Nursing facilities; related party rent disclosures; incentive payment reduction; penalty. Requires any nursing facility enrolled as a Medicaid provider that makes rent or lease payments to publicly disclose information related to the rent or lease payments, including whether payments are made to a related party, the nature of the related party, and the related party rent expense, as defined in the bill. The bill requires the Department of Medical Assistance Services to determine whether related party rent expenses exceed a fair rental value benchmark and if so, deduct a portion of any incentive payment owed to the nursing facility. A knowingly false attestation or disclosure is punishable as a Class 3 misdemeanor.
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.
State employee health insurance plan; coverage for prosthetic devices. Provides that the plan established by the Department of Human Resource Management for the provision of health insurance coverage for state employees shall include coverage for medically necessary prosthetic devices and their repair, fitting, replacement, and components.
Special fund for emergency medical services; distribution of certain funds to localities. Expands the use of funds by localities from the special emergency medical services fund. The bill allows funds to be used for (i) training of emergency medical services personnel; (ii) the purchase of equipment and supplies; (iii) maintenance of equipment, facilities, and certain vehicles; and (iv) operating expenses deemed necessary by the locality to ensure the provision of emergency medical expenses in such locality. Under current law, funds may only be used for training of personnel and purchase of equipment and supplies.
School boards; courses of instruction; high school courses or dual enrollment programs for certification as a certified nurse aide, emergency medical technician, or firefighter; establishment permitted; requirements. Permits any school board to provide to high school students, either on school premises or through a dual enrollment program or other partnership with a comprehensive community college, courses of instruction that prepare students for and lead to (i) certification as a certified nurse aide, provided that such course is approved by and meets the requirements of the Board of Nursing and is taught by a qualified individual, consistent with the requirements of the Board of Nursing; (ii) certification as an emergency medical technician, provided that such course is consistent with the requirements established by the Office of Emergency Medical Services and taught by an emergency medical technician instructor who meets the requirements set forth in the bill; or (iii) firefighting level 1 certification, as defined by the bill, provided that such course is consistent with the National Fire Protection Association 1001, level one, firefighter standards as administered by the Department of Fire Programs and taught by an individual qualified to provided such instruction. The bill also requires any school board that provides any such course of instruction on school premises to high school students to ensure that any individual employed, contracted, or permitted to volunteer to provide instruction in such course meets the requirements set forth in applicable law relating to data on convictions for certain crimes and child abuse and neglect, fingerprinting, and criminal history records checks.
Emergency Response Exposure Grant Fund and Program. Creates the Emergency Response Exposure Grant Fund and Program, to be administered by the Department of Fire Programs, to award grants to localities to support certain emergency responders who were exposed to a qualifying emergency, defined in the bill. The bill requires funding to be used for annual cancer screenings and health care expenses incurred by eligible emergency responders, defined in the bill, in the event such emergency responders are diagnosed with cancer from toxic material exposure. The bill permits funding to be used for out-of-pocket medical expenses not otherwise covered by insurance, workers' compensation, or other available funding.
Certificate of public need; exception; maternal and perinatal health services. Creates an exception to certificate of public need requirements for any project or action related to maternal and perinatal health services. The bill also removes neonatal intensive care from the definition of tertiary care for purposes of determining health planning regions.
Virginia Birth-Related Neurological Injury Compensation Program; electronic filing; review of claims. Requires electronic filing of claims under the Virginia Birth-Related Neurological Injury Compensation Program. The bill requires such claims to include an uncondensed and uncompressed fetal heart rate monitoring record and prenatal records and increases from 10 days to 21 days the timeframe in which the Program is required to file a response to a claim. The bill also increases from $3,000 to $6,000 the amount paid to the medical school that assesses and prepares a report for a claim.
Health insurance; prior authorization requests reviewed by physician. Requires a provider contract between a health insurance carrier and a provider to contain provisions requiring (i) any decision to deny a prior authorization request for drug benefits or health care services is made by a licensed physician who is (a) an expert in the treatment of the enrollee's medical condition that is the subject of the prior authorization request and (b) knowledgeable about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar medical condition of the enrollee and (ii) if the carrier is questioning the medical necessity of the request, the carrier will provide the enrollee's physician an opportunity to discuss the medical necessity of the health care service with the physician who will be responsible for determining authorization of the health care service or drug benefit under review.
Health insurance; prior authorization for health care services. Decreases from 72 hours to 24 hours and from seven days to five days the time by which a health insurance carrier is required to respond to expedited and standard requests for prior authorization for health care services, respectively. The bill prohibits a carrier from (i) denying a claim for the provision of dental services by a dentist or oral surgeon for failure to obtain prior authorization if the dentist or oral surgeon calls the dental plan during business hours to obtain such prior authorization and is unable to reach the dental plan or is placed on hold for longer than 15 minutes and (ii) downcoding a claim if a prior authorization was approved. The bill requires carriers to establish a system in which providers with high prior authorization approval rates are not required to obtain prior authorization for routine health care services. Additionally, the bill provides that if a prior authorization request is denied, the carrier is required to notify providers and enrollees if artificial-intelligence based tools were used in reviewing the request.
