Workers' compensation; employer's offset in event of recovery. Amends provisions related to an employer's offset for recovery in certain actions brought under the Virginia Workers' Compensation Act. The bill requires that lifetime medical award benefits and ongoing indemnity award benefits shall remain in full force and effect if the claimant is under such an award at the time that recovery is effected, subject to the employer offset provisions. Under the bill, an employer's credit shall be applied as a continuing, pro rata reduction to benefits otherwise payable under an existing award until the employer's required credit is exhausted. The bill also removes language limiting an employee's entitlement to compensation and expenses for medical, surgical, and hospital attention and funeral expenses.
Pharmacy benefits managers; various requirements; report. Prohibits a pharmacy benefits manager from (i) reimbursing a pharmacy in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee; (ii) basing pharmacy reimbursement for prescription drugs on patient outcomes, scores, or metrics; (iii) imposing a point-of-sale or retroactive fee on a pharmacy, pharmacist, or covered individual; (iv) receiving deductibles or copayments; (v) redirecting any prescription drug claims submitted by a pharmacy to any third-party discount card program, cash discount program, or any other non-insurance adjudication platform; (vi) using policy agreements incorporation into a pharmacy agreement, to materially change, alter, or modify the pharmacy agreement, reimbursement rates, payment terms, or other financial obligations; (vii) prohibiting a pharmacy from providing an individual certain information; (viii) charging a pharmacy a fee related to participation in a pharmacy network; (ix) requiring multiple specialty pharmacy accreditations as a prerequisite for participation in a pharmacy network that dispenses specialty drugs; or (x) deriving any revenue from a pharmacist, pharmacy, or covered individual in connection with performing pharmacy benefits management services. The bill requires a pharmacy benefits manager to calculate a covered individual's out-of-pocket cost for a covered prescription drug based on the net price of the prescription drug after taking into account all retained rebates associated with the prescription drug. The bill adds certain information to be included in a report that pharmacy benefit managers are currently required to submit and requires such report to be filed quarterly rather than annually. The bill also requires the Commissioner of Insurance to annually prepare and submit a report to the Governor and the General Assembly based on the information submitted by pharmacy benefits managers. Additionally, the bill prohibits a carrier or its pharmacy benefits manager from imposing any payment or condition relating to the purchase of pharmaceutical benefits from any pharmacy that is more costly or more restrictive than that which would be imposed upon such person if the same pharmaceutical services were purchased from a mail order pharmacy provider.
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.
Department of Medical Assistance Services; Medicaid estate recoveries. Directs the Department of Medical Assistance Services (the Department) to limit the operation of its estate recovery program to the recovery of only federally required costs. The bill directs the Department to make information on estate recovery available on its website in multiple languages. The bill directs the Department to adopt emergency regulations to implement the provisions of the bill.
Boards of Medicine and Nursing; advanced practice registered nurses; feasibility of temporary or provisional licensure; report. Directs the Boards of Medicine and Nursing to assess the feasibility of implementing a temporary or provisional licensure pathway for advanced practice registered nurses.
Health insurance; coverage for the treatment of acquired brain injury required. Requires health insurance carriers to provide coverage for the treatment of acquired brain injury that includes coverage for treatment using cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy, neuropsychological testing, neurofeedback therapy, functional rehabilitation therapy, community reintegration services, post-acute residential treatment services, inpatient services, outpatient and day treatment services, and home and community-based treatment.
Covenants not to compete; health care professionals; civil penalty. Adds health care professionals as a category of employee with or upon whom no employer shall enter into, enforce, or threaten to enforce a covenant not to compete. The bill defines "health care professional" as any person licensed, registered, or certified by the Board of Medicine, Nursing, Counseling, Optometry, Psychology, or Social Work. The bill provides that any employer that violates the prohibition against covenants not to compete with a health care professional is subject to the civil penalty in current law of $10,000 for each violation. This bill is identical to HB 627.
Recovery residences; regulations. Establishes certain requirements for recovery residences and directs the State Board of Behavioral Health and Developmental Services (the Board) to promulgate regulations to establish minimum certification standards for recovery residences. The bill also requires that the regulations promulgated by the Department of Behavioral Health and Developmental Services (the Department) related to the certification of recovery residences include provisions that no recovery residence, or operator, employee, or agent of a recovery residence, may require a resident to participate in medical or psychological services, including clinical substance use treatment, that such recovery residence receives financial benefit from, either directly or indirectly, as a condition of entering or continuing residence at such recovery residence. The bill requires the Department to monitor credentialing agencies providing credentials to recovery residences to ensure criteria related to certification comply with regulations and specifies that no such credentialing agency shall provide credentials to a recovery residence that is owned or operated by an individual who is employed by or in a position of authority at such credentialing agency, or an immediate family member of any such individual. The bill also requires that referrals to recovery residences made by the Department, any agency of the Commonwealth, or by a court may only be made to recovery residences that are certified. This bill is identical to HB 931.
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.
Comprehensive crisis system; Marcus alert system; Department of Behavioral Health and Developmental Services; comprehensive mental health, substance abuse, and developmental disability crisis services; written plan. Allows the Department of Behavioral Health and Developmental Services, in collaboration with the Department of Criminal Justice Services, to amend the written plan created pursuant to relevant law after the publication of such written plan, provided that (i) the stakeholders listed in relevant law are consulted during the development of any new language to be added to such written plan and (ii) a public comment period of no less than 30 days is held prior to the finalization of such written plan. The bill also provides that the written plan shall serve as the operational framework for relevant components of the comprehensive crisis system and the Marcus alert system and that state agencies and local implementing partners shall align their policies, procedures, and operations on an ongoing basis with the requirements and guidance set forth in the written plan, as amended. As introduced, this bill was a recommendation of the Behavioral Health Commission. This bill is identical to HB 453.
