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2019 SESSION
19100464DBe it enacted by the General Assembly of Virginia:
1. That the Code of Virginia is amended by adding a section numbered 54.1-2910.3:1 as follows:
§ 54.1-2910.3:1. Medicaid recipients; treatment involving prescription of opioids; payment.
[ A. ] No provider licensed pursuant to this
chapter shall request or require a patient who is a recipient of medical
assistance services pursuant to the state plan for medical assistance and who
is a recipient of health care services involving (i) the prescription of an
opioid for the management of pain or (ii) the prescription of
buprenorphine-containing products, methadone, or other opioid replacements
approved for the treatment of opioid addiction by the U.S. Food and Drug
Administration for medication-assisted treatment of opioid addiction to pay
costs associated with the provision of such service out-of-pocket [ ,
unless such provider has received a rejection of prior authorization, a
rejection of a submitted claim, or a written denial of reimbursement for such
service from the Department of Medical Assistance Services. Documentation of
such rejection shall be included in the patient's medical record .
The prohibition on the payment of costs shall not apply to a member’s
cost-sharing amounts ] .
[ B. Every provider who does not participate in the Commonwealth’s program of medical assistance services who provides health care services described in subsection A to a patient who is a recipient of medical assistance services pursuant to the state plan for medical assistance shall provide notice to such patient that (i) the Commonwealth’s program of medical assistance services covers the health care services described in subsection A and the Department of Medical Assistance Services will pay for such health care services and (ii) the provider does not participate in the Commonwealth’s program of medical assistance and will not accept payment from the Department of Medical Assistance Services for such health care services. Such notice and the patient’s acknowledgement of such notice shall be documented in the patient’s medical record. ]