SEARCH SITE
VIRGINIA LAW PORTAL
- Code of Virginia
- Virginia Administrative Code
- Constitution of Virginia
- Charters
- Authorities
- Compacts
- Uncodified Acts
- RIS Users (account required)
SEARCHABLE DATABASES
- Bills & Resolutions
session legislation - Bill Summaries
session summaries - Reports to the General Assembly
House and Senate documents - Legislative Liaisons
State agency contacts
ACROSS SESSIONS
- Subject Index: Since 1995
- Bills & Resolutions: Since 1994
- Summaries: Since 1994
Developed and maintained by the Division of Legislative Automated Systems.
2011 SESSION
HB 1928 Health insurance; independent external reviews.
Introduced by: Daniel W. Marshall, III | all patrons ... notes | add to my profiles | history
SUMMARY AS PASSED HOUSE:
Health insurance; independent external reviews. Revises the process for independent external reviews of a health carrier's adverse decision regarding covered health care benefits. The measure (i) eliminates the minimum eligibility threshold, (ii) eliminates the $50 filing fee, and (iii) expands situations for which an independent external review may be requested to include covered persons of all licensed health carriers. Currently, only persons covered by managed care health insurance programs may request an independent external review. Under this measure, insurers are required to incur the full cost of every review; currently, the Commonwealth incurs the cost of any review that does not result in denied services being covered. The measure tracks the Uniform Health Carrier External Review Model Act prepared by the National Association of Insurance Commissioners. The federal Patient Protection and Affordable Care Act requires states to adopt such an external review program by July 1, 2011. The measure also requires health carriers to establish an internal appeals process. The utilization review standards are revised to apply to adverse determinations, which are defined as determinations by a managed care health insurance plan that a request for benefit does not meet the plan's requirements or is determined to be experimental or investigational, thereby resulting in a denial, reduction, or termination of the requested benefit. The length of time the utilization review entity is required to maintain records is increased from five to six years. The measure expires July 1, 2014.
SUMMARY AS INTRODUCED:
Health insurance; independent external reviews. Expands the scope of Virginia's process for independent reviews of a health carrier's adverse decision regarding covered health care benefits, in order to comply with requirements of the federal Patient Protection and Affordable Care Act. The measure (i) eliminates the minimum eligibility threshold, (ii) eliminates the $50 filing fee, and (iii) expands situations for which an independent external review may be requested to include covered persons of all licensed health carriers. Currently, only persons covered by managed care health insurance programs may request an independent external review. Under this measure, insurers are required to incur the full cost of every review; currently, the Commonwealth incurs the cost of any review that does not result in denied services being covered. The measure tracks the Uniform Health Carrier External Review Model Act prepared by the National Association of Insurance Commissioners.