Pharmacy benefits managers; requirements; scope; report. Requires all health insurance carriers to use the pass-through pricing model and may limit a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) reducing any payment to a pharmacist or pharmacy to an effective rate of reimbursement, or (iii) retroactively denying or reducing a claim or aggregate of claims except under certain circumstances. The bill requires the State Corporation Commission (the Commission) to examine the practice of carriers or pharmacy benefits managers requiring or inducing covered individuals to utilize pharmacy services at an affiliated pharmacy. The Commission is required to report its findings and recommendations to the General Assembly by December 1, 2027. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill incorporates SB 410 and SB 413 and is identical to HB 830.
Virginia Health Workforce Development Authority; administration of nursing scholarships. Grants the Virginia Health Workforce Development Authority the authority to administer scholarships related to nursing and to promulgate regulations exempt from the requirements of the Administrative Process Act as may be necessary to carry out the administration of nursing scholarship and loan programs. Under current law, the Board of Health is the administrative authority for such scholarships and the Commissioner of Health serves as the fiscal agent for the Board in the administration of some scholarship funds. The bill directs the Authority to establish an annual reporting schedule requiring submission of health workforce data, requires the Authority to establish and provide oversight and strategic guidance to the Virginia Nursing Workforce Center, and grants the Authority the authority to evaluate health workforce programs administered or supported by the Commonwealth. The bill directs the Virginia Nursing Workforce Center to establish an advisory board to provide it with strategic oversight and guidance. This bill is identical to HB 815.
Health care providers; required estimate for nonemergency health care services. Requires health care providers to provide a good faith estimate of the payment amount for which the patient will be responsible for such nonemergency health care service, including any fees or other charges for an item or service the patient may reasonably be expected to receive in connection with the nonemergency health care service. The bill requires the good faith estimate to include (i) description of the scheduled nonemergency health care service, (ii) the provider's standard charge for the service and any related item or service, (iii) the provider's standard charges and any contracted rates known at the time the estimate is prepared, and (iv) a statement that the estimate is not binding and the actual amount billed may differ depending on changes in the scope of services or the health carrier's processing of the claim.
Department of Medical Assistance Services; Department of Social Services; administration of medical assistance and social services programs; technology modernization; report. Directs the Department of Social Services (DSS) and the Department of Medical Assistance Services (DMAS) to contract with a third-party vendor to study and create a plan for the modernization of the technological systems used to administer federal benefit programs in the Commonwealth. The bill requires DSS and DMAS to develop and submit a legislative report that includes a plan to modernize the current technological systems to the Governor and the Chairs of the House Committee on Health and Human Services and the Senate Committee on Rehabilitation and Social Services by December 1, 2026, and to use the recommendations and plan outlined in such legislative report to move forward with the procurement process.
Department of Medical Assistance Services; Medicaid waivers; consumer-directed services; employer of record. Directs the Department of Medical Assistance Services (DMAS) to modify the program rules for consumer-directed services available through certain Medicaid waivers to allow an individual receiving services to serve as the employer of record (EOR) for his own service delivery and designate another individual to perform all or a portion of the duties of the EOR on the individual's behalf when the individual receiving services is unable to perform such duties or direct his own care. The bill specifies that when an individual (i) has not yet reached the age of majority, (ii) is ineligible to use his existing employer identification number (EIN) to facilitate the taxation of benefits, or (iii) is otherwise determined to be ineligible by DMAS by administrative rule, the EIN shall be assigned to the individual receiving services and shall not be transferred to another individual. Under the bill, DMAS has the authority to limit such amendments to specify that an individual receiving services may make such designation no more than twice per calendar year.
Department of Medical Assistance Services; enhanced oversight of services facilitators. Directs the Department of Medical Assistance Services to enhance oversight of Medicaid services facilitation for consumer directed services, including incorporation of such services into the statewide Fiscal Employer Agent contract and development of a contract monitoring and oversight plan.
Firefighters Cancer Screening Grant Program and Fund established. Creates the Firefighters Cancer Screening Grant Program and Fund to award grants to localities for costs incurred in providing certain cancer detection tests to firefighters. The bill provides that in any year that the amount of funds in the Firefighters Cancer Screening Fund reduces to zero and the Fund does not receive a separate appropriation, the Grant Program and Fund shall expire.
Fees for vehicles designed and used for transportation of passengers; funds returned to a locality; permitted uses. Expands the permitted use of funds returned to a locality from certain vehicle fees to include the purchase or maintenance of necessary equipment, supplies, facilities, and vehicles permitted by the Office of Emergency Medical Services and other operating expenses deemed necessary by the locality to ensure the provision of emergency medical services in such locality by nonprofit emergency medical services agencies. Under current law, such funds may be used for the purchase of necessary equipment and supplies for use in the locality for emergency medical services provided by nonprofit emergency medical services agencies.
Residential Well Water Testing and Treatment Program and Fund. Directs the State Board of Health to adopt regulations to utilize point-of-use or point-of-entry drinking water treatment or filtration systems to remove or significantly reduce concentrations of perfluorooctanoic acid, perfluorooctane sulfonate, and other established and emerging contaminants of concern that meet or exceed maximum contaminant levels or health advisory levels for the same contaminant adopted by the U.S. Environmental Protection Agency (EPA) or, in the in the absence of an EPA health advisory for such contaminant, a contaminant level determined by the Department of Health's Office of Drinking Water. The bill also establishes the Residential Well Water Testing and Treatment Program and Program Fund to allow the Department to test and treat contaminated drinking water through grants for the use of eligible treatment or filtration systems in private residential wells. This bill is a recommendation of the State Water Commission.
