Healthcare

Commissioner of Health; feasibility of a statewide maternal health safety initiative; work group; reports. Directs the Commissioner of Health to convene a work group of relevant stakeholders, described in the bill, to evaluate the feasibility of a statewide maternal health safety initiative. The bill directs the Commissioner to submit an interim report of the work group by November 1, 2026, and a final report with the work group's recommendations no later than July 1, 2027, to the House Committee on Health and Human Services, the Senate Committee on Education and Health, and the Commission on Women's Health.

Department of Medical Assistance Services; community health workers in Medicaid managed care; report. Directs the Department of Medical Assistance Services (DMAS) to evaluate and develop recommendations for a statewide strategy to integrate community health workers into Medicaid managed care and related health and human services programs. The bill instructs DMAS to consult with the Department of Health, the Department of Social Services, the Department of Behavioral Health and Developmental Services, the Department for Aging and Rehabilitative Services, the Virginia Community Health Worker Association, Medicaid managed care organizations, local departments of social services, community-based providers, and other relevant stakeholders. The bill requires DMAS to submit a report of its findings and recommendations to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and the Senate Committee on Finance and Appropriations by December 1, 2026.

Health insurance; prohibited restrictions on in-network referrals. Prohibits a health insurance carrier from prohibiting an in-network provider, as defined in the bill, from referring any enrollee or specimen to any in-network clinical laboratory or in-network pathology service provider under the terms of such insurance unless such referral would constitute a violation of certain laws. This bill is identical to HB 424.

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.

Department of Education; culturally responsive and language-appropriate mental health support and services; guidance and policies. Requires, no later than October 1, 2027, the Department of Education to develop, adopt, and provide to each local school board guidance on the adoption of policies governing the provision of culturally responsive and language-appropriate mental health support and services for students in the local school division and permits any school board to develop and adopt policies in the local school division that are consistent with the guidelines adopted and provided by the Department of Education.

State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.

Physician assistants; authorization to practice without a practice agreement. Authorizes a physician assistant with at least three years of full-time clinical experience to practice without a practice agreement upon receipt of an attestation from a patient care team physician or patient care team podiatrist who provided collaboration and consultation to such physician assistant verifying the length and nature of the physician assistant's practice. The bill establishes methods for a physician assistant who is unable to obtain the required attestation to submit other evidence that the physician assistant meets the requirements to practice without a practice agreement and establishes a method for physician assistants who obtain licensure by endorsement to practice without a practice agreement if they meet the applicable requirements. The bill also establishes a scope of practice for physician assistants who practice without a practice agreement. The bill specifies that the effective date of the foregoing provisions are contingent upon the Board of Medicine adopting regulations to implement the bill's provisions and to establish processes for granting authorization to physician assistants to practice without a practice agreement.

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.

Health insurance; large group policies; coverage for scalp treatment during cancer chemotherapy treatment. Requires health insurance carriers offering policies in the large group market to provide coverage for scalp cooling systems for the preservation of hair during cancer chemotherapy treatment. Provisions of the bill apply to health insurance policies, contracts, and plans delivered, issued for delivery, or renewed in the large group market in the Commonwealth on and after January 1, 2027.

Health insurance credits for general registrars and employees of general registrars. Increases the amount of monthly health insurance credits received by retired general registrars and employees of general registrars with a minimum of 15 years of creditable service from $1.50 to $1.75 per month per year of creditable service not to exceed $52.50 per month beginning July 1, 2026.