and Commerce (HB1251-Torian)02/04/20
notes: Provides that when a covered person receives covered emergency services from an out-of-network health care provider, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure deletes a provision that allows an out-of-network provider to charge an individual for the balance of the provider's billed amount after applying the amount the health carrier is required to pay for such services. The measure also establishes a fourth standard for calculating the health carrier's required payment to the out-of-network provider of the emergency services, which standard is (i) the regional average for commercial payments for such service if the provider is a health care professional or (ii) the fair market value for such services if the provider is a facility. This fourth standard is the amount the health carrier is obligated to pay to the out-of-network provider if the amount is greater than any of the other three standards, which are (a) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (b) the amount for the emergency service calculated using the same method the health carrier generally uses to determine payments for out-of-network services, such as the usual, customary, and reasonable amount; or (c) the amount that would be paid under Medicare for the emergency service. The measure requires the health carrier to pay the required amount, less applicable cost-sharing requirements, directly to the out-of-network health care provider of the emergency services. If such provider determines that the amount to be paid by the health carrier does not comply with
HB 66 - Carter - Health insurance; cost-sharing payments for prescription insulin drugs. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Referred to Committee on Commerce and Labor02/04/20
notes: Prohibits health insurance companies and other carriers from setting an amount exceeding $30 per 30-day supply that a covered person is required to pay at the point of sale in order to receive a covered prescription insulin drug. The measure also prohibits a provider contract between a carrier or its pharmacy benefits manager and a pharmacy from containing a provision (i) authorizing the carrier's pharmacy benefits manager or the pharmacy to charge, (ii) requiring the pharmacy to collect, or (iii) requiring a covered person to make a cost-sharing payment for a covered prescription insulin drug in an amount that exceeds such limitation. This bill incorporates HB 1403.
HB 165 - Hope - Teledentistry; definition, establishes requirements for the practice of teledentistry, etc. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Passed Senate (40-Y 0-N)02/17/20
notes: Defines "teledentistry," establishes requirements for the practice of teledentistry and the taking of dental scans for use in teledentistry by dental scan technicians, and clarifies requirements related to the use of digital work orders for dental appliances in the practice of teledentistry.

HB 299 - Sickles - Fluoride varnish; possession and administration by medical assistants, etc. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Passed Senate (38-Y 2-N)02/17/20
notes: Allows an authorized agent of a doctor of medicine, osteopathic medicine, or dentistry to possess and administer topical fluoride varnish pursuant to an oral or written order or a standing protocol issued by a doctor of medicine, osteopathic medicine, or dentistry.

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HB 303 - Hope - Clinical psychologists; telepsychology; out of state. (H) Committee on Health, Welfare and Institutions(H) Left in Health, Welfare and Institutions02/11/20
notes: Allows clinical psychologists to provide services by telepsychology to established patients who are out of state at the time services are provided. The bill establishes the criteria that must be met for the clinical psychologist to offer telepsychology services. Clinical psychologists who offer telepsychology services must comply with the Standards of Practice set by the Board of Psychology.
HB 474 - Guzman - Certified community health workers; establishes requirements for use of the title. (H) Committee on Health, Welfare and Institutions(H) Incorporated by Health, Welfare and Institutions (HB688-Aird)01/28/20
notes: Establishes requirements for use of the title "certified community health worker."

HB 517 - Bulova - Collaborative practice agreements; adds nurse practitioners and physician assistants to list. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Passed Senate (40-Y 0-N)02/17/20
notes: Adds nurse practitioners and physician assistants to the list of health care practitioners who shall not be required to participate in a collaborative agreement with a pharmacist and his designated alternate pharmacists, regardless of whether a professional business entity on behalf of which the person is authorized to act enters into a collaborative agreement with a pharmacist and his designated alternate pharmacists. This bill is a recommendation of the Joint Commission on Healthcare.
HB 530 - Samirah - Health care coverage; qualified health plans. (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce01/30/20
notes: Requires the Department of Medical Assistance Services, in collaboration with the State Corporation Commission, to contract with health carriers to offer qualified health plans on the health benefit exchange beginning January 1, 2022. The bill provides that such qualified health plans are designed to reduce deductibles, make more services available before the deductible is met, provide predictable cost sharing, maximize subsidies, limit adverse premium impacts, reduce barriers to maintaining and improving health, encourage choice based on value, and limit adverse premium impacts and increases in premium rates. The bill requires that any health carrier contracted with the Department to offer such qualified health plans (i) is licensed and in good standing to offer health insurance coverage in the Commonwealth and (ii) offers at least one qualified health plan at a silver level of coverage and one qualified health plan at a gold level of coverage. The bill provides that any fee-for-service rates for providers and facilities under any such qualified health plan cannot exceed the Medicare rates for the same or similar covered services, and for reimbursement other than fee-for-service, the aggregate amount the qualified health plan pays to providers and facilities cannot exceed the equivalent of the aggregate amount the qualified health plan would have reimbursed providers using fee-for-service Medicare rates.
HB 603 - Freitas - Medical Assistance Services, Board of; reimbursement for services, family members. (H) Committee on Health, Welfare and Institutions(H) Continued to 2021 in Health, Welfare and Institutions01/30/20
notes: Directs the Board of Medical Assistance Services to revise its regulations governing reimbursement for individuals receiving treatment under the state plan for medical assistance and any waivers thereto to allow reimbursement of family members, including spouses, who provide qualifying services.
HB 612 - Plum - Health insurance; coverage for medicines to cover amino acid-based elemental formula. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/11/20
notes: Requires health insurers, health care subscription plans, and health maintenance organizations whose policy, contract, or plan includes coverage for medicines to cover amino acid-based elemental formula for the treatment of specified diseases or disorders.
HB 688 - Aird - Certified community health workers; establishes requirements for use of the title. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Assigned Education sub: Health Professions02/12/20
notes: Establishes requirements for use of the title "certified community health worker." This bill incorporates HB 474.
HB 763 - Orrock - Hospitals; notification to patient of outpatient physical therapy following discharge. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Assigned Education sub: Health02/17/20
notes: Requires the Board of Health to adopt regulations requiring hospitals to establish protocols to ensure that any patient scheduled to receive an elective surgical procedure for which the patient can reasonably be expected to require outpatient physical therapy as a follow-up treatment after discharge is informed that he (i) is expected to require outpatient physical therapy as a follow-up treatment and (ii) will be required to select a physical therapy provider prior to being discharged from the hospital.

HB 776 - Helmer - Health insurance; coverage for fertility preservation procedures for cancer patients. (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce01/28/20
notes: Requires health insurance policies, subscription contracts, and health care plans to provide coverage for standard fertility preservation procedures that are medically necessary to preserve the fertility of a covered individual due to the covered individual's receiving cancer treatment that may directly or indirectly cause iatrogenic infertility.
HB 795 - Hurst - Health insurance; association health plans. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Reported from Commerce and Labor with substitute (15-Y 0-N)02/17/20
notes: Provides that for policies of group accident and sickness insurance issued to an association, members of such an association may include (i) a self-employed individual and (ii) an employer member (a) with at least one employee that is domiciled in the Commonwealth or (b) that has a principal place of business that does not exceed the boundaries of a metropolitan area that is at least partially in the Commonwealth. The bill provides that for such policies issued to an association that covers at least 51 members and employees of employer members of such association on the first day of the plan year the policies shall be considered a large group market plan and are required to meet various provisions in the bill. The bill provides that to determine the size of an association all of the members and employees of employer members are aggregated and treated as employed by a single employer.

The bill requires an insurer issuing a policy to an association to (1) treat all of the members and employees of employer members who are enrolled in coverage under the policy as a single risk pool; (2) set premiums based on the collective group experience of the members and employees of employer members who are enrolled in coverage under the policy; (3) vary premiums by age, except that the rate shall not vary by more than 5 to 1 for adults; (4) not vary premiums based on gender; (5) not establish discriminatory rules based on the health status of an employer member, an individual employee of an employer member, or a self-employed individual for eligibility or contribution.

The bill requires the Commissioner of Insurance to, within 90 days of the enactment of the bill, apply to the U.S. Secretary of Health and Hu
HB 807 - Delaney - Health care services; explanation of benefits. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Reported from Commerce and Labor with substitute (15-Y 0-N)02/17/20
notes: Requires health carriers and Medicaid managed care organizations to provide an explanation of benefits to covered persons or recipients. The measure requires the State Corporation Commission to adopt regulations that establish alternative methods of delivery of the explanation of benefits that permit the receipt of an explanation of benefits by an alternative method, provided that such alternative method is in compliance with the provisions of federal regulations regarding the right to request privacy protection for protected health information. The measure requires health carriers and Medicaid managed care organizations to take all reasonable actions to ensure that their internal processes and systems prohibit the identification or description of sensitive health care services in their explanations of benefits. The measure requires a health carrier that requires a covered person to make a request for confidential communications in writing in accordance with federal law to accept the form of the explanation of benefits approved by the Commission. The measure also requires the Commission to define "sensitive health care services." The measure will take effect 90 days after the Commission has adopted the required regulations. The measure is a recommendation of the Joint Commission on Health Care.
HB 840 - Murphy - Health insurance; formula and enteral nutrition products. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Reported from Commerce and Labor (13-Y 0-N)02/17/20
notes: Requires health insurers, health care subscription plans, and health maintenance organizations whose policy, contract, or plan includes coverage for medicines to classify medically necessary formula and enteral nutrition products as medicine and to include coverage for medically necessary formula and enteral nutrition products for covered individuals requiring treatment for an inherited metabolic disorder. Such coverage is required to be provided on the same terms and subject to the same conditions imposed on other medicines covered under the policy, contract, or plan. The measure provides that the required coverage includes any medical equipment, supplies, and services that are required to administer the covered formula or enteral nutrition products. These requirements apply only to formula and enteral nutrition products that are furnished pursuant to the prescription or order of a physician or other health care professional qualified to make such prescription or order for the management of an inherited metabolic disorder and are used under medical supervision.
HB 901 - Sickles - Health insurance; payment to out-of-network providers. (H) Committee on Appropriations(H) Incorporated by Appropriations (HB1251-Torian)02/07/20
notes: Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also establishes a standard for calculating the health carrier's required payment to the out-of-network provider of the services, which standard is the lower of the market-based value for the service or 125 percent of the amount that would be paid under Medicare for the service. If such provider determines that the amount to be paid by the health carrier does not comply with the applicable requirements, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request the State Corporation Commission to review the disputed reimbursement amount and determine if the amount complies with applicable requirements. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly.
HB 1251 - Torian - Health insurance; definitions, payment to out-of-network providers. (H) Committee on Appropriations

(S) Committee on Commerce and Labor
(S) Referred to Committee on Commerce and Labor02/12/20
notes: Provides that when a covered person receives covered emergency services from an out-of-network health care provider, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure deletes a provision that allows an out-of-network provider to charge an individual for the balance of the provider's billed amount after applying the amount the health carrier is required to pay for such services. The measure also establishes a fourth standard for calculating the health carrier's required payment to the out-of-network provider of the emergency services, which standard is (i) the regional average for commercial payments for such service if the provider is a health care professional or (ii) the fair market value for such services if the provider is a facility. This fourth standard is the amount the health carrier is obligated to pay to the out-of-network provider if the amount is greater than any of the other three standards, which are (a) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (b) the amount for the emergency service calculated using the same method the health carrier generally uses to determine payments for out-of-network services, such as the usual, customary, and reasonable amount; or (c) the amount that would be paid under Medicare for the emergency service. The measure requires the health carrier to pay the required amount, less applicable cost-sharing requirements, directly to the out-of-network health care provider of the emergency services. If such provider determines that the amount to be paid by the health carrier does not comply with
HB 1304 - Hodges - Pharmacy technicians and pharmacy technician trainees; registration. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Passed Senate (40-Y 0-N)02/17/20
HB 1331 - Byron - Health insurance; in-network guarantees. (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce02/06/20
notes: Prohibits a health carrier that offers a managed care plan from entering into, extending, or renewing a provider contract with a facility unless such provider contract contains provisions requiring that each health care provider (i) that provides emergency or ancillary services at the facility is an in-network provider or has agreed to have his reimbursement from the health carrier included as part of the health carrier's payment to the facility and to not separately bill the health carrier or the covered person for emergency or ancillary services provided at such facility and (ii) that any laboratory or diagnostic services provided at the facility are in-network or, if such services are referred by a provider at the facility, the referral is to an in-network provider.
HB 1332 - Kilgore - Telehealth services; definition, report. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Assigned Education sub: Health Professions02/12/20
notes: Defines "telehealth services" as the delivery of health care services, including telemedicine services and other medical, emergency medical, and behavioral health services that are not equivalent to health care services provided through face-to-face consultation or contact between a health care provider and a patient, through the use of telecommunications and information technology that supports the delivery of remote or long-distance health care services. The bill requires the Board of Medical Assistance Services to include in the state plan for medical assistance services a provision for coverage of telehealth services. The bill also requires (i) requires the Board of Health to develop and maintain an Emergency Telehealth Plan as a component of the Statewide Emergency Medical Services Plan, (ii) every insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; (iii) each corporation providing individual or group accident and sickness subscription contracts; and (iv) each health maintenance organization providing a health care plan for health care services to provide coverage for the cost of such health care services provided through telehealth services.

The bill also requires the Secretary of Health and Human Resources to establish a workgroup to develop recommendations for innovative payment models that support the use of telehealth services and telemedicine services in accordance with the Statewide Emergency Telehealth Plan including payment of the cost of transporting of a patient to a destination providing services appropriate to the patient%92s level of acuity and in-place treatment of a
HB 1384 - Robinson - Health insurance; provider contracts, business practices, penalties. (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce01/28/20
notes: Provides that amendments to a provider contract or any material provision, addenda, schedule, exhibit, or policy thereto, as it relates to any material provision that was agreed to or accepted by the provider in the previous 12-month period, or that occurred during the current term of the provider contract and resulted in an adverse change, are not effective unless agreed to by the provider in writing. The measure requires such an amendment to be agreed to by the provider in a signed written amendment to the provider contract. The measure defines a material provision of a provider contract as any policy manual, coverage guideline, edit, multiple procedure logic, or audit procedure that (i) decreases the provider's payment or compensation, (ii) limits an enrollee's access to covered services under his health plan, or (iii) changes the administrative procedures applicable to a provider contract in a way that may reasonably be expected to significantly increase the provider's administrative expense. The measure requires carriers to permit a provider to determine the carrier's policies regarding the use of edits or multiple procedure logic. The measure requires carriers to provide, for each health plan in which the provider participates or is proposed to participate, a complete fee schedule for all health care services included under the provider contract with the provider in writing and to make such fee schedules available in machine-readable electronic format. The measure requires a provider contract to permit a provider a minimum of one year from the date a health care service is rendered to submit a claim for payment, unless otherwise agreed upon. The measure also (a) requires the State Corporation Commission to as
HB 1428 - Sickles - Virginia Health Benefit Exchange; created. (H) Committee on Appropriations

(S) Committee on Finance and Appropriations
(S) Rereferred to Finance and Appropriations02/17/20
notes: Virginia Health Benefit Exchange. Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange shall make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. The Exchange will be funded by assessments on health insurers. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan, which is the largest plan in the largest product in the Commonwealth's small group market as supplemented in order to provide coverage for the items and services within the statutory essential health benefits categories. The SCC may contract with other eligible entities and enter into memoranda of understanding with other agencies of the Commonwealth to carry out any of the functions of the Exchange, including agreements with other states or federal agencies to perform joint administrative functions. Such contracts are not subject to the Virginia Public Procurement Act ( 2.2-4300 et seq.). The measure repeals a provision enacted in 2013 th
HB 1429 - Roem - Health insurance; nondiscrimination, gender identity or transgender status. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Referred to Committee on Commerce and Labor02/05/20
notes: Prohibits a health carrier from denying or limiting coverage or imposing additional cost sharing or other limitations or restrictions on coverage, under a health benefit plan for health care services that are ordinarily or exclusively available to covered individuals of one sex, to a transgender individual on the basis of the fact that the individual's sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. The measure also prohibits a health carrier from (i) subjecting an individual to discrimination under a health benefit plan on the basis of gender identity or being a transgender individual or (ii) requiring that an individual, as a condition of enrollment or continued enrollment under a health benefit plan, pay a premium that is greater than the premium for a similarly situated covered person enrolled in the plan on the basis of the covered person's gender identity or being a transgender individual. The measure requires health carriers to assess medical necessity according to nondiscriminatory criteria that are consistent with current medical standards.
HB 1494 - Bagby - Health insurance; payment to out-of-network providers, emergency services. (H) Committee on Labor and Commerce(H) Incorporated by Labor and Commerce (HB1251-Torian)02/04/20
notes: Provides that when a covered person receives covered emergency services from an out-of-network health care provider, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure deletes a provision that allows an out-of-network provider to charge an individual for the balance of the provider's billed amount after applying the amount the health carrier is required to pay for such services. The measure also establishes a fourth standard for calculating the health carrier's required payment to the out-of-network provider of the emergency services, which standard is (i) the regional average for commercial payments for such service if the provider is a health care professional or (ii) the fair market value for such services if the provider is a facility. This fourth standard is the amount the health carrier is obligated to pay to the out-of-network provider if the amount is greater than any of the other three standards, which are (a) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (b) the amount for the emergency service calculated using the same method the health carrier generally uses to determine payments for out-of-network services, such as the usual, customary, and reasonable amount; or (c) the amount that would be paid under Medicare for the emergency service. The measure requires the health carrier to pay the required amount, less applicable cost-sharing requirements, directly to the out-of-network health care provider of the emergency services. If such provider determines that the amount to be paid by the health carrier does not comply with
HB 1540 - Collins - Behavioral health providers; barrier crimes, exceptions. (H) Committee on Health, Welfare and Institutions

(S) Committee on Rehabilitation and Social Services
(S) Constitutional reading dispensed (39-Y 0-N)02/17/20
notes: Adds additional crimes to the list of barrier crimes for which an exception is available in the case of employment with an adult substance abuse or mental health program at community services boards and private providers of behavioral health services licensed by the Department of Behavioral Health and Developmental Services. The bill also allows the Department of Behavioral Health and Developmental Services to hire individuals convicted of various barrier crimes in a position of employment at a state facility if the Department determines that the individual has been rehabilitated successfully and is not a risk to individuals receiving services.
HB 1606 - Cole, M.L. - Hospitals; notice and consent, out-of-network providers. (H) Committee on Health, Welfare and Institutions(H) Left in Health, Welfare and Institutions02/11/20
notes: Hospitals; notice and consent; out-of-network providers. Requires every hospital to notify patients when any service associated with a nonemergency procedure, test, or service to be provided by the hospital will be provided by an out-of-network provider and to obtain written consent to the provision of such service by such out-of-network provider prior to performing such procedure, test, or service.
HB 1682 - Samirah - Health benefit plans; coding for adverse childhood experiences. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/11/20
notes: Health benefit plans; coding for adverse childhood experiences. Requires any carrier that offers a health benefit plan that provides coverage for screening of covered persons for adverse childhood experiences that may impact a patient's physical or mental health or the provision of health care services to such patient to utilize a coding system that enrolls a code for such screening services.
HB 1701 - Tran - Medical Excellence Zone Program; VDH to determine feasibility of establishment. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(S) Referred to Committee on Education and Health02/10/20
notes: Directs the Department of Health to determine the feasibility of the establishment of a Medical Excellence Zone Program and directs the Department of Health Professions to pursue reciprocal agreements with states contiguous with the Commonwealth for licensure for certain primary care practitioners under the Board of Medicine. The Medical Excellence Zone Program would allow citizens of the Commonwealth living in rural underserved areas to receive medical treatment via telemedicine services from providers licensed or registered in a state that is contiguous with the Commonwealth. The bill requires the Department of Health to set out the criteria that would be required for a locality or group of localities in the Commonwealth to be eligible for the designation as a medical excellence zone and report its findings to the Senate Committee on Education and Health and the House Committee on Health, Welfare and Institutions by November 1, 2020. The bill states that reciprocal agreements with states that are contiguous with the Commonwealth for the licensure of doctors of medicine, doctors of osteopathic medicine, physician assistants, and nurse practitioners shall only require that a person hold a current, unrestricted license in the other jurisdiction and that no grounds exist for denial based on 54.1-2915. The Department of Health Professions shall report on its progress in establishing such agreements to the Senate Committee on Education and Health and the House Committee on Health, Welfare and Institutions by November 1, 2020. The bill provides that applicants for licensure as a doctor of medicine or osteopathic medicine from such states shall receive priority in processing their applications for licensure by endorsement through a streamlined process with
HB 1704 - Kory - Health insurance; coverage for case management services and peer support services. (H) Committee on Labor and Commerce(H) Stricken from docket by Labor and Commerce (22-Y 0-N)01/28/20
notes: Health insurance; coverage for case management services and peer support services. Requires health insurance policies, subscription contracts, and health care plans to provide coverage for (i) case management services that are prescribed by a licensed physician for a covered individual who has a primary diagnosis of a substance abuse disorder and (ii) peer support services for any covered person who has a primary diagnosis of a mental health disorder other than substance abuse disorder.
HB 1731 - Hudson - Health care provider panel; definition of "vertically-integrated carrier." (H) Committee on Labor and Commerce(H) Continued to 2021 in Labor and Commerce02/04/20
HJ 18 - Carter - Universal health care; JLARC to study cost of implementing in the Commonwealth. (H) Committee on Rules(H) Left in Rules02/11/20
notes: Directs the Joint Legislative Audit and Review Commission to study the cost of implementing universal health care in the Commonwealth.

SB 95 - Favola - Health insurance; essential health benefits, preventive services. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(H) Assigned L & C sub: Subcommittee #202/14/20
notes: Requires a health carrier offering or providing a health benefit plan, including (i) short-term and catastrophic health insurance policies, and policies that pay on a cost-incurred basis; (ii) association health plans; and (iii) plans provided by a multiple-employer welfare arrangement, to provide, as an essential health benefit, coverage that includes preventive care. Essential health benefits include items and services covered in accordance with regulations issued pursuant to the Patient Protection and Affordable Care Act in effect as of January 1, 2019.
SB 172 - Favola - Health insurance; payment to out-of-network providers, emergency services. (H) Committee on Labor and Commerce

(S) Committee on Finance and Appropriations
(H) Referred to Committee on Labor and Commerce02/14/20
notes: Provides that when a covered person receives covered emergency services from an out-of-network health care provider, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure deletes a provision that allows an out-of-network provider to charge an individual for the balance of the provider's billed amount after applying the amount the health carrier is required to pay for such services. The measure also establishes a fourth standard for calculating the health carrier's required payment to the out-of-network provider of the emergency services, which standard is (i) the regional average for commercial payments for such service if the provider is a health care professional or (ii) the fair market value for such services if the provider is a facility. This fourth standard is the amount the health carrier is obligated to pay to the out-of-network provider if the amount is greater than any of the other three standards, which are (a) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (b) the amount for the emergency service calculated using the same method the health carrier generally uses to determine payments for out-of-network services, such as the usual, customary, and reasonable amount; or (c) the amount that would be paid under Medicare for the emergency service. The measure requires the health carrier to pay the required amount, less applicable cost-sharing requirements, directly to the out-of-network health care provider of the emergency services. If such provider determines that the amount to be paid by the health carrier does not comply with
SB 192 - Peake - Health insurance; physical therapist office visit, cost-sharing requirements. (S) Committee on Commerce and Labor(S) Passed by indefinitely in Commerce and Labor with letter (13-Y 2-N)01/27/20
notes: Prohibits health insurers, corporations providing health care coverage subscription contracts, and health maintenance organizations whose policies, contracts, or plans include coverage for physical therapy from imposing any cost-sharing requirements such as a copayment, coinsurance, or deductible for a physical therapist office visit that exceeds the cost-sharing requirements for a physician or osteopath office visit.
SB 210 - Locke - Teledentistry; definition, report, dental scans. (S) Committee on Education and Health(S) Incorporated by Education and Health (SB122-Barker) (15-Y 0-N)01/23/20
notes: Defines "teledentistry," establishes requirements for the practice of teledentistry, establishes requirements for the taking of dental scans for use in teledentistry by dental scan technicians, and clarifies requirements related to the use of digital work orders for dental appliances in the practice of teledentistry. The bill also requires the Board of Dentistry to review all applications for renewal of a license to identify those applicants who deliver dental services through teledentistry and report such information annually, by October 1, to the Chairmen of the House Committee on Health, Welfare and Institutions, the Senate Committee on Education and Health, and the Joint Commission on Health Care.
SB 226 - Edwards - Virginia Health Benefit Exchange; created. (S) Committee on Commerce and Labor(S) Incorporated by Commerce and Labor (SB732-McClellan) (14-Y 0-N)01/27/20
notes: Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange shall make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. The Exchange will be funded by assessments on health insurers offering plans in the Exchange. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan, which is the largest plan in the largest product in the Commonwealth's small group market as supplemented in order to provide coverage for the items and services within the statutory essential health benefits categories. The SCC may contract with other eligible entities and enter into memoranda of understanding with other agencies of the Commonwealth to carry out any of the functions of the Exchange, including agreements with other states or federal agencies to perform joint administrative functions. Such contracts are not subject to the Virginia Public Procurement Act ( 2.2-4300 et seq.). The measure repeals a provision enacted in 2013 that
SB 264 - Bell - Certified registered nurse anesthetists; prescriptive authority. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(H) Referred to Committee on Health, Welfare and Institutions02/13/20
notes: Authorizes certified registered nurse anesthetists to prescribe Schedule II through Schedule VI controlled substances and devices to a patient requiring anesthesia, as part of the periprocedural care of the patient, provided that such prescribing is in accordance with requirements for practice by certified registered nurse anesthetists and is done under the supervision of a doctor of medicine, osteopathy, podiatry, or dentistry.
SB 300 - Stanley - DMAS; remote patient monitoring, rural populations. (H) Committee on Health, Welfare and Institutions

(S) Committee on Finance and Appropriations
(H) Assigned HWI sub: Health02/13/20
notes: Amends the State Plan for Medical Assistance Services to require the payment of medical assistance for medically necessary and clinically effective remote patient monitoring services for rural and underserved populations, with the home as an eligible telemedicine originating site. The bill requires the Department of Medical Assistance Services to prepare and submit to the Centers for Medicare and Medicaid Services an application for such waiver or waivers as may be necessary to implement the provisions of the bill. The bill also requires the Department to report to the Governor and the General Assembly on the status of such application or applications by October 1, 2020. The provisions of the bill are contingent on funding in a general appropriation act.
SB 362 - Dunnavant - Hyperbaric oxygen therapy; data collection. (H) Committee on General Laws

(S) Committee on Finance and Appropriations
(H) Assigned GL sub: Professions/Occupations and Administrative Process02/14/20
notes: Allows the Department of Veterans Services (the Department) to contract with any hospital in the Commonwealth that furnishes the treatment option of hyperbaric oxygen therapy to provide hyperbaric oxygen therapy to any veteran in the Commonwealth who has been certified by the U.S. Department of Veterans Affairs or any branch of the United States Armed Forces as having post-traumatic stress disorder or traumatic brain injury. The Department shall include in any contract with such hospital to furnish hyperbaric oxygen therapy the requirement that data be collected to assess the efficacy of hyperbaric oxygen therapy for veterans and any other information deemed relevant by the Department.
SB 364 - Dunnavant - Commonwealth Care Health Benefits Program; association health plans for individual market. (H) Committee on Rules

(S) Committee on Rules
(H) Referred to Committee on Rules02/13/20
SB 365 - Dunnavant - Health care provider; SHHR to convene a work group related to credentialing. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(H) Assigned HWI sub: Health Professions02/13/20
notes: Requires the State Board of Health to promulgate regulations requiring a health carrier to establish reasonable protocols and procedures that deem a provider credentialed who has been approved for credentialing by a licensed hospital within 14 days of such approval if such licensed hospital has a contract with the health carrier to provide health care services to a covered person under a health benefit plan offered by the health carrier as a member of the health benefit plan's network.
SB 382 - McPike - Health insurance; coverage for prosthetic devices. (H) Committee on Labor and Commerce

(S) Committee on Finance and Appropriations
(H) Assigned L & C sub: Subcommittee #202/14/20
notes: Requires health insurers, corporations providing health care coverage subscription contracts, health maintenance organizations, and the Commonwealth's Medicaid program to provide coverage for prosthetic devices, including myoelectric, biomechanical, or microprocessor-controlled prosthetic devices that have a Medicare code. The measure repeals the existing requirement that coverage for prosthetic devices be offered and made available. The measure has a delayed effective date of January 1, 2021.
SB 404 - Hashmi - Health insurance; short-term limited-duration medical plans, renewals and extensions. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(H) Referred to Committee on Labor and Commerce02/13/20
notes: Prohibits carriers from issuing in the Commonwealth any short-term limited-duration medical plan with a duration that exceeds three months or that can be renewed or extended, or if the plan's issuance would result in a covered person being covered by a short-term limited-duration medical plan for more than three months in any 12-month period. The measure prohibits a carrier from issuing a short-term limited-duration medical plan during an annual open enrollment period. The measure also requires carriers to rebate premiums from short-term limited-duration medical plans when the medical loss ratio for such plans is less than 85 percent.
SB 424 - DeSteph - Health plans; calculation of enrollee's contribution to out-of-pocket maximum requirement. (S) Committee on Commerce and Labor(S) Failed to report (defeated) in Commerce and Labor (6-Y 9-N)01/27/20
notes: Requires any carrier issuing a health plan in the Commonwealth to count the amount of any rebates received or to be received by the carrier or its pharmacy benefits manager in connection with the dispensing or administration of a prescription drug when calculating the enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under the carrier's health plan.
SB 471 - Reeves - Medical Assistance Services, Department of; contracts with managed care organizations. (S) Committee on Education and Health(S) Stricken at request of patron in Education and Health (14-Y 0-N)01/23/20
notes: Directs the Department of Medical Assistance Services to amend contracts with managed care organizations to ensure that eligible individuals are not denied coverage for therapeutic day treatment.
SB 522 - McDougle - Balance billing; emergency and elective services. (S) Committee on Commerce and Labor(S) Incorporated by Commerce and Labor (SB172-Favola) (14-Y 0-N)02/09/20
notes: Requires health care facilities and health care providers to determine if providers scheduled to deliver elective services to a covered person are in the network of the covered person's managed care plan. The measure requires that when an elective service provider is determined to be out-of-network, in order for the covered person to assume financial responsibility for the out-of-network provider's charges, the health care facility or provider shall (i) inform the covered person of the out-of-network status of the provider, (ii) provide the covered person with the opportunity to be referred to an in-network provider, and (iii) prepare a document for signature by the covered person in which the covered person or his legal representative assumes financial responsibility for services performed by the out-of-network provider, and the covered person must sign the document described in clause (iii). The bill provides that such requirements will also apply to a health care provider in an office-based setting making a referral for elective radiology or pathology services.

The bill identifies post-stabilization services, performed in order to maintain or improve a person's stabilized condition related to an emergency medical condition, as emergency services if (a) the post-stabilization services are preapproved or related to preapproved services; (b) for an out-of-network facility, the health carrier does not effectuate transfer of the covered person within a reasonable amount of time after being notified by the facility of the covered person's need for post-stabilization services; (c) for an out-of-network health care professional, the facility is in-network; or (d) the out-of-network facility is unable
SB 565 - Edwards - Collaborative practice agreements; adds nurse practitioners and physician assistants to list. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(H) Referred to Committee on Health, Welfare and Institutions02/13/20
notes: Adds nurse practitioners and physician assistants to the list of health care practitioners who shall not be required to participate in a collaborative agreement with a pharmacist and his designated alternate pharmacists, regardless of whether a professional business entity on behalf of which the person is authorized to act enters into a collaborative agreement with a pharmacist and his designated alternate pharmacists. This bill is a recommendation of the Joint Commission on Healthcare.
SB 573 - Dunnavant - Health plans; calculation of enrollee's contribution to out-of-pocket maximum requirements. (S) Committee on Commerce and Labor(S) Incorporated by Commerce and Labor (SB424-DeSteph) (14-Y 0-N)01/27/20
notes: Requires any carrier issuing a health plan in the Commonwealth to count the amount of any rebates received or to be received by the carrier or its pharmacy benefits manager in connection with the dispensing or administration of a prescription drug when calculating the enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under the carrier's health plan.
SB 946 - Locke - Medical assistance services; state plan to include doulas. (S) Committee on Finance and Appropriations(S) Continued to 2021 in Finance and Appropriations (15-Y 0-N)02/04/20
notes: Directs the Board of Medical Assistance Services to amend the state plan for medical assistance services to include a provision for the payment of medical assistance for antepartum, intrapartum, and postpartum services provided to a pregnant person by a doula, including services for labor and delivery support and at least four visits during the antenatal period and seven visits during the postpartum period. The bill also directs the Department of Medical Assistance Services to conduct a rate study to determine appropriate reimbursement rates for doula services provided to Medicaid recipients and to report its findings to the Governor and the General Assembly by December 1, 2020.
SB 983 - Lucas - Certificate of public need; definition of "medical care facility," facilities subject to review. (H) Committee on Health, Welfare and Institutions

(S) Committee on Education and Health
(H) Assigned HWI sub: Health02/17/20
notes: Adds to the list of medical care facilities for which a certificate of public need is required any facility located in Planning District 20 that has common ownership with an affiliated licensed hospital located within 35 miles of the facility and that includes, as part of the facility, a dedicated emergency department as defined in 42 C.F.R. 489.24(b) that is subject to the requirements of the federal Emergency Medical Treatment and Active Labor Act.
SB 1031 - Barker - Health insurance; coverage for autism spectrum disorder, individual and small group markets. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(H) Referred to Committee on Labor and Commerce02/14/20
notes: Health insurance; coverage for autism spectrum disorder; individual and small group markets. Eliminates the exemption from the requirements to provide coverage for the diagnosis and treatment of autism spectrum disorder for insurers, corporations, and organizations issuing policies, contracts, and plans in the individual and small group markets. Under current law, only policies, contracts, and plans issued in the large group market are required to provide such coverage.
SB 1047 - Deeds - Health insurance; narrow network plans. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(H) Assigned L & C sub: Subcommittee #202/14/20
notes: Health insurance; narrow network plans. Prohibits a health carrier from offering more than one narrow network plan, as defined in the bill, in a geographic region if any two narrow network plans offered by the health carrier would have the two lowest monthly premiums of any silver-level plans offered by the health carrier in the geographic region.

SB 1086 - Pillion - Health insurance; coverage for infertility treatment. (S) Committee on Commerce and Labor(S) Passed by indefinitely in Commerce and Labor with letter (14-Y 0-N)02/03/20
notes: Health insurance; coverage for infertility treatment. Requires health insurance policies, subscription contracts, and health care plans, including plans administered by the Department of Medical Assistance Services, to provide coverage for infertility treatment.

SJ 25 - Stanley - Va. Tech. Carilion School of Medicine; VPSI&SU to study. (S) Committee on Education and Health(S) Continued to 2021 in Education and Health (12-Y 0-N)01/30/20
notes: Requesting Virginia Polytechnic Institute and State University to study the requirements for the Virginia Tech Carilion School of Medicine to be designated as a teaching hospital in the Code of Virginia.