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Developed and maintained by the Division of Legislative Automated Systems.
2020 SESSION
HB 1251 Health insurance; definitions, payment to out-of-network providers, emergency services.
Introduced by: Luke E. Torian | all patrons ... notes | add to my profiles
SUMMARY AS PASSED: (all summaries)
Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes that includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation with health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. 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 authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021. This bill incorporates HB 58, HB 189, HB 901, HB 1494, and HB 1546 and is identical to SB 172.
FULL TEXT
- 01/08/20 House: Prefiled and ordered printed; offered 01/08/20 20102088D pdf | impact statement
- 02/04/20 House: Committee substitute printed 20107376D-H1 pdf | impact statement
- 02/07/20 House: Committee substitute printed 20108018D-H2 pdf
- 02/10/20 House: Printed as engrossed 20108018D-EH1 pdf | impact statement
- 02/24/20 Senate: Committee substitute printed 20109073D-S1 pdf | impact statement
- 03/05/20 Senate: Floor substitute printed 20109579D-S2 (Favola) pdf | impact statement
- 03/12/20 House: Bill text as passed House and Senate (HB1251ER) pdf | impact statement
- 04/10/20 Governor: Acts of Assembly Chapter text (CHAP1080) pdf
AMENDMENTS
- House subcommittee amendments and substitutes adopted
- House committee, floor amendments and substitutes offered
- House amendments adopted
HISTORY
- 01/08/20 House: Prefiled and ordered printed; offered 01/08/20 20102088D
- 01/08/20 House: Referred to Committee on General Laws
- 01/16/20 House: Referred from General Laws by voice vote
- 01/16/20 House: Referred to Committee on Labor and Commerce
- 01/23/20 House: Assigned L & C sub: Subcommittee #2
- 01/30/20 House: Subcommittee recommends reporting with substitute (8-Y 0-N)
- 01/30/20 House: Subcommittee recommends referring to Committee on Appropriations
- 02/04/20 House: Reported from Labor and Commerce with substitute (22-Y 0-N)
- 02/04/20 House: Referred to Committee on Appropriations
- 02/04/20 House: Committee substitute printed 20107376D-H1
- 02/04/20 House: Incorporates HB1546 (Adams)
- 02/04/20 House: Incorporates HB1494 (Bagby)
- 02/04/20 House: Incorporates HB58 (Ware)
- 02/07/20 House: Committee substitute printed 20108018D-H2
- 02/07/20 House: Incorporates HB1546 (Adams)
- 02/07/20 House: Incorporates HB1494 (Bagby)
- 02/07/20 House: Incorporates HB189 (Levine)
- 02/07/20 House: Incorporates HB901 (Sickles)
- 02/07/20 House: Incorporates HB58 (Ware)
- 02/07/20 House: Reported from Appropriations with substitute (22-Y 0-N)
- 02/09/20 House: Read first time
- 02/10/20 House: Read second time
- 02/10/20 House: Committee Labor and Commerce substitute rejected 20107376D-H1
- 02/10/20 House: Committee on Appropriations substitute agreed to 20108018D-H2
- 02/10/20 House: Amendments by Delegate Torian agreed to
- 02/10/20 House: Engrossed by House - committee substitute with amendments HB1251EH1
- 02/10/20 House: Printed as engrossed 20108018D-EH1
- 02/11/20 House: Read third time and passed House (94-Y 5-N)
- 02/11/20 House: VOTE: Passage (94-Y 5-N)
- 02/12/20 Senate: Constitutional reading dispensed
- 02/12/20 Senate: Referred to Committee on Commerce and Labor
- 02/24/20 Senate: Reported from Commerce and Labor with substitute (13-Y 2-N)
- 02/24/20 Senate: Committee substitute printed 20109073D-S1
- 02/24/20 Senate: Rereferred to Finance and Appropriations
- 03/02/20 Senate: Reported from Finance and Appropriations (14-Y 0-N)
- 03/04/20 Senate: Constitutional reading dispensed (40-Y 0-N)
- 03/05/20 Senate: Floor substitute printed 20109579D-S2 (Favola)
- 03/05/20 Senate: Read third time
- 03/05/20 Senate: Committee substitute rejected 20109073D-S1
- 03/05/20 Senate: Reading of substitute waived
- 03/05/20 Senate: Substitute by Senator Favola agreed to 20109579D-S2
- 03/05/20 Senate: Engrossed by Senate - committee substitute HB1251S2
- 03/05/20 Senate: Passed Senate with substitute (40-Y 0-N)
- 03/05/20 House: Senate substitute agreed to by House 20109073D-S1 (98-Y 0-N)
- 03/05/20 House: VOTE: Adoption (98-Y 0-N)
- 03/12/20 House: Enrolled
- 03/12/20 House: Bill text as passed House and Senate (HB1251ER)
- 03/12/20 House: Signed by Speaker
- 03/12/20 Senate: Signed by President
- 03/17/20 House: Enrolled Bill communicated to Governor on March 17, 2020
- 03/17/20 Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020
- 04/10/20 Governor: Approved by Governor-Chapter 1080 (effective - see bill)
- 04/10/20 Governor: Acts of Assembly Chapter text (CHAP1080)