Healthcare

Health insurance; carrier business practices; electronic attachments. Provides that, in the following contexts, information may be submitted by a provider to a health insurance carrier through electronic attachment, as defined in the bill: (i) information related to services rendered as required by the carrier in its provider contract; (ii) information related to any defect or impropriety that prevents the carrier from deeming a health insurance claim a clean claim, as defined in existing law; and (iii) information required to establish medical necessity, benefit coverage, or prior authorization of services, or to conduct reconsideration activities. The bill has a delayed effective date of January 1, 2027. This bill is identical to HB 676.

Foreign-trained chiropractors; licensure by endorsement. Permits the Board of Medicine to issue a license to practice chiropractic to a foreign-trained chiropractor who meets certain requirements.

Public institutions of higher education; financial assistance; Medical Education Loan-for-Service Fund and Program established; report. Establishes the Medical Education Loan-for-Service Fund and Program (the Program) for the purpose of providing loans to any person enrolled in or admitted to an eligible institution, as defined in the bill, that shall be forgiven in whole or in part upon satisfactory completion of a service agreement entered into by a recipient to engage in clinical practice in a designated service area, as defined in the bill, for the requisite period and in accordance with the requirements set forth by the bill. The bill directs the State Council of Higher Education for Virginia (the Council) and the Virginia Health Workforce Development Authority (the Authority) to administer the Program and to enter into a memorandum of understanding establishing policies and procedures for the administration of the Program. The bill also (i) establishes requirements for the administration of the Program, including (a) requirements for eligibility to apply to and receive a loan under the Program and the prioritization of Program applications and (b) terms and conditions governing the receipt, forgiveness, and repayment of loans under the Program; (ii) directs the Council and the Authority to promulgate regulations for the administration of the Program relating to monitoring and enforcing compliance of recipients with Program requirements and terms and conditions; (iii) authorizes the Council to take certain actions relating to the enforcement of Program requirements and the collection of loans in certain circumstances; and (iv) directs the program administrator to annually collect data on the activities of the Program for the preceding fiscal year and submit to the Governor and the Chairs of the House Committees on Education, Health and Human Services, and Appropriations and the Senate Committees on Education and Health and Finance and Appropriations a report on such data by October 1 of each year. Finally, the bill directs the Council to promulgate such regulations as are necessary for (a) the program administrator to begin collecting applications for the Program by January 1, 2027, and (b) the disbursement of loans under the Program no later than July 1, 2027.

Virginia Opioid Use Reduction and Jail-Based Substance Use Disorder Treatment and Transition Fund; grant procedures. Requires the grant procedure to govern funds awarded to local and regional jails for the planning or operation of substance use disorder treatment services and transition services for persons with substance use disorder who are incarcerated in local and regional jails to include requirements that (i) any grant awarded shall be made for up to three years and (ii) an applicant for a grant submit a plan demonstrating how such applicant will become independently financially viable within the time period for which the grant is awarded. This bill is a recommendation of the Joint Commission on Health Care and is identical to HB 455.

Unregulated pregnancy clinics; unauthorized practice of medicine; unprofessional conduct of medical providers; civil penalty. Requires unregulated pregnancy clinics, as defined by the bill, to have a qualified medical provider who supervises and takes responsibility for the provision of all medical care at such facility. The bill provides that any such clinic is required to provide to a client, upon request, the name and contact information for the qualified medical provider who supervises medical care to such client. A clinic shall notify the Board of Health, in accordance with rules promulgated by the Board, of the name and contact information for its qualified medical providers. Any person who violates the provisions of the bill is subject to a civil penalty of up to $3,000 for a first violation and up to $10,000 for a second or subsequent violation. The bill provides that individuals licensed by the Board of Medicine or the Board of Nursing are subject to disciplinary action for making or knowing of certain willful representations of the care provided at such unregulated pregnancy clinics if such representations are not true.

Department of Medical Assistance Services; consultation with federally recognized tribes. Establishes a Tribal Medicaid Advisory Group to work collaboratively on (i) plan amendments, waiver requests, and policies affecting tribal health programs at least 60 days prior to submitting them for public notice and comment and (ii) a tribal health program billing manual. The advisory group is required to meet in person on at least a quarterly basis. The bill also requires the Department of Medical Assistance Services to (a) recognize the eligibility of any tribal health program to participate as a provider in the state plan, (b) consult with any tribal health program participating in the state plan at least 60 days prior to taking any adverse action, including suspension of payments or investigation regarding the participation of any tribal health program in the state plan, and (c) engage in ongoing consultation with federally recognized tribes and tribal health programs to address the needs of the state and tribal governments. This bill is a recommendation of the Commission on Updating Virginia Law to Reflect Federal Recognition of Virginia Tribes.

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.

Suicide Prevention Program Coordinator; deaths by suicide of veterans or military service members; State Registrar of Vital Records; Department of Veterans Services annual report. Adds to the duties of the Suicide Prevention Coordinator within the Department of Veterans Services the duty to (i) compile and analyze data relating to the suicides of veterans and military service members pursuant to death certificates filed with the State Registrar of Vital Records, with such data to be included in the Department's annual report, and (ii) collaborate with the Department of Behavioral Health and Developmental Services to develop programs and resources related to suicide prevention for veterans and military service members. The bill provides that in any case where the death certificate of a veteran or military service member lists suicide as the manner of death, the State Registrar of Vital Records shall provide such information concerning the suicide to the Department.

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.

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.