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2020 SESSION

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20104167D
HOUSE BILL NO. 1331 Offered January 8, 2020 Prefiled January 8, 2020 A BILL to amend the Code of Virginia by adding a section numbered 38.2-3445.2, relating to health insurance; in-network guarantees. ---------- Patron-- Byron ---------- Referred to Committee on Labor and Commerce ----------

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered 38.2-3445.2 as follows:

§ 38.2-3445.2. Provider contracts; in-network guarantees.

A. As used in this section, "cost-sharing requirement" and "in-network provider" have the same meaning as provided in § 38.2-3445.1.

B. No health carrier offering a managed care plan shall enter into, extend, or renew a provider contract with a facility unless such provider contract contains provisions requiring that:

1. Each health care provider that provides emergency or ancillary services at such facility (i) is a participating health care professional or (ii) has agreed (a) to have his reimbursement from the health carrier included as part of the health carrier's payment to the facility and (b) to not separately bill the health carrier or the covered person for emergency or ancillary services provided at such facility; and

2. All laboratory or diagnostic services provided at such facility are provided by an in-network provider and all laboratory or diagnostic services referred by a health care provider at such facility are referred only to in-network providers.

C. The provisions of this section shall apply to any provider contract entered into, extended, or renewed between a health carrier and a facility on or after January 1, 2021.