Healthcare

Health insurance; claims experience information. Provides that provisions requiring insurers to provide policyholders with certain claims experience information apply to all employee welfare benefit plans and include pharmacy benefits claims.

Certificate of public need; expedited review of certain projects; duties of the State Health Services Plan Task Force. Directs the State Health Services Plan Task Force to develop recommendations for designating areas of the state with an identifiable need for additional projects, taking into account numerous barriers of access to health care. The bill also directs the Board of Health to promulgate updated regulations for expedited application and review processes for certain projects. This bill is identical to SB 239.

Department of Health; State Health Commissioner; nursing homes; periodic medical visits and resident assessments; oversight and accountability. Requires all nursing homes to notify the resident of a nursing home, the resident's family, and the Department of Health if a federally required physician visit does not take place. The bill also requires each nursing home to conduct a comprehensive assessment on an annual basis to determine each resident's needs and describe each resident's capability to perform daily life functions. Such assessments must be reviewed at least once every 92 days, and more frequently in the event of a significant change in the resident's physical or mental condition. The bill directs the Department of Health and State Health Commissioner to take steps to improve care quality, protect residents, and strengthen oversight and accountability of nursing homes in the Commonwealth. The bill directs the Department to enhance recruitment efforts and expand workforce capacity in the Office of Licensure and Certification, accelerate training and onboarding initiatives, and explore measures to reduce administrative burdens. The bill requires the Commissioner to submit an annual report with recommendations for continuing improvement of nursing home quality and oversight. This bill incorporates SB 555.

Virginia Birth-Related Neurological Injury Compensation Program and Fund; board of directors; plan of operation; filing of claims; awards and coverage for expenses or services. Makes various changes to the Virginia Birth-Related Neurological Injury Compensation Program and Fund. The bill provides that a civil action arising out of or related to a birth-related neurological injury against a participating hospital or physician shall be referred to the Virginia Workers' Compensation Commission. Under the bill, the costs of the Virginia Workers' Compensation Commission maintaining an electronic filing system for the submission of petitions shall be reimbursed from the Fund. Under the bill, the Auditor of Public Accounts shall receive and review any audit conducted on the accounts of the Fund. The bill includes compensation for services provided by an education advocate. The bill requires the Program's board of directors to include a relative of a current or former beneficiary, allows for the electronic submission of claims, and expands discovery of parties to a claim. The bill further requires the Program's board of directors to establish a blanket surety bonding program for all employees with access to the Fund and requires the board to meet at least once monthly. Finally, the bill increases from $100,000 to $500,000 the amount that may be awarded to families whose infant has sustained a birth-related neurological injury. This bill is identical to SB 398.

Sickle Cell Trait Awareness and Education Program established. Directs the Department of Health to establish the Sickle Cell Trait Awareness and Education Program to raise public awareness of and provide education on sickle cell trait.

Prescription Drug Affordability Advisory Panel established; maximum fair price; annual reports; civil penalties. Directs the Secretary of Health and Human Resources to establish the Prescription Drug Affordability Advisory Panel to conduct data analyses, develop policy recommendations, and identify implementation barriers related to strategies to improve prescription drug affordability, enhance price transparency, and strengthen data collection practices for prescription drugs across public and private payers. The bill requires the Panel to (i) report annually on prescription drug pricing trends and any policy recommendations on legislation to improve prescription drug affordability and (ii) provide quarterly updates on prescription drug pricing trends. The bill requires each pharmacy benefits manager to provide to the Panel, upon request, certain information relating to the dispensation of a referenced drug, as defined in the bill.The bill prohibits prescription drug manufacturers or wholesale distributors permitted or licensed in the Commonwealth from accepting payment at an amount higher than the maximum fair price established by the U.S. Secretary of Health and Human Services pursuant to federal law for the sale of a referenced drug intended for use by individuals in the Commonwealth. Under the bill, an entity that violates such prohibition is subject to a civil penalty of $10,000 per violation. The bill also prohibits a manufacturer subject to its provisions from removing a referenced drug from sale distribution in the Commonwealth for the purpose of avoiding the impact of the bill's rate limitations without providing certain prior notice. Under the bill, a manufacturer that violates such prohibition on removing a referenced drug without the required notice is subject to a civil penalty equal to the greater of $100,000 or the total amount of annual savings for the referenced drug, as determined by the Board of Pharmacy. This bill is identical to HB 483.

Minor elementary or secondary school students admitted to inpatient treatment; certain disclosures to certain school personnel upon discharge. Provides that in the event that the facility to which a minor elementary or secondary school student is admitted to inpatient treatment determines that such minor student requires additional educational services upon discharge from the facility, the parents of such student may opt in to the disclosure, prior to or at the time of such minor student's discharge from the facility, of such determination by the facility to a mental health professional employed in such minor student's school or, if applicable, by the school division in which the student is enrolled. The bill also provides that, in the event that the facility to which a minor elementary or secondary school student is admitted to inpatient treatment determines, based on communications from such minor student to a mental health service provider at such facility, that the student poses a specific and immediate threat to cause serious bodily injury or death to an identified or readily identifiable person or persons at the time of the student's discharge from the facility, the facility shall disclose, prior to or at the time of discharge in accordance with the requirements set forth in relevant law, such determination to a mental health professional employed in such minor student's school or, if applicable, by the school division. The bill also prohibits any such facility from withholding discharge of such a student for the purpose of making any such disclosure. The provisions of the bill have a delayed effective date of January 1, 2027.

Virginia Birth-Related Neurological Injury Compensation Program and Fund; board of directors; plan of operation; filing of claims; awards and coverage for expenses or services. Makes various changes to the Virginia Birth-Related Neurological Injury Compensation Program and Fund. The bill provides that a civil action arising out of or related to a birth-related neurological injury against a participating hospital or physician shall be referred to the Virginia Workers' Compensation Commission. Under the bill, the costs of the Virginia Workers' Compensation Commission maintaining an electronic filing system for the submission of petitions shall be reimbursed from the Fund. Under the bill, the Auditor of Public Accounts shall receive and review any audit conducted on the accounts of the Fund. The bill includes compensation for services provided by an education advocate. The bill requires the Program's board of directors to include a relative of a current or former beneficiary, allows for the electronic submission of claims, and expands discovery of parties to a claim. The bill further requires the Program's board of directors to establish a blanket surety bonding program for all employees with access to the Fund and requires the board to meet at least once monthly. Finally, the bill increases from $100,000 to $500,000 the amount that may be awarded to families whose infant has sustained a birth-related neurological injury. This bill incorporates SB 434 and is identical to HB 1007.

Bureau of Insurance; evaluation of All-Payer Claims Database; report. Directs the State Corporation Commission's Bureau of Insurance (the Bureau) to conduct an evaluation of the All-Payer Claims Database and the data submitted thereto in facilitating data-driven, evidence-based improvements in access, quality, and cost of health care in the Commonwealth. The bill requires the Bureau to submit a report of its findings and recommendations to the Governor and General Assembly no later than December 1, 2026.

Prior authorization; requiring physician review for denial. Prohibits a health insurance carrier from making an adverse determination of a prior authorization request (i) for prescription drugs unless such denial has been reviewed and approved by a licensed physician or, if a licensed physician is not available, by a licensed pharmacist or (ii) for health care services unless such adverse determination has been reviewed and approved by (a) a licensed physician; (b) in the case of mental health services, a licensed mental health provider if a licensed physician is unavailable; or (c) in the case of dental services, a licensed dentist if a licensed physician is unavailable.