Health insurance; pharmacy benefits managers; requirements and prohibited conduct; retail pharmacy network access standards; enforcement; civil penalty. Amends the definition of "pharmacy benefits management" to exclude certain activities and amends certain provisions related to prohibited conduct by health carriers and pharmacy benefits managers (PBMs). The bill prohibits a health carrier or PBM from denying a pharmacy the opportunity to participate in a network at preferred status if the pharmacy is willing to accept the same terms and conditions as other pharmacies that receive preferred status. The bill prohibits a health carrier or PBM from retroactively denying or reducing reimbursement for a covered service claim, except in certain circumstances. The bill also prohibits health carriers and PBMs from failing to make a payment due to a pharmacy or pharmacist upon termination from a network and from charging a pharmacist or pharmacy a fee related to participation in a PBM's network. Under the bill, no PBM shall restrict a pharmacy from informing an individual of any differential between the individual's out-of-pocket costs and the amount the individual would pay to purchase the drug directly or through the individual's health insurance coverage. The bill also requires PBMs to establish and maintain an electronic claim inquiry processing system using national standards to provide certain disclosures and to maintain records of network development activities. The bill prohibits a PBM from including the name of any pharmacy or hospital in any material issued by the PBM unless it lists all pharmacies participating in the preferred and nonpreferred pharmacy and health networks. Under the bill, the Attorney General is authorized to issue civil investigative demands regarding violations of the provisions of the bill and to bring an action in circuit court to enjoin any violation of such provisions. If the court finds that a person has willfully violated the provisions of the bill, the Attorney General may assess a civil penalty of up to 5,000 per violation.
Health insurance; coverage for speech therapy as a treatment for stuttering. Requires health insurance carriers whose health care plans include coverage for habilitative services and rehabilitative services, as such terms are defined in the bill, to provide coverage for habilitative speech therapy and rehabilitative speech therapy, as such terms are defined in the bill, as a treatment for stuttering. The bill provides that such coverage is not (i) subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist; (ii) limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or (iii) subject to utilization review or utilization management requirements, including prior authorization or a determination that the habilitative or rehabilitative speech therapy services are medically necessary. The bill applies to health care plans delivered, issued for delivery, or renewed on and after January 1, 2027.
Constitutional amendment (voter referendum); fundamental right to reproductive freedom. Provides for a referendum at the November 3, 2026, election to approve or reject an amendment to the Constitution of Virginia relating to the right to make one's own decisions related to reproductive health care, including access to abortion. The amendment protects patients and their doctors and nurses from being punished for making such decisions. The amendment allows the state to place restrictions on access to abortion during the third trimester of pregnancy except when the patient's life or physical or mental health is at risk or the pregnancy cannot survive. This bill is identical to HB 781.
Health insurance; pharmacies; freedom of choice; delivery of prescription drugs; penalties. Prohibits an insurer, health maintenance organization, corporation providing preferred provider subscription contracts, or pharmacy benefits manager from imposing upon any person receiving pharmaceutical benefits any policy or practice requiring or incentivizing certain provisions relating to the delivery of prescription drugs. A violation of the bill's provisions constitutes an unfair trade practice under existing law and is subject to injunctive, penalty, and enforcement provisions in existing law.
Department of Medical Assistance Services; consultation with federally recognized tribes. Establishes a Tribal Medicaid Advisory Group to work collaboratively on (i) plan amendments, waiver requests, and policies affecting tribal health programs at least 60 days prior to submitting them for public notice and comment and (ii) a tribal health program billing manual. The advisory group is required to meet in person on at least a quarterly basis. The bill also requires the Department of Medical Assistance Services to (a) recognize the eligibility of any tribal health program to participate as a provider in the state plan, (b) consult with any tribal health program participating in the state plan at least 60 days prior to taking any adverse action, including suspension of payments or investigation regarding the participation of any tribal health program in the state plan, and (c) engage in ongoing consultation with federally recognized tribes and tribal health programs to address the needs of the state and tribal governments. This bill is a recommendation of the Commission on Updating Virginia Law to Reflect Federal Recognition of Virginia Tribes.
Regional Care Compacts Pilot Program established; workforce development; certified nurse aides; licensed practical nurses; report. Directs the Department of Health to establish the Regional Care Compacts Pilot Program to permit health care entities to enter into compacts, as defined by the bill, to incentivize health care workforce development. The bill permits such compacts to engage in workforce development activities, pool resources, enter into agreements with other entities to expand training and placement capacity, establish shared goals, and share workforce data in accordance with applicable privacy laws. The bill directs the Department to provide technical assistance and permits the Department to administer the Program in coordination with the Department of Health Professions, the Virginia Health Workforce Development Authority, and other relevant entities. The bill requires compacts to report to the Department on their activities and requires the Department to submit a consolidated report to the Governor and General Assembly each year by December 1.
Constitutional amendment (voter referendum); fundamental right to reproductive freedom. Provides for a referendum at the November 3, 2026, election to approve or reject an amendment to the Constitution of Virginia relating to the right to make one's own decisions related to reproductive health care, including access to abortion. The amendment protects patients and their doctors and nurses from being punished for making such decisions. The amendment allows the state to place restrictions on access to abortion during the third trimester of pregnancy except when the patient's life or physical or mental health is at risk or the pregnancy cannot survive. This bill is identical to SB 449.
Department of Medical Assistance Services; state plan for medical assistance; patient-initiated consultation; provider-to-provider consultation. Directs the Department of Medical Assistance Services to modify state plan provisions covering provider-to-provider consultations to also include patient-generated consultations. The bill specifies that consultations provided through telemedicine services, including audio-only telemedicine services where applicable, shall be included in such provision. This bill was incorporated into HB 1284.
Reports of fetal death; miscarriage; personally identifiable information not required. Provides that any fetal death report relating to a miscarriage shall not include a patient's name or any other personally identifiable information. The bill further directs the Department of Health to update its regulations in accordance with the provisions of the bill.
