Healthcare

Health insurance; treatment of cancer and certain diseases; coverage of certain medications. Requires an insurer, corporation providing preferred provider subscription contracts, or health maintenance organization that provides coverage for drugs approved by the Food and Drug Administration and prescribed for the treatment of cancer or diseases of the blood to allow, at the patient's direction, (i) provider-administered drugs for such treatment to be dispensed by an in-network treating provider consistent with a provider agreement; (ii) provider-administered drugs for such treatment to be dispensed by an in-network treating provider when there is a documented delay of at least three days in the delivery of a medication from the designated specialty pharmacy; and (iii) self-administered drugs for such treatment to be sent to the pharmacy of the patient's choosing.

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.

Health insurance; large group policies; coverage for scalp treatment during cancer chemotherapy treatment. Requires health insurance carriers offering policies in the large group market to provide coverage for scalp cooling systems for the preservation of hair during cancer chemotherapy treatment. Provisions of the bill apply to health insurance policies, contracts, and plans delivered, issued for delivery, or renewed in the large group market in the Commonwealth on and after January 1, 2027.

Health insurance; State Plan for Medical Assistance; coverage for prosthetic and custom orthotic devices and components; reports. Amends provisions related to health insurance coverage for prosthetic devices and components to include custom orthotic devices and components. Under the bill, such coverage does not include repair and replacement due to theft or loss and may include more than one prosthetic or custom orthotic device when medically necessary, as determined by an enrollee's provider. The bill prohibits an insurer from denying coverage for a prosthetic or custom orthotic device for an individual with limb loss, limb absence, or limb impairment that would otherwise be covered for a nondisabled individual seeking medical or surgical intervention. The bill requires health plans that provide such coverage to include language describing an enrollee's rights related to coverage for prosthetic and custom orthotic devices and provide a written explanation of any claim denials. The bill also directs the Department of Medical Assistance Services to seek the necessary permissions from the Centers for Medicare and Medicaid Services to provide payment of medical assistance for prosthetic and custom orthotic devices, subject to the same requirements as insurers. Such payment is conditional on the Department obtaining all necessary approvals and federal financial participation. The bill sunsets on July 1, 2027, if such approval and federal financial participation is not obtained. The bill directs the health insurance carriers, the Department of Medical Assistance Services, and any managed care plan administering Medicaid benefits in the Commonwealth to submit reports to the Health Insurance Reform Commission regarding implementation of the provisions of the bill during plan years 2027 and 2028.

Department of Medical Assistance Services; community health workers in Medicaid managed care; report. Directs the Department of Medical Assistance Services (DMAS) to evaluate and develop recommendations for a statewide strategy to integrate community health workers into Medicaid managed care and related health and human services programs. The bill instructs DMAS to consult with the Department of Health, the Department of Social Services, the Department of Behavioral Health and Developmental Services, the Department for Aging and Rehabilitative Services, the Virginia Community Health Worker Association, Medicaid managed care organizations, local departments of social services, community-based providers, and other relevant stakeholders. The bill requires DMAS to submit a report of its findings and recommendations to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and the Senate Committee on Finance and Appropriations by December 1, 2026.

Agricultural Workforce Mental Health and Suicide Prevention Program established; report. Requires the Department of Agriculture and Consumer Services (the Department) to establish and administer the Agricultural Workforce Mental Health and Suicide Prevention Program (the Program) to support the mental health and well-being of the agricultural workforce, as defined in the bill, in the Commonwealth. The bill requires the Program to (i) increase public awareness of mental health and suicide prevention, (ii) provide access to culturally and contextually appropriate mental health services, and (iii) address mental health challenges arising from certain stressors affecting agricultural communities in the Commonwealth. The bill directs the Department to submit a report on the Program's progress, including data collected and any recommendations, to the Chairmen of the House Committee on Agriculture, Chesapeake and Natural Resources and Senate Committee on Agriculture, Conservation and Natural Resources by September 1, 2027, and biennially thereafter.

Health insurance; coverage for standard fertility preservation procedures. Requires health insurance carriers to provide coverage for standard fertility preservation procedures. The bill provides that "standard fertility preservation procedures" means procedures to preserve fertility that are consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology for a person who has cancer, sickle cell disease, or other medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

Supervised billing; Medicaid and health insurance plans. Requires the Department of Medical Assistance Services to permit a qualified licensed provider to bill for clinical services provided by a qualified non-licensed provider under the supervision of the qualified licensed provider and requires health insurance carriers to provide coverage for mental health services or substance use services provided by a qualified non-licensed provider under the supervision of a qualified licensed provider when such services would be covered if provided by a qualified licensed provider. Additionally, the bill reduces the time limit for a retroactive denial by a health insurance carrier from 12 months to 180 days.

Health insurance; coverage for non-opioid prescription drugs. Prohibits a health insurance carrier from imposing any cost-sharing, prior authorization, step therapy, or other limitation on coverage of a covered non-opioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain that is more restrictive or less favorable to the enrollee relative to a covered opioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain.

Insurance; Fire Programs Fund; purposes; Virginia At Risk Fire Grant Program established. Increases the assessment on certain insurance companies from one percent to 1.5 percent. The bill provides that the portion of the Fire Programs Fund allocated to localities may be used for the additional purposes of (i) constructing, improving, or expanding fire station facilities; (ii) providing mental health resources for fire personnel; or (iii) hiring additional fire personnel and funding recruitment and retention programs. The bill also prohibits such funds from being used, except as provided, for the purposes of investments, operating expenses, debt repayment, taxes, or fees. The bill also establishes the Virginia At Risk Fire Grant Program, to be funded by 0.25 percent of the assessments on insurance companies, for the purposes of providing assistance to localities with fire departments that are determined to be most at risk of being unable to provide fire suppression or rescue activities or maintain compliance with relevant laws and regulations.