Access to Health Care & Insurance

Bills CommitteeLast actionDate
HB 64 - Campbell - Medicare supplement policies; annual open enrollment period. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/13/24
notes: Requires an insurer, health services plan, or health maintenance organization issuing Medicare supplement policies or certificates in the Commonwealth to offer to an individual currently insured under any such policy an annual open enrollment period commencing on the day of the individual's birthday and remaining opening for at least 30 days thereafter, during which time the individual may purchase any Medicare supplement policy made available by the insurer in the Commonwealth that offers the same benefits as or lesser benefits than those provided by the current coverage. The bill also requires such insurer, health services plan, or health maintenance organization to notify, at least 15 days but not more than 30 days prior to the commencement of such annual open enrollment period, each individual to which such open enrollment period applies of the dates of that open enrollment period, the rights of the individual during that open enrollment period, and any modification of benefits provided by or adjustment of premiums charged for such Medicare supplement policy.
HB 123 - Sullivan - Health insurance; ethics and fairness in carrier business practices. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Signed by President03/01/24
notes: Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim". The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12 month-limit. The bill requires carriers, beginning July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically.
HB 218 - Orrock - Health insurance; health care provider panels, continuity of care. (H) Committee on Appropriations

(S) Committee on Commerce and Labor
(S) Passed Senate (39-Y 0-N)02/29/24
notes: Requires a provider to continue 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, at the time of a provider's terminations, (i) has been medically confirmed to be pregnant, the provider is required to continue care through the postpartum period; (ii) is determined to be terminally ill, the provider is required to continue care for the remainder of the enrollee's life; (iii) has been determined by a medical professional to have a life-threatening condition, the provider is required to continue care for up to 180 days; and (iv) is admitted to and receiving treatment in an inpatient facility, the provider is required to continue care until the enrollee is discharged from the inpatient facility. Under current law, the carrier is required to permit the provider to provide such continuity of care. The bill provides that the continuity of care provisions also apply to plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act.
HB 230 - Simonds - Health insurance; cost sharing for breast examinations. (H) Committee on Appropriations(H) Continued to 2025 in Appropriations02/05/24
notes: Prohibits health insurance carriers from imposing cost sharing for diagnostic breast examinations and supplemental breast examinations, as those terms are defined in the bill, under certain insurance policies, subscription contracts, and health care plans delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2025. The bill provides that such examinations include examinations using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound.
HB 238 - McQuinn - Health insurance; coverage for colorectal cancer screening. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Signed by President03/01/24
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, 2025.
HB 445 - Williams - Health insurance; approval of rates to dental plans, medical loss ratio. (H) Committee on Labor and Commerce(H) Stricken from docket by Labor and Commerce (18-Y 1-N)01/25/24
notes: Requires the State Corporation Commission to review and approve premium rates applicable to dental plans issued in the Commonwealth. Under the bill, benefits are deemed to be reasonable in relation to premiums, provided that the medical loss ratio of the policy form, including riders and endorsements, is at least as great as 85 percent. The bill provides that if the Commission finds that the premium rate filed is not meeting or will not meet a medical loss ratio of 85 percent, the Commission shall require appropriate rate adjustments, premium refunds, or premium credits as deemed necessary for the coverage to conform with the medical loss ratio standard of 85 percent.
HB 591 - Sickles - Commonwealth Health Reinsurance Program; payment parameters. (H) Committee on Appropriations

(S) Committee on Finance and Appropriations
(S) Passed Senate (39-Y 0-N)02/28/24
notes: Requires the State Corporation Commission, in setting the payment parameters for the upcoming benefits year, to set such payment parameters at levels designed to achieve the premium reduction target established in the general appropriation act or, if such target is not established in the general appropriation act, the premium reduction target of the previous benefit year.
HB 601 - Kilgore - Health insurance; patient access to emergency services, mobile crisis response services. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Passed Senate with amendment (39-Y 0-N)02/29/24
notes: Provides that emergency services, with respect to an emergency medical condition, include (i) a screening examination, including ancillary services, that is within the capability of a provider licensed by the Department of Behavioral Health and Developmental Services as a behavioral health crisis service provider and (ii) such further examination and treatment as is required to stabilize the patient. The bill also adds crisis receiving centers to locations where mobile crisis response services and support may be provided and thereby be covered by health insurance.
HB 610 - Price - Health insurance; coverage for diabetes. (H) Committee on Appropriations(H) Continued to 2025 in Appropriations02/09/24
notes: Requires that each insurer providing coverage for diabetes shall include benefits for FDA-approved insulin, continuous blood glucose monitoring, and regular foot care and eye care exams in addition to equipment, supplies, and self-management training and education. The bill allows for such self-management training and education to be provided either in-person outpatient or through telemedicine. Under the bill, such coverage for self-management training and education shall include up to three outpatient visits upon an individual receiving an initial diagnosis of diabetes and up to two medically necessary visits to a qualified provider upon a significant change in the patient's symptoms or medical condition. The bill also repeals certain provisions of law related to cost-sharing for insulin and provides that the coverage required by the bill shall be exempt from any deductible or cost-sharing payment requirement. The provisions of the bill apply to insurance policies, contracts, and plans issued for delivery, reissued, extended, or amended on and after January 1, 2025.
HB 760 - Delaney - Health insurance; cost-sharing payments for insulin and diabetes equipment and supplies. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/13/24
notes: Decreases the cap on the cost-sharing payment that a covered person is required to pay for a covered prescription insulin drug from $50 to $35 for a 30-day supply of the prescription insulin drug and provides such cap is an aggregate cap that applies in situations where the covered person is prescribed more than one insulin drug. The bill also establishes such an aggregate cap of $35 for a 30-day supply of diabetes equipment and supplies.
HB 864 - Clark - Health insurance; coverage for therapeutic day treatment services. (H) Committee on Labor and Commerce(H) Continued to 2025 in Labor and Commerce02/01/24
notes: Requires health insurers providing health care plans to provide coverage for therapeutic day treatment services for children with serious emotional disturbances, defined in the in bill as children who have a mental illness diagnosis and have experienced functional limitations due to emotional disturbance, including experiencing a school shooting or the loss of a loved one in a school setting, over the past 12 months on a continuous or intermittent basis. Under the bill, "therapeutic day treatment services" are treatment programs that combine psychotherapeutic interventions with education and mental health and may include evaluation; medication education and management; opportunities to learn and use daily living skills and to enhance social and interpersonal skills; and individual, group, and family counseling. The bill applies to plans delivered, issued for delivery, or renewed on and after January 1, 2025.
HB 903 - Srinivasan - Health insurance; cost-sharing requirements for the treatment of cancer. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/13/24
notes: Prohibits any (i) 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; (ii) corporation providing individual or group accident and sickness subscription contracts; and (iii) health maintenance organization providing a health care plan for health care services from imposing (a) any cost-sharing requirement for the treatment of cancer and (b) if the policy, contract, or plan, including any certificate or evidence of coverage issued in connection with such policy, contract, or plan, includes coverage for medicines, any cost-sharing requirement for a covered prescription drug for the treatment of cancer in an enrollee who is 18 years of age or younger under such policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth. The bill applies with respect to health plans and provider contracts entered into, amended, extended, or renewed on or after January 1, 2025.
HB 946 - Lopez - Health insurance; limit on cost-sharing payments for prescription drugs under certain plans. (H) Committee on Labor and Commerce(H) Left in Labor and Commerce02/13/24
notes: Requires each carrier that offers a health plan in either the individual or small group market to ensure that at least 50 percent of all health plans offered by the carrier, or at least one health plan if the carrier offers fewer than two health plans, in each rating area and in each of the bronze, silver, gold, and platinum levels of coverage in the individual and small group market conform with the following: (i) a plan that offers a silver, gold, or platinum level of coverage limits a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $100 per 30-day supply of the prescription drug and (ii) a plan that offers a bronze level of coverage limits a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug. The bill provides that such limits apply at any point in the benefit design, including before and after any applicable deductible is reached. The bill requires that any plans offered to meet its requirements are (a) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (b) marketed in the same manner as other plans offered by the health insurance carrier. The provisions of the bill apply with respect to health plans entered into, amended, extended, or renewed on or after January 1, 2025.
HB 1041 - O'Quinn - Health insurance; cost-sharing, pharmacy benefits managers' compensation and duties, civil penalty. (H) Committee on Labor and Commerce(H) Continued to 2025 in Labor and Commerce02/08/24
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 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.

The bill prohibits a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier or health benefit plan except for income derived from a pharmacy benefits management fee. The bill requires the amount of any pharmacy benefits management fees to be set forth in the agreement between the pharmacy benefits manager and the carrier or health benefit plan and that such fee not be based on the acquisition cost or any other price metric of a drug; the amount of savings, rebates, or other fees charged, realized, or collected by or generated based on the activity of the pharmacy benefits manager; or the amount of premiums, deductibles, or other cost-sharing or fees charged, realized, or collected by the pharmacy benefits manager from enrollees or other persons on behalf of an enrollee. The bill requires a pharmacy benefits manager to annually certify to the State Corporation Commission that it has met certain requirements.
HB 1134 - Willett - Health insurance; if prior authorization request is approved for prescription drugs. (H) Committee on Labor and Commerce

(S) Committee on Commerce and Labor
(S) Passed Senate (39-Y 0-N)02/29/24
notes: Requires that any provider contract between a carrier and a participating health care provider contain specific provisions that prohibit the carrier from revoking, limiting, conditioning, modifying, or restricting a prior authorization if such prior authorization request has been approved and services, drugs, or supplies have been provided or delivered to the patient consistent with such prior authorization unless there is evidence that the request was approved based on fraud or misinformation. The bill also extends from 30 days to 90 days the period of a member's prescription drug benefit coverage under a new health plan during which a carrier is required to honor a prior authorization by another carrier.
SB 202 - Diggs - Health insurance; disclosure of summary health information. (S) Committee on Commerce and Labor(S) Failed to report (defeated) in Commerce and Labor (7-Y 8-N)01/22/24
notes: Requires, to the extent permitted by various protected health information privacy laws, a group health plan that has 50 or more participants to disclose information that summarizes the claims history, claims expenses, or type of claims experienced by individuals for whom a plan sponsor has provided health benefits under a group health plan to the plan sponsor if the plan sponsor requests the summary health information for the purposes of (i) obtaining premium bids from health plans for providing health insurance coverage under the group health plan or (ii) modifying, amending, or terminating the group health plan.