Access to Health Care & Insurance
| Bills | Committee | Last action | Date |
| HB 1375 - Greenhalgh - Health insurance; tobacco surcharge. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes: Eliminates the authority of a health carrier to vary its premium rates based on tobacco use. Under current law, a health carrier may charge premium rates up to 1.5 times higher for a tobacco user than for a nonuser. The provisions of the bill apply to health benefit plans providing individual or small group health insurance coverage entered into, amended, extended, or renewed on or after January 1, 2024. | |||
| HB 1503 - Orrock - Health insurance; provider contracts, timeframe for provider to request appeal. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Requires every carrier to provide at least 60 days following notice to a health care provider of any findings of an audit conducted by the carrier during which such health care provider may request a first-level or any subsequent-level appeal of any such findings. | |||
| HB 1505 - Orrock - Health insurance; provider contracts, audits. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Prohibits a health insurance carrier, in conducting an audit of a provider, from reviewing any claim that was paid more than six months prior to the date of the audit. The bill prohibits a carrier from seeking recoupment from a provider until the time period for filing an appeal to an initial audit report has passed or until the appeals process has been exhausted, whichever is later. | |||
| HB 1538 - Clark - Health insurance; coverage for doula care services. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Requires health insurers, health care subscription plans, and health maintenance organizations whose policy, contract, or plan includes coverage for obstetrical services to provide coverage for doula care services provided by a state-certified doula. The bill requires such coverage to include coverage for at least eight visits during the antepartum or postpartum period and support during labor and delivery. The bill provides that health insurance carriers are (i) not required to pay for duplicate services actually rendered by both a state-certified doula and another health care provider and (ii) prohibited from requiring supervision, signature, or referral by any other health care provider as a condition of reimbursement for doula care services, except when those requirements are also applicable to other categories of health care providers. The provisions of the bill apply to health benefit plans delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2024. | |||
| HB 1594 - Gooditis - Multijurisdictional community services boards; health insurance coverage for employees. | (H) Committee on Appropriations | (H) Left in Appropriations | 02/07/23 |
| notes: Adds employees of community services boards that serve more than one locality to the definition of "state employee" for the purpose of allowing such employees to be eligible for the health insurance coverage provided to state employees by the Department of Human Resource Management. | |||
| HB 1602 - Robinson - State plan for medical assistance services; telemedicine, in-state presence. | (H) Committee on Health, Welfare and Institutions (S) Committee on Education and Health | (G) Acts of Assembly Chapter text (CHAP0112) | 03/21/23 |
| notes: Establishes that health care providers are not required to maintain a physical presence in the Commonwealth to maintain eligibility to enroll as a Medicaid provider. Additionally, the bill establishes that telemedicine services provider groups with health care providers duly licensed by the Commonwealth are not required to maintain an in-state service address to maintain eligibility to enroll as a Medicaid vendor or Medicaid provider group. | |||
| HB 1615 - Clark - Statute of limitations; medical debt payment period. | (H) Committee for Courts of Justice | (H) Failed to report (defeated) in Courts of Justice (9-Y 11-N) | 02/03/23 |
| notes: Provides that the statute of limitations for an action on any contract, written or unwritten, to collect medical debt, including actions brought by the Commonwealth, is three years from the original date of a health care service unless the contract with a hospital or health care provider is for a payment plan that allows for a longer period of time for the collection of debt by the hospital or health care provider. | |||
| HB 1640 - Kilgore - Medicare; supplement policies for certain individuals under age 65. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 371 (effective 7/1/23) | 03/23/23 |
| notes: Requires each insurer issuing Medicare supplement policies or certificates in the Commonwealth to offer the opportunity of enrolling in at least one of its issued Medicare supplement policies or certificates to any individual under age 65 who resides in the Commonwealth, is enrolled in Medicare Part A and B, and is eligible for Medicare by reason of disability, including individuals with end-stage renal disease. The bill also prohibits an insurer from charging individuals who become eligible for Medicare by reason of disability and who are under 65 years of age premium rates for any Medicare supplement plan or certificate offered by the issuer that exceeds the premium rates charged for such plan to individuals who are 65 years of age or older. | |||
| HB 1681 - Robinson - Long-term services and supports screening; screening after admission. | (H) Committee on Health, Welfare and Institutions (S) Committee on Education and Health | (G) Approved by Governor-Chapter 184 (effective 7/1/23) | 03/22/23 |
| notes: Provides that if an individual is admitted to a skilled nursing facility for skilled nursing services not covered by the Commonwealth's program of medical assistance services and such individual was not screened but is subsequently determined have been required to be screened prior to admission to the nursing home, then the screening may be conducted after admission. Under the bill, coverage of institutional long-term services and supports by the Commonwealth for such non-prescreened patients shall not begin until six months after the initial admission to the skilled nursing facility. During this six-month period, the skilled nursing facility in which the individual resides shall be responsible for all costs indicated for institutional long-term services and supports, in excess of available patient funds, excluding the personal needs allowance that would otherwise have been covered by the Commonwealth. The bill provides that if sufficient evidence indicates that the admission without screening was of no fault of the skilled nursing facility, the Department of Medical Assistance Services shall begin coverage of institutional long-term services and supports immediately upon the completion of the functional screening indicating skilled nursing facility level of care pending the financial eligibility determination. | |||
| HB 1782 - O'Quinn - Health insurance; ensuring fairness in cost-sharing. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Amends provisions related to rebates provided by carriers and health benefit plans to health plan enrollees by defining defined cost-sharing, price protection rebates, and pharmacy benefits management services. The bill requires that an enrollee's defined cost-sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or expected to be received in connection with the dispensing or administration of the prescription drug. | |||
| HB 1815 - Simonds - Health insurance; coverage for breast examinations.. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Requires health insurance carriers to provide coverage for diagnostic breast examinations and supplemental breast examinations, as those terms are defined in the bill. The bill provides that such examinations include examinations using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound. The bill prohibits such examinations from being subject to cost-sharing requirements, including annual deductibles, coinsurance, copayments, or similar out-of-pocket expenses, or any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense. | |||
| HB 1918 - Batten - Health insurance; coverage for audio-only telehealth services, definition. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (S) Passed by indefinitely in Commerce and Labor with letter (15-Y 0-N) | 02/13/23 |
| notes: Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage beginning January 1, 2024, for the cost of health care services provided through audio-only telehealth services, defined in the bill as counseling interventions designed to facilitate a patient's achievement of human development goals and remediate mental, emotional, or behavioral disorders and associated distresses that interfere with mental health and development by a mental health professional delivered to a patient via audio-only means when no other means of real-time two-way audio-visual or other telecommunications or electronic communications are available and operational to the patient or the patient does not have the capability to use such real-time two-way means of communication. The bill requires that prescribing of controlled substances via audio-only telehealth services comply with state requirements for prescribing controlled substances and all applicable federal law. | |||
| HB 2198 - Byron - Essential health benefits benchmark plan; Bureau of Insurance to select a new plan. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 271 (effective 3/22/23) | 03/22/23 |
| notes: Requires the Bureau of Insurance to select a new essential health benefits benchmark plan for the 2025 plan year that includes, in addition to the essential health benefits package included in the existing benchmark plan, coverage for prosthetic devices and components and formula and enteral nutrition products as medicine. The bill contains an emergency clause. This bill is a recommendation of the Health Insurance Reform Commission. | |||
| HB 2199 - Byron - Health Insurance Reform Commission; review of essential health benefits benchmark plan. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes: Requires that the Health Insurance Reform Commission review the essential health benefits benchmark plan and establishes a process for such review. The bill requires the Commission, in coordination with the Bureau of Insurance, to conduct a review of the essential health benefits benchmark plan in 2025 and every five years thereafter. The bill requires during such review (i) the Bureau to convene a stakeholder workgroup to make recommendations to the Commission, (ii) the Bureau to estimate the effects of certain referred legislation on the costs of health coverage in the Commonwealth, (iii) the Commission to determine if any changes are to be made to the benchmark plan and to identify such changes, (iv) the Bureau to conduct an actuarial analysis of any changes identified by the Commission, and (v) the Commission to determine which changes will be recommended and to make a recommendation to the General Assembly, in the form of a bill, regarding such changes. The bill (a) requires public hearings to be held throughout the process, (b) establishes a timeline for each step of the process, and (c) requires the Bureau to maintain a website to convey relevant information regarding the process to the public. This bill is a recommendation of the Health Insurance Reform Commission. | |||
| HB 2201 - Byron - Association health plans; rates based on employer member's risk profile. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes: Provides that for association health plans, a carrier may establish base premium rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims and utilize each employer member's specific risk profile to determine premium rates for each employer member by actuarially adjusting above or below established base premium rates. | |||
| HB 2215 - Tran - Long-term care insurance; rate increases, notice requirements. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Requires an insurer of long-term care insurance policies to issue a written notice to each policyholder of the insurer's filing for a rate increase with the State Corporation Commission within 60 days of making such filing. Additionally, the bill requires the insurer to (i) if the Commission denies the rate increase, issue a written notice to each policyholder of the Commission's final decision to deny the rate increase or (ii) if the Commission approves the rate increase, issue a written notice to policyholders of the rate increase at least 90 days before its effective date that includes certain information. The bill requires the Commission to consider, to the extent practicable, consider how the rate increase will impact policyholders in reviewing requests to increase long-term care insurance rates. | |||
| HB 2262 - Hodges - Health insurance; online credentialing system, processing of new applications. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 376 (effective 7/1/23) | 03/23/23 |
| notes: Requires a health insurance carrier that credentials the physicians, mental health professionals, or other providers in its network to establish reasonable protocols and procedures for processing of new provider credentialing applications. The bill requires such protocols and procedures to require the carrier to to approve or deny new provider credentialing applications within 60 days of receiving a completed application and to provide notice to the new provider applicant that the provider's application is received and complete. The bill also requires payment no later than 30 days after the carrier approves the new provider credentialing application for services that are rendered from the date the new provider applicant's completed credentialing application is provided to the carrier for consideration. | |||
| HB 2354 - Orrock - Health care provider panels; changes to provisions related to continuity of care. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes:
Makes various changes to provisions related to the continuity of care for an enrollee after a provider is terminated from a health insurance carrier's provider panel. The bill requires a carrier that uses a provider panel to establish procedures for notifying an enrollee of (i) the termination from the carrier's provider panel of a provider who was furnishing health care services to the enrollee or furnished health care services to the enrollee in the six months prior to the notice and (ii) the right of an enrollee upon request to continue to receive health care services as provided in the bill following the provider's termination from a carrier's provider panel. The bill requires the carrier to provide such notices prior to the date of the termination of the provider. The bill removes separate notice requirements for the termination of a primary care provider or a specialty referral services provider. The bill provides that a provider is permitted to render health care services to any of the carrier's enrollees for a period of at least 90 days from the date of a provider's termination from the carrier's provider panel, except when a provider is terminated for cause. The bill provides that for an enrollee who (a) has been medically confirmed to be pregnant at the time of a provider's termination, the provider may continue care through the postpartum period; (b) has been determined by a medical professional to have a life-threatening condition at the time of a provider's termination of participation, the provider may continue care for up to 180 days; and (c) is admitted to and receiving treatment in any inpatient facility at the time of a provider's termination, the provider may continue care, without any t |
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| HB 2356 - McQuinn - Health insurance; coverage for colorectal cancer screening. | (H) Committee on Commerce and Energy | (H) Left in Commerce and Energy | 02/07/23 |
| notes: Requires health insurers to provide coverage for examinations and laboratory tests related to colorectal cancer screening in accordance with the American Cancer Society guidelines for colorectal cancer screening of average-risk individuals. The bill (i) prohibits such coverage from being subject to any deductible, coinsurance, or any other cost-sharing requirements for services received from participating providers and (ii) provides that an initial screening test is not complete until a follow-up colonoscopy is performed. The provisions of the bill apply to individual or group accident and sickness insurance policies, individual or group accident and sickness subscription contracts, or health care plans delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2024. | |||
| SB 828 - Spruill - Long-term care insurance; premium rate increases. | (S) Committee on Commerce and Labor | (S) Passed by indefinitely in Commerce and Labor with letter (15-Y 0-N) | 01/16/23 |
| notes: Prohibits the State Corporation Commission from approving any long-term care insurance annual premium rate increase or premium rate schedule increase that exceeds six percent of the current rate or current rate schedule. | |||
| SB 945 - Suetterlein - Individuals with developmental disabilities; financial flexibility, report. | (H) Committee on Health, Welfare and Institutions (S) Committee on Finance and Appropriations | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes: Directs the Department of Medical Assistance Services to take steps to amend the Family and Individual Supports, Community Living, and Building Independence waivers to provide greater financial flexibility to individuals with developmental disabilities who are receiving waiver services. The bill requires the Department to report on its progress to the Governor and the General Assembly by December 1, 2023. | |||
| SB 1154 - Mason - Health insurance; online credentialing system, processing of new applications. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 377 (effective 7/1/23) | 03/23/23 |
| notes: Requires a health insurance carrier that credentials the physicians, mental health professionals, or other providers in its network to establish reasonable protocols and procedures for processing of new provider credentialing applications. The bill requires such protocols and procedures to require the carrier to to approve or deny new provider credentialing applications within 60 days of receiving a completed application and to provide notice to the new provider applicant that the provider's application is received and complete. The bill also requires payment no later than 30 days after the carrier approves the new provider credentialing application for services that are rendered from the date the new provider applicant's completed credentialing application is provided to the carrier for consideration. | |||
| SB 1157 - Marsden - Health insurance; coverage for audio-only telehealth services. | (S) Committee on Commerce and Labor | (S) Passed by indefinitely in Commerce and Labor with letter (9-Y 4-N 1-A) | 01/23/23 |
| notes: Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage beginning January 1, 2024, for the cost of health care services provided through audio-only telehealth services, defined in the bill as counseling interventions designed to facilitate a patient's achievement of human development goals and remediate mental, emotional, or behavioral disorders and associated distresses that interfere with mental health and development by a mental health professional delivered to a patient via audio-only means when no other means of real-time two-way audio-visual or other telecommunications or electronic communications are available and operational to the patient or the patient does not have the capability to use such real-time two-way means of communication. The bill provides that "audio-only telehealth services" does not include counseling interventions delivered by a mental health professional while such mental health professional is operating or riding in a motor vehicle unless the patient is experiencing an acute mental health crisis. The bill requires that prescribing of controlled substances via audio-only telehealth services comply with state requirements for prescribing controlled substances and all applicable federal law. | |||
| SB 1171 - Dunnavant - Association health plans; rates based on employer member's risk profile. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Governor's Action Deadline 11:59 p.m., March 27, 2023 | 03/02/23 |
| notes: Provides that for association health plans, an insurer may (i) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims and (ii) utilize each employer member's specific risk profile to determine premium rates for each employer member by actuarially adjusting above or below established base rates. | |||
| SB 1285 - Peake - Health insurance; catastrophic plans. | (S) Committee on Commerce and Labor | (S) Failed to report (defeated) in Commerce and Labor (3-Y 11-N) | 01/23/23 |
| notes: Authorizes health carriers to offer catastrophic plans on the individual market and to offer such plans to all individuals. The measure provides that a catastrophic plan is deemed to provide an essential health benefits package and to meet certain requirements of federal law. A catastrophic plan is a high-deductible health care plan that provides essential health benefits and coverage for at least three primary care visits per policy year. Under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended, catastrophic plans satisfy requirements that health benefit plans provide minimum levels of coverage only if they cover individuals who are younger than 30 years of age or who qualify for a hardship exemption or affordability exemption. The measure requires the Commissioner of Insurance to apply to the federal government for a State Innovation Waiver allowing the implementation of the provision allowing catastrophic plans to be offered on the individual market to all individuals. The provision will become effective 30 days after the Commissioner notifies certain persons that the request has been approved. | |||
| SB 1336 - Reeves - Health insurance; short-term limited-duration medical plans. | (S) Committee on Commerce and Labor | (S) Passed by indefinitely in Commerce and Labor (12-Y 3-N) | 01/30/23 |
| notes: Authorizes a health insurance carrier to issue short-term limited-duration medical plans with an expiration date that is less than 12 months after the original effective date of the contract, policy, or plan and, taking into account renewals or extensions, that has a duration that is no longer than 36 months. Under current law, a carrier is prohibited from selling a short-term limited-duration medical plan that exceeds three months or that can be renewed or extended beyond six months. The bill provides that, notwithstanding any of the provisions of the bill, a carrier may issue any short-term limited-duration health plan that meets the definition of "short-term limited-duration insurance" provided in federal law. Finally, the bill sets out a disclaimer notice to be included on any short-term limited-duration medical plan sold or offered for sale in the Commonwealth. | |||
| SB 1338 - Edwards - Health insurance; pharmacy benefits managers, employee welfare benefit plans. | (S) Committee on Commerce and Labor | (S) Passed by indefinitely in Commerce and Labor with letter (15-Y 0-N) | 01/30/23 |
| notes: Provides that entities providing or administering self-insured or self-funded employee welfare benefit plans are subject to provisions related to pharmacy benefits management, including certain prohibited conduct and recordkeeping requirements. | |||
| SB 1368 - Vogel - Multijurisdictional community services boards; health insurance coverage for employees. | (S) Committee on Finance and Appropriations | (S) Passed by indefinitely in Finance and Appropriations (10-Y 6-N) | 02/01/23 |
| notes: Adds employees of community services boards that serve more than one locality to the definition of "state employee" for the purpose of allowing such employees to be eligible for the health insurance coverage provided to state employees by the Department of Human Resource Management. | |||
| SB 1399 - Surovell - Essential health benefits benchmark plan; Bureau of Insurance to select a new plan. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 272 (effective 3/22/23) | 03/22/23 |
| notes: Requires the Bureau of Insurance to select a new essential health benefits benchmark plan for the 2025 plan year that includes, in addition to the essential health benefits package included in the existing benchmark plan, coverage for prosthetic devices and components and formula and enteral nutrition products as medicine. The bill contains an emergency clause. This bill is a recommendation of the Health Insurance Reform Commission. | |||
| SB 1409 - Barker - Medicare; supplement policies for certain individuals under age 65. | (H) Committee on Commerce and Energy (S) Committee on Commerce and Labor | (G) Approved by Governor-Chapter 372 (effective 7/1/23) | 03/23/23 |
| notes: Requires each insurer issuing Medicare supplement policies or certificates in the Commonwealth to offer the opportunity of enrolling in at least one of its issued Medicare supplement policies or certificates to any individual under age 65 who resides in the Commonwealth, is enrolled in Medicare Part A and B, and is eligible for Medicare by reason of disability, including individuals with end-stage renal disease. The bill also prohibits an insurer from charging individuals who become eligible for Medicare by reason of disability and who are under 65 years of age premium rates for any Medicare supplement plan or certificate offered by the issuer that exceeds the premium rates charged for such plan to individuals who are 65 years of age or older. | |||
| SB 1425 - Mason - Health insurance; ensuring fairness in cost-sharing. | (S) Committee on Commerce and Labor | (S) Left in Commerce and Labor | 02/08/23 |
| notes: Amends provisions related to rebates provided by carriers and health benefit plans to health plan enrollees by defining defined cost-sharing, price protection rebates, and pharmacy benefits management services. The bill requires that an enrollee's defined cost-sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or expected to be received in connection with the dispensing or administration of the prescription drug. | |||