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ACROSS SESSIONS
- Subject Index: Since 1995
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Developed and maintained by the Division of Legislative Automated Systems.
2019 SESSION
Chairman: Frank W. Wagner
Clerk: Chad Starzer
Staff: Frank Munyan Chrissy Noonan
Date of Meeting: January 31, 2019
Time and Place: 8:30 AM, Senate Room 3, The Capitol
Patron: Chase
Health benefit plans; sale by authorized foreign health insurers. Establishes a procedure by which the State Corporation Commission may authorize health insurers licensed to sell health benefit plans in any other state to sell health benefit plans in Virginia without obtaining a license to engage in the business of insurance in Virginia or complying with other requirements applicable to Virginia-licensed insurers. A health benefit plan sold by an authorized foreign health insurer is not required to include state-mandated health benefits. The measure establishes criteria to be used by the Commission in determining whether to authorize a foreign health insurer to sell, offer, or provide a health benefit plan in the Commonwealth. The measure authorizes the Commission to conduct market conduct and financial condition examinations of any foreign health insurer that has applied for, or has received, authorization to sell health benefit plans in Virginia. The measure also specifies disclosures that an authorized foreign health insurer is required to include in applications and policies. The measure has a delayed effective date of January 1, 2020.
A BILL to amend and reenact § 38.2-1802 of the Code of Virginia and to amend the Code of Virginia by adding in Title 38.2 a chapter numbered 64, consisting of sections numbered 38.2-6400 through 38.2-6405, relating to the sale of health benefit plans by insurers licensed only in other states.19100073D
Patron: Black
Health insurance; coverage for Lyme disease therapy. Requires health insurers, corporations providing health care coverage subscription contracts, and health maintenance organizations, whose policy, contract, or plan includes coverage for prescription drugs, to provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient's symptoms, diagnostic test results, or response to treatment. The measure applies to policies, contracts, and plans delivered, issued for delivery, or renewed on or after January 1, 2020.
A BILL to amend and reenact § 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3418.18, relating to health insurance coverage for long-term antibiotic therapy for a patient with Lyme disease.19100146D
Patron: Sturtevant
Health insurance; catastrophic health plans. 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 Affordable Care Act, catastrophic plans satisfy requirements that health benefit plans provide minimum levels of coverage only if they cover individuals who are under 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. The provision will become effective 30 days after the Commissioner notifies certain persons that the request has been approved.
A BILL to amend the Code of Virginia by adding a section numbered 38.2-3446.1, relating to health insurance; catastrophic plans.19100753D
Patron: Marsden
Electric utilities; rate abatement offsetting consequences of reduced consumption. Requires each electric utility to provide eligible customers with a rate abatement that ensures that residential, commercial, and industrial customers are not subjected to higher rates per unit of consumption due to decreased consumption resulting from the customer's implementation of not less than $10,000 in investments in energy efficiency. The abatement shall be provided for not less than 20 years following the completion of the material investment in energy efficiency or conservation products or services. The measure requires the State Corporation Commission to adopt regulations to implement this requirement.
A BILL to amend the Code of Virginia by adding a section numbered 56-235.2:1, relating to electric utility regulation; customer classifications; energy efficiency.19103383D
Patron: Petersen
Uninsured and underinsured motorist insurance policies; bad faith. Provides that if an insurance company denies, refuses, or fails to pay its insured, or refuses a reasonable settlement demand within the policy's coverage limits for a claim for uninsured or underinsured motorist benefits within a reasonable time after being presented with a demand for such benefits and it is subsequently found that such denial, refusal, or failure was not in good faith, then the insurance company shall be liable to the insured for the full amount of the judgment and reasonable attorney fees, expenses, and interest.
A BILL to amend and reenact §§ 8.01-66.1 and 38.2-2206 of the Code of Virginia, relating to uninsured and underinsured motorist insurance policies; bad faith.19100551D
Patron: Locke
Reproductive health services. Requires health benefit plans to cover the costs of specified health care services, drugs, devices, products, and procedures related to reproductive health, including (i) contraception and women's preventive health services identified by the Health Resources and Services Administration of the U.S. Department of Health and Human Services or the women's preventive services initiative as of January 1, 2017; (ii) screening to determine whether counseling and testing related to the BRCA1 or BRCA2 genetic mutations is indicated and testing and genetic counseling related to the BRCA1 or BRCA2 genetic mutations if indicated; (iii) abortion to the extent permitted by applicable law; and (d) voluntary sterilization. The health benefit plan requirements become effective when a plan is delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2020, or at any time thereafter when any term of the health benefit plan is changed or any premium adjustment is made. The measure also requires the Board of Medical Assistance Services to include in the state plan for medical assistance services a provision for the payment of the costs of a reproductive health care program providing reimbursement for medically necessary reproductive health care services, drugs, devices, products, and procedures for eligible individuals.
A BILL to amend and reenact §§ 32.1-325, 38.2-3407.5:1, and 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3418.18, relating to health benefit plans and the state plan for medical assistance services; coverage for reproductive health services.19102426D
Patron: Ruff
Expedited review of adverse coverage determinations; cancer patients. Provides that a covered person shall not be required to have exhausted his health carrier's internal appeal process before seeking an external review of an adverse determination regarding coverage of treatment if the treatment is to treat his cancer. The measure also provides that a covered person may request an expedited external review if the adverse determination relates to the treatment of a cancer of the covered person.
A BILL to amend and reenact §§ 38.2-3561 and 38.2-3562 of the Code of Virginia, relating to health carriers; expedited reviews of adverse coverage determinations; exhaustion of internal reviews; cancer patients.19103054D
Patron: McPike
Virginia Health Club Act; automated external defibrillator required in health clubs. Requires each health club location to have a working automated external defibrillator, which is defined in the bill.
A BILL to amend and reenact § 59.1-296 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 59.1-296.2:2, relating to Virginia Health Club Act; automated external defibrillators required in health clubs.19103255D
Patron: Sturtevant
Health carriers; nurse practitioners. Requires health insurers and health services plan providers whose policies or contracts cover services that may be legally performed by licensed nurse practitioners to provide equal coverage for such services when rendered by a licensed nurse practitioner.
A BILL to amend and reenact §§ 38.2-3408 and 38.2-4221 of the Code of Virginia, relating to accident and sickness insurance and health services plans; reimbursement for services provided by nurse practitioners.19100960D
Patron: Favola
Health insurance; coverage for contraceptives. Requires health insurance carriers to provide coverage, under any health insurance policy, contract, or plan that includes coverage for prescription drugs on an outpatient basis, for any prescribed contraceptive drug, contraceptive device, or contraceptive procedure. Currently, health insurance carriers are required to offer and make available such coverage. The measure prohibits a health insurance carrier from imposing any copayment, coinsurance payment, or fee upon any person receiving contraceptive benefits pursuant to the provisions of the measure. The measure applies to health insurance contracts, policies, or plans delivered, issued for delivery, or renewed on and after January 1, 2020.
A BILL to amend and reenact § 38.2-3407.5:1 of the Code of Virginia, relating to health insurance; coverage for contraceptives.19102683D
Patron: Dance
Pharmacies; freedom of choice. Requires carriers that provide exclusive provider policies and contracts to allow consumers freedom of choice for pharmacy benefits. This requirement currently applies to health insurers, health services plans, and health maintenance organizations in Virginia.
A BILL to amend and reenact § 38.2-3407.7 of the Code of Virginia, relating to health insurance; pharmacies; freedom of choice.19102497D
Patron: Chafin
Insurance licensing. Requires the biennial renewal, for individuals and business entities, of licenses by insurance agents, consultants, public adjusters, surplus lines brokers, and viatical settlement brokers by a producer's year and month of birth. The measure also requires fingerprinting for the purpose of conducting state and federal criminal background checks on new resident applicants. The measure establishes fees for processing license renewal applications, requires proof of compliance with continuing education requirements, addresses reinstatement of licenses, and provides for waivers of certain requirements. The measure requires licensed persons to report changes in their name or address. The measure provides that the registration fee for settlement agents will be prescribed by the Commission and that the Commission will retain the authority to enforce these provisions against any person who is under investigation for or charged with a violation. The measure also includes clarifications and removes obsolete requirements.
A BILL to amend and reenact §§ 19.2-389, 38.2-1819, 38.2-1820, 38.2-1824, 38.2-1826, 38.2-1838, 38.2-1840, 38.2-1841, 38.2-1842, 38.2-1845.2, 38.2-1845.8, 38.2-1845.9, 38.2-1845.17, 38.2-1845.22, 38.2-1857.2, 38.2-1857.5, 38.2-1857.9, 38.2-1865.1, 38.2-1865.5, 38.2-1876, 38.2-1882, 38.2-1888, and 55-525.30 of the Code of Virginia, to amend the Code of Virginia by adding sections numbered 38.2-1825.1 and 38.2-1857.4:1, and to repeal §§ 38.2-1857.3 and 38.2-1857.4 of the Code of Virginia, relating to biennial insurance licensing; fingerprinting; criminal background checks; producer licensing standards.19103129D
Patron: Chase
Health insurance; payment to out-of-network providers; emergency services. Directs health carriers that provide individual or group health insurance that provide any benefits with respect to services rendered in an emergency department of a hospital to pay directly to an out-of-network health care provider, less applicable cost-sharing requirements, the greatest of (i) the amount negotiated with out-of-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (ii) the amount for the emergency service calculated using the same method the health carrier generally uses to determine payments for out-of-network services, such as the usual, customary, and reasonable amount; or (iii) the amount that would be paid under Medicare for the emergency service. The bill provides that direct payment from the health carrier to the out-of-network health care provider precludes the out-of-network health care provider from billing or seeking payment from the covered person for any other amount other than the applicable cost-sharing requirements.
A BILL to amend and reenact §§ 38.2-3407.13:2, 38.2-3438, and 38.2-3445 of the Code of Virginia, relating to health insurance; payment to out-of-network providers; emergency services.19103060D
Patron: Reeves
Health insurance; short-term, limited-duration plans. Authorizes health insurance carriers in the Commonwealth to offer short-term, limited-duration health plans. Short-term, limited-duration health plans are defined as plans that have 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, have a duration that does not exceed 36 months. Short-term health plans are required to include a specified disclaimer.
A BILL relating to individual health insurance coverage; short-term, limited-duration policies.19100803D
Patron: Saslaw
Open-end credit plans; penalty. Requires that any person engaged in the business of extending credit under an open-end credit plan under which interest is charged at an annual rate that exceeds 36 percent obtain a license to do so from the State Corporation Commission. The measure prohibits a person licensed as a motor vehicle title lender from extending credit under an open-end credit plan and prohibits a third party from making open-end credit loans in the office of a licensed motor vehicle title lender. The measure prohibits a person that extends credit under an open-end credit plan under which interest is charged at an annual rate that exceeds 36 percent from (i) obtaining or accepting from a borrower an authorization to electronically debit the borrower's deposit account; (ii) failing to comply with certain restrictions and prohibitions applicable to debt collectors contained in the federal Fair Debt Collection Practices Act; (iii) filing a legal proceeding against a borrower until 60 days after the date of default on an open-end credit plan, during which period the person and the borrower may voluntarily enter into a repayment arrangement; or (iv) causing a person to be obligated to the licensee for a principal amount that exceeds $500. The measure also makes it a prohibited practice under the Virginia Consumer Protection Act to violate the requirements applicable to extending credit under an open-end credit plan.
A BILL to amend and reenact §§ 6.2-312 and 59.1-200 of the Code of Virginia, relating to open-end credit plans; penalty.19101155D
Patron: Barker
Health insurance; nondiscrimination; gender identity or transgender status. Prohibits a health carrier from denying or limiting coverage or imposing additional cost sharing or other limitations or restrictions on coverage under a health benefit plan for health care services that are ordinarily or exclusively available to covered individuals of one sex to a transgender individual based on the fact that the individual's sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. The measure also prohibits a health carrier from (i) subjecting an individual to discrimination under a health benefit plan on the basis of gender identity or being a transgender individual or (ii) requiring that an individual, as a condition of enrollment or continued enrollment under a health benefit plan, pay a premium that is greater than the premium for a similarly situated covered person enrolled in the plan on the basis of the covered person's gender identity or being a transgender individual. The measure requires health carriers to assess medical necessity according to nondiscriminatory criteria that are consistent with current medical standards.
A BILL to amend the Code of Virginia by adding a section numbered 38.2-3449.1, relating to health insurance; discrimination on the basis of gender identity or status as a transgender individual prohibited.19102070D
Patron: Favola
Health insurance; essential health benefits; preventive services. Requires a health carrier offering or providing a health benefit plan, including (i) short-term and catastrophic health insurance policies, and policies that pay on a cost-incurred basis; (ii) association health plans; (iii) plans provided by a multiple-employer welfare arrangement; (iv) plans provided pursuant to a benefits consortium, the members of which are banks and employers that provide products and services to banks; and (v) plans provided pursuant to a not-for-profit benefits consortium consisting of five or more private educational institutions, to provide, as an essential health benefit, coverage that includes preventive care. Essential health benefits include items and services covered in accordance with regulations issued pursuant to the Patient Protection and Affordable Care Act in effect as of January 1, 2019.
A BILL to amend and reenact §§ 38.2-3438, 38.2-3442, and 38.2-3451 of the Code of Virginia, relating to health insurance; essential health benefits; preventive services.19103765D
Patron: Wagner
Benefits consortium. Authorizes an association organized as a nonstock corporation whose members are employers conducting business in the Commonwealth to sponsor a trust. The measure authorizes the trust, called a benefits consortium, to sell benefits plans to its members. To be eligible to sponsor a plan, the association is required to have been actively in existence for 10 years, have at least five members, have been formed for purposes other than obtaining or providing health benefits, and operate as a nonprofit entity. The benefits plans may provide medical prescription drug, dental, and vision coverage for the employees of members and the sponsoring association and their dependents. The benefits may be self-funded or purchased from an insurer. The benefits consortium will be a multiple employer welfare arrangement subject to the provisions of the federal Employee Retirement Income Security Act of 1974. The measure exempts the benefits consortium from state taxation and insurance regulations.
A BILL to amend the Code of Virginia by adding in Title 59.1 a chapter numbered 52, consisting of sections numbered 59.1-571 through 59.1-574, relating to the formation of a benefits consortium by a sponsoring association.19103022D
Patron: Wagner
Group health benefit plans; bona fide associations. Replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association." The measure defines "sponsoring association" as a nonstock corporation that, among other conditions, has been actively in existence for 10 years, has at least five members, has been formed for purposes other than obtaining or providing health benefits, and operates as a nonprofit entity.
A BILL to amend and reenact §§ 38.2-508.5, 38.2-3430.6, 38.2-3430.7, 38.2-3431, 38.2-3432.1, 38.2-3432.2, and 38.2-3432.3 of the Code of Virginia, relating to group health benefit plans; sponsoring associations.19103025D
Patron: McDougle
Balance billing; emergency and elective services. Requires health care facilities and health care providers to determine if providers scheduled to deliver elective services to a covered person are in the network of the covered person's managed care plan. The measure requires that when an elective service provider is determined to be out-of-network, in order for the covered person to assume financial responsibility for the out-of-network provider's charges, the health care facility or provider shall (i) inform the covered person of the out-of-network status of the provider, (ii) provide the covered person with the opportunity to be referred to an in-network provider, and (iii) prepare a document for signature by the covered person in which the covered person or his legal representative assumes financial responsibility for services performed by the out-of-network provider, and the covered person must sign the document described in clause (iii). The bill provides that such requirements will also apply to a health care provider in an office-based setting making a referral for elective radiology or pathology services. The bill identifies post-stabilization services, performed in order to maintain or improve a person's stabilized condition related to an emergency medical condition, as emergency services if (a) the post-stabilization services are pre-approved or related to pre-approved services; (b) for an out-of-network facility, the health carrier does not effectuate transfer of the covered person within a reasonable amount of time after being notified by the facility of the covered person's need for post-stabilization services; (c) for an out-of-network health care professional, the facility is in-network; or (d) the out-of-network facility is unable to reasonably obtain health carrier information from the covered person prior to the furnishing of such services. The measure directs health carriers that provide individual or group health insurance that provide any benefits with respect to services rendered in an emergency department of a hospital to pay directly to an out-of-network health care provider the fair market value, as defined in the bill, for the emergency services, less applicable cost-sharing requirements. The bill provides that direct payment from the health carrier to the out-of-network health care provider precludes the out-of-network health care provider from billing or seeking payment from the covered person for any other amount other than the applicable cost-sharing requirements. The bill removes from the determination of whether a medical condition is an emergency medical condition the final diagnosis rendered to the covered person.
A BILL to amend and reenact §§ 38.2-3438 and 38.2-3445 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3445.1, relating to health insurance; payment of out-of-network providers.19103926D
Patron: Wagner
Balance billing; emergency services. Provides that for emergency services an individual shall not be required to pay out-of-network provider charges in excess of the amount the health carrier is required to pay except applicable deductibles, copayment amounts, coinsurance rates, or amounts deemed by the health carrier to be noncovered services. The measure provides that in the event of a dispute between the health carrier and the out-of-network provider as to the appropriate reimbursement amount, either party may request the State Corporation Commission's Bureau of Insurance to determine the appropriate reimbursement amount.
A BILL to amend and reenact § 38.2-3445 of the Code of Virginia, relating to health insurance; emergency services.19103091D
Patron: Wagner
Health benefit plans; balance billing for ancillary services. Prohibits an out-of-network provider from balance billing a covered person for the costs of an ancillary service when an in-network provider referred the covered person to the out-of-network provider unless (i) the referring in-network provider provided the covered person with a notice of liability for the balance; (ii) the out-of-network provider, prior to providing an ancillary service to the covered person, provided a good faith estimate of the out-of-network provider's charges upon request; (iii) the out-of-network provider provided the covered person with a notice of liability for the balance; and (iv) the covered person acknowledged, by signing the out-of-network provider's notice of liability for the balance, that he is aware that using the out-of-network provider may result in his being balance billed. The prohibition on balance billing applies to amounts in excess of the allowed amount, which is the amount that a carrier is obligated to pay, pursuant to the terms of the covered person's health benefit plan, to a covered person for ancillary services provided by an out-of-network provider, net any copayment, deductible, or other cost-sharing amount.
A BILL to amend the Code of Virginia by adding a section numbered 38.2-3407.13:3, relating to health insurance; balance billing by out-of-network providers of ancillary services; liability of covered person.19103739D
Patron: Petersen
Health care provider panels; vertically integrated carriers; public hospitals. Requires any vertically integrated carrier to offer to every public hospital participation in each provider panel or network established for each of the vertically integrated carrier's policies, products, and plans, including all policies, products, and plans offered to individuals, employers, and enrollees in state and federal government benefit programs. The measure requires that the offered participation (i) be without any adverse tiering or other financial incentives that may discourage enrollees from utilizing the services of the public hospital and (ii) include all services offered by the public hospital and any other entity owned, operated, or controlled by a public hospital. The bill defines "vertically integrated carrier" as a health insurer or other carrier that owns an interest in, is owned by, or is under common ownership or control with an acute care hospital facility, excluding an entity that is under the ultimate control of or under common control with a public hospital.
A BILL to amend and reenact § 38.2-3407.10 of the Code of Virginia, relating to health care provider panels; vertically integrated carriers; reimbursements to public hospitals.19102724D
Patron: Deeds
Health insurance; small employers. Revises the definition of "small employer" for purposes of group health insurance policies to provide that an individual who performs any service for remuneration under a contract of hire for a limited liability company in which he is a member, regardless of the number of members of the limited liability company, shall be deemed to be an employee of the limited liability company.
A BILL to amend and reenact § 38.2-3431 of the Code of Virginia, relating to group health plans; small employers.19101957D
Patron: Dunnavant
Health insurance; cost-sharing payments. Requires any carrier issuing a health plan in the Commonwealth to include any amounts paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee's overall contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing requirement under the health plan.
A BILL to amend and reenact §§ 38.2-4214 and 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding in Article 1 of Chapter 34 of Title 38.2 a section numbered 38.2-3407.20, relating to health insurance; calculation of cost-sharing payments.19102900D
Patron: Dunnavant
Health insurance; carrier business practices; authorization of health care services. Provides that if a carrier has previously authorized an invasive or surgical health care service as medically necessary and during the procedure the health care provider discovers clinical evidence prompting the provider to perform a less or more extensive or complicated procedure than was previously authorized, then the carrier shall pay the claim, provided that it is appropriately coded consistent with the procedure actually performed. The measure requires any provider contract between a carrier and a participating health care provider to contain certain specific provisions addressing how carriers interact with prior authorization requests. The measure clarifies that the 24-hour period during which a carrier must communicate to a prescriber if an urgent prior authorization request submitted telephonically or in an alternate method directed by the carrier has been approved, denied, or requires supplementation includes weekend hours. The bill provides that no prior authorization shall be required for substance abuse medication-assisted treatment or if the prescriber is using a clinical decision support system, defined as applications that analyze data to help providers make decisions and improve patient care.
A BILL to amend and reenact §§ 38.2-3407.15 and 38.2-3407.15:2 of the Code of Virginia, relating to health insurance; carrier business practices; authorization of health care services.19103921D
Patron: Dunnavant
Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered health care service from a lower-cost provider. Incentive payments are not required for savings of $25 or less. Programs are required to be approved by the Commissioner of Insurance. The measure also requires health carriers to make available an interactive mechanism on their website that enables a covered person to calculate estimated out-of-pocket costs for comparable health care services from network providers and obtain quality data for those providers, to the extent available.
A BILL to amend and reenact §§ 38.2-4214, 38.2-4319, and 54.1-2910.01 of the Code of Virginia and to amend the Code of Virginia by adding in Chapter 34 of Title 38.2 an article numbered 8, consisting of sections numbered 38.2-3461 through 38.2-3465, relating to health care shared savings; required disclosures by health care providers; and health insurance incentive programs.19104163D
Patron: Barker
Health carriers; registered surgical assistants. Requires health insurers and health service plan providers whose policies or contracts cover services that may be legally performed by a registered surgical assistant to provide equal coverage for such services when rendered by a registered surgical assistant.
A BILL to amend and reenact §§ 38.2-3408 and 38.2-4221 of the Code of Virginia, relating to insurance; reimbursement for services provided by a registered surgical assistant.19104104D
Patron: Howell
Health insurance; coverage for donated human breast milk. Requires health insurers, corporations providing health care coverage subscription contracts, and health maintenance organizations to provide coverage for expenses incurred in the provision of pasteurized donated human breast milk. The requirement applies if the covered person is an infant under the age of six months, the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health, and a licensed medical practitioner has issued an order for an infant who satisfies certain criteria. The measure applies to policies, contracts, and plans delivered, issued for delivery, or renewed on or after January 1, 2020. The measure also requires the state plan for medical assistance services to include a provision for payment of medical assistance services incurred in the provision of pasteurized donated human breast milk.
A BILL to amend and reenact §§ 32.1-325 and 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3418.18, relating to health insurance and medical assistance services; coverage for expenses incurred in the provision of donated human breast milk.19103542D
Patron: Reeves
Health insurance; short-term, limited-duration health plans; renewal guarantees. Provides that any carrier offering short-term, limited-duration health plans may offer for sale a renewal guarantee, defined in the bill as a contract or agreement between a covered person and a carrier that guarantees the option of the covered person to purchase a new short-term, limited-duration health plan at a future date without re-underwriting. The measure specifies that a renewal guarantee is not a health benefit plan and that any renewal guarantee may set a specified premium rate for any short-term, limited-duration health plan that it guarantees will be available to the covered person in the future.
A BILL to amend the Code of Virginia by adding in Article 1 of Chapter 34 of Title 38.2 a section numbered 38.2-3407.20, relating to health insurance; short-term, limited-duration health plans; renewal guarantees.19104119D
Patron: Dunnavant
Health insurance; credentialing; mental health professionals. Requires health insurers and other carriers that credential the mental health professionals in their provider networks to establish reasonable protocols and procedures for reimbursing a mental health professional who has submitted a completed credentialing application to a carrier, after being credentialed by the carrier, for mental health services provided to covered persons during the period in which the applicant's completed credentialing application is pending. The measure provides that health insurers that credential mental health professionals in their network may establish reasonable protocols and procedures for credentialing private mental health agencies. The bill establishes minimum standards that must be maintained by credentialed private mental health agencies.
A BILL to amend and reenact § 38.2-3407.10:1 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3407.10:2, relating to health insurance; credentialing; mental health services.19103738D
Patron: Dunnavant
Group health benefit plans; bona fide associations; benefits consortium. Authorizes an association organized as a nonstock corporation whose members are employers conducting business in the Commonwealth to sponsor a trust. The measure authorizes the trust, called a benefits consortium, to sell benefits plans to its members. The benefits plans may provide medical prescription drug, dental, and vision coverage for the employees of members and the sponsoring association and their dependents. The benefits may be self-funded or purchased from an insurer. The benefits consortium will be a multiple employer welfare arrangement subject to the provisions of the federal Employee Retirement Income Security Act of 1974. The measure exempts the benefits consortium from state taxation and insurance regulations. The measure also replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."
A BILL to amend and reenact §§ 38.2-508.5, 38.2-3431, 38.2-3432.1, 38.2-3432.2, 38.2-3432.3, and 38.2-3521.1 of the Code of Virginia and to amend the Code of Virginia by adding in Title 59.1 a chapter numbered 52, consisting of sections numbered 59.1-571 through 59.1-574, relating to group health benefit plans; sponsoring associations; the formation of a benefits consortium.19103876D
Patron: Carrico
Broadband service providers; fiber optic broadband lines; railroad crossings. Establishes a procedure by which a broadband service provider may obtain approval to place its fiber optic broadband lines across a railroad right-of-way. The measure provides that a broadband service provider may submit to the railroad company a notice of intent to construct, accompanied by a specification exhibit and a standard crossing fee of $800; if the railroad does not claim within 35 days that special circumstances exist or that the required specification exhibit is inadequate or incomplete, the broadband service provider is deemed to have authorization to commence placing the fiber optic broadband line across the railroad's right-of-way. The measure provides that a railroad company that believes that special circumstances exist may file a petition for relief with the State Corporation Commission. The bill requires the Commission to adopt regulations prescribing the terms and conditions for a crossing.
A BILL to amend the Code of Virginia by adding a section numbered 56-16.3, relating to broadband service providers; fiber optic broadband lines; railroad crossings.19103944D
Patron: Vogel
Group health benefit plans; bona fide associations. Replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association." The measure defines "sponsoring association" as a nonstock corporation that, among other conditions, has been actively in existence for 10 years, has at least five members, has been formed for purposes other than obtaining or providing health benefits, and operates as a nonprofit entity.
A BILL to amend and reenact §§ 38.2-508.5, 38.2-3430.6, 38.2-3430.7, 38.2-3431, 38.2-3432.1, 38.2-3432.2, and 38.2-3432.3 of the Code of Virginia, relating to group health benefit plans; sponsoring associations.19104349D
Patron: Dunnavant
State Corporation Commission; Commonwealth Care Division; Commonwealth Care Health Benefits Program. Directs the State Corporation Commission (the Commission), through a division within the Commission designated as the Commonwealth Care Division (the Division), to establish a nonprofit corporation (the Corporation) to establish, implement, and administer the Commonwealth Care Health Benefits Program (the Program), through which individuals may purchase individual health insurance coverage through qualifying health plans offered by the Corporation as a self-insuring entity. The measure identifies the parameters of the Program, including, in part, the following elements: (i) implementation of the Program shall be contingent on the approval of the U.S. Secretary of Health and Human Services of a state innovation waiver under § 1332 of the Affordable Care Act; (ii) the Commission shall retain staff sufficient to establish and implement the Program; (iii) the Program shall arrange for a number of third-party administrators, sufficient to ensure competition but in no event fewer than two; (iv) the Program shall design and implement health plans that replace the existing individual market; (v) the covered benefits provided under a plan offered through the Program shall provide coverage that a large group plan or association health plan subject to ERISA is required to provide so long as one or more health plans provide additional benefits as may be required to provide coverage that is at least as comprehensive and affordable as plans currently offered on the exchange pursuant to the ACA or otherwise to comply with the Guardrail requirements of the ACA; (vi) the Program shall address the establishment of a reinsurance program; (vii) health plan premiums for individuals with a household income between 100 percent and 400 percent of the federal poverty level shall be subsidized; (viii) the Program shall offer a cost-sharing reduction feature that removes disincentives to Program participation by low-income individuals who are enrolled in the Medicaid program; (ix) individuals will still be able to purchase individual health insurance coverage outside of the Program; (x) premiums for the plans offered through the Program shall be set by the third-party administrators, subject to approval by the Commission with assistance of qualified actuaries; (xi) the Program shall be designed and operated in order to ensure that any shortfall in revenues is addressed by the reinsurance program and by self-funding a reserve that is determined by the Corporation's actuary to be adequate, and (xii) the Program shall include premium incentives for compliance with wellness or chronic disease management benefit programs.. The measure directs the Commissioner of Insurance to apply to the U.S. Secretary of Health and Human Services for a state innovation waiver under § 1332 of the Affordable Care Act. The bill has a contingent effective date of 30 days following the date the Commissioner of Insurance notifies the Governor and the Chairmen of the House Committees on Appropriations and Commerce and Labor and the Senate Committees on Finance and Commerce and Labor of federal approval of the state innovation request required to be submitted.
A BILL to establish the Commonwealth Care Health Benefits Program; association health plan for the individual market; state innovation waiver.19102425D
Patron: Deeds
Health policies; variances in area rating factors. Requires a rate filing by a health carrier that proposes rates in a rating area that exceed the average of the proposed rates over all rating areas by more than 15 percent to include a comparison of the area rating factor for comparable individual and small group plans and a disclosure of the area rating factor methodology. In addition, to the extent that the health carrier is deriving any area rating factor from experience data, the measure requires the health carrier to provide additional information, including a claims breakdown by provider for any provider exceeding 30 percent of total claims for that area. The measure requires the State Corporation Commission to hold a public hearing before approving such proposed rates. The measure also bars the Commission from approving such a proposed rate filing if the comparison of the area rating factors for comparable individual and small group plans establishes that a variance of 15 percent exists between the area rating factors for plans offered in the individual market and plans offered in the small group market. Finally, the measure imposes requirements for quarterly reporting if the health carrier had an area rating factor that exceeded the average of the premium rates among all rating areas in which it offers health benefit plans by more than 30 percent in 2019.
A BILL to amend and reenact § 38.2-3447 of the Code of Virginia, relating to restrictions relating to accident and sickness insurance premium rates; variances in area rating factors.19101946D
Patron: Chafin
Insurance agents; continuing education requirements. Revises the timeline for completion of continuing education course information or waiver requirements by insurance agents to a schedule that is biennial, based on the agent's month and year of birth. Current law requires insurance agents to complete and submit proof of such requirements to the insurance continuing education board (the Board) by no later than December 31, or the next working day thereafter if December 31 falls on a weekend, of each even-numbered year. The measure provides a process by which insurance agents may request a waiver under particular extenuating circumstances and a process by which the Board may approve or disapprove such waiver application. The measure modifies the membership of the Board and the criteria for selection by the State Corporation Commission of the same. The bill has a delayed effective date of January 1, 2021. The measure contains technical amendments.
A BILL to amend and reenact §§ 38.2-1867, 38.2-1868.1, 38.2-1869, 38.2-1871, 38.2-1872, and 38.2-1873 of the Code of Virginia and to repeal § 38.2-1870 of the Code of Virginia, relating to insurance agents; continuing education requirements.19104296D
Patron: Surovell
Undergrounding utility lines; transportation infrastructure improvement. Provides that when the Commonwealth Transportation Board determines that it is necessary that any existing overhead electric distribution, cable, or telecommunications line be replaced with an underground line in order to accommodate a transportation infrastructure improvement in an area of transit-oriented development, the utility shall relocate the line underground, with the Board paying to the utility the cost of relocating or removing the line above ground. An electric utility may apply to recover the net costs of undergrounding a distribution line through a rate adjustment clause. A cable operator or telecommunications service provider may recover the net cost of undergrounding overhead cable or telecommunications lines in the same manner as it recovers other capital costs.
A BILL to amend and reenact §§ 56-466.2 and 56-585.1 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 33.2-367.1, relating to relocation, removal, and replacement of utility lines; transportation infrastructure improvements in areas of transit-oriented development.19100654D
Patron: Sturtevant
Balance billing; emergency services. Directs health carriers that provide individual or group health insurance that provides any benefits with respect to services rendered in an emergency department of a hospital to pay directly to an out-of-network health care provider an amount equal to the greatest of (i) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (ii) the regional average for commercial payments for emergency services as of the date of treatment; and (iii) the amount that would be paid under Medicare for an emergency service. The measure defines "regional average for commercial payments" as that fixed price that is determined and reported to the State Corporation Commission's Bureau of Insurance (the Bureau) by Virginia Health Information and adjusted annually by the Bureau in accordance with the United States Average Consumer Price Index (CPI) for medical care for the South region by considering the amounts paid to and accepted from health carriers or managed care plans in 2017 by similar providers for comparable out-of-network emergency services, as identified by Current Procedural Terminology codes, Health Care Common Procedure Coding System codes, diagnosis related group classifications, or revenue codes, in the community where the services were rendered, with the exclusion of amounts accepted by providers for patients covered by Medicare, TRICARE, or Medicaid. The bill removes from the determination of whether a medical condition is an "emergency medical condition" the final diagnosis rendered to the covered person. The measure provides that the State Corporation Commission shall resolve disputes between health care providers and health carriers regarding the appropriate reimbursement amount for such services rendered. The bill directs Virginia Health Information to submit a report to the Bureau establishing the regional average for commercial payments for emergency services based on 2017 data from the All-Payer Claims Database.
A BILL to amend and reenact §§ 38.2-3438 and 38.2-3445 of the Code of Virginia, relating to health insurance; payment to out-of-network providers; emergency services.19104632D