Health insurance; carrier contracts; required provisions regarding prior authorization for prescription drugs. Amends existing required provisions for health carrier contracts related to prior authorizations for prescription drugs. Current law requires that if prior authorization is approved for prescription drugs and such prescription drugs have been scheduled, provided, or delivered to the patient consistent with the authorization, health carriers may not revoke, limit, condition, modify, or restrict that authorization except in certain circumstances. The bill requires this limitation on carriers to apply for the duration of the authorization, which the bill requires to be a minimum of six months for initial authorizations and a minimum of 12 months for continued authorizations. The bill adds circumstances under which a prior authorization may be revoked, limited, conditioned, modified, or restricted by a carrier, including (i) a final action by the U.S. Food and Drug Administration, other regulatory agencies, or the manufacturer communicating a patient efficacy issue that would affect the authorization and (ii) when additional safety and efficacy monitoring is clinically appropriate or recommended by the U.S. Food and Drug Administration, other regulatory agencies, or the manufacturer.
Hospitals; psychiatric emergency departments. Allows hospitals with psychiatric emergency departments located in the City of Hampton to operate without a physician on duty when certain conditions are met, including having written agreements in place with emergency medical service providers and being immediately adjacent to a non-psychiatric emergency department. The bill requires such psychiatric emergency departments to submit treatment data to the General Assembly on an annual basis by November 1. This bill is identical to HB 1318.
Health insurance; application of cost-sharing prohibitions. Provides that provisions of state law that prohibit a health insurance carrier from imposing a cost-sharing requirement on an enrollee for receiving a health care service (i) apply only when such enrollee receives such health care service from a participating provider under the health benefit plan and (ii) do not apply if the application of such prohibition would disqualify a high-deductible health benefit plan from eligibility for a health savings account under federal law.
Department of Health; Department of Corrections; peer recovery specialists. Directs the Virginia Department of Health and the Virginia Department of Corrections to develop agency guidelines for hiring peer recovery specialists with previous criminal convictions for compensated employment. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to SB 608.
Health records; disclosure of laboratory test results; waiting period. Requires health care entities to wait 72 hours before disclosing test results that could indicate malignancy or genetic markers as part of a patient's health records unless the disclosure of such test results is requested by the patient, is not possible due to the health care entity's electronic health records system, or such early disclosure is in the patient's best interest. The bill permits health care entities to disclose health records to an electronic health information exchange to comply with the federal 21st Century Cures Act.
Hospitals; psychiatric emergency departments. Allows hospitals with psychiatric emergency departments located in the City of Hampton to operate without a physician on duty when certain conditions are met, including having written agreements in place with emergency medical service providers and being immediately adjacent to a non-psychiatric emergency department. The bill requires such psychiatric emergency departments to submit treatment data to the General Assembly on an annual basis by November 1. This bill is identical to SB 738.
Board of Pharmacy; regulation of psilocybin. Directs the Board of Pharmacy to reschedule psilocybin consistent with federal scheduling upon approval by the U.S. Food and Drug Administration of a formulation of psilocybin designed to be administered by a health care professional in a health care setting. This bill is identical to SB 379.
State Board of Health regulations; standards for levels of neonatal care. Directs the State Board of Health to establish standards for designation of care in neonatal services consistent with, but not necessarily identical to, standards published by the American Academy of Pediatrics. The bill directs the Board of Health to promulgate regulations to implement the provisions of the bill by July 1, 2027, and prohibits enforcement of such regulations until July 1, 2029. This bill is identical to SB 291.
Health insurance; coverage for early refills of prescription eye drops. Prohibits a health carrier from denying coverage to a covered person of an early refill of prescription eye drops if (i) the prescription eye drops are a covered benefit, (ii) the amount of time that has elapsed from the previous dispensing of such prescription would result in at least 85 percent of such prescription eye drops being used if taken consistently with the prescriber's directions, and (iii) the prescriber has indicated that additional quantities are medically necessary and the refill requested does not exceed such additional quantity. The provisions of the bill are applicable to contracts, policies, or plans delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2027.
Department of Behavioral Health and Developmental Services; individuals receiving services; right to send and receive mail. Allows state facilities operated by the Department of Behavioral Health and Developmental Services to process sealed letter mail for electronic delivery. This bill is identical to HB 1304.
