Health insurance; ethics and fairness in carrier business practices, downcoded claims.

The bill now explicitly amends both § 38.2-3407.15 and § 38.2-3407.15:8, expanding the legislative reach compared to the prior Senate version which only referenced the first section.

The document structure changed from a 'Senate Substitute' to an 'Amendment in the Nature of a Substitute' offered by the House Committee on Labor and Commerce, indicating a procedural shift in how the bill is being processed.

The text was reformatted with different line breaks and spacing, but the substantive legal language regarding definitions, claim timelines, and provider rights appears unchanged.

Deleted the requirement to establish a work group to monitor federal electronic prior authorization developments and assess prescription drug processes.

Deleted the specific instruction for the work group to recommend a date for implementing electronic prior authorization for medical items and services.

Removed the deadline for the work group to submit an annual report by November 1 and a final report by November 1, 2028.

The text of the main section regarding carrier ethics and claim processing was truncated, cutting off the detailed provisions before the new draft text was inserted.

Added a new section prohibiting carriers from discriminating against enrollees solely because they are involved in litigation or potential litigation related to motor vehicle accidents.

Added a new section (§ 38.2-3407.15:8) requiring carriers to include specific provisions regarding prior authorization and contract terms.

Expanded the definition of 'carrier' to include any licensed person offering managed care plans or arranging health care services, broadening the entities subject to these rules.

Included standard legislative formatting changes, such as adding 'ENROLLED' headers, page numbers, and act titles, which reflect the bill's final passage.