Healthcare

Department of Medical Assistance Services; expedited review process for Medicaid service authorization requests; report. Directs the Department of Medical Assistance Services to (i) implement expedited review of Medicaid service authorization requests consistent with applicable federal law and (ii) annually transmit the prior authorization report required by the Centers for Medicare and Medicaid Services to the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Finance and Appropriations and Education and Health.

Department of Behavioral Health and Developmental Services; Early Childhood Mental Health Consultation Program established; pilot programs; development of modules; report. Establishes the Early Childhood Mental Health Consultation Program, to be administered by the Department of Behavioral Health and Developmental Services (the Department) in coordination with the Department of Education and the Department of Health, for the purpose of providing and expanding the accessibility of early childhood mental health consultation services, as that term is defined in the bill. The bill requires, pursuant to the Program, early childhood mental health consultation services shall be provided to families of children three through five years of age who exhibit developmental delays and behavioral health concerns and to early childhood care and education programs as enumerated in the bill. The bill requires the Department, in administering the Program, to (i) develop, or contract with community services boards to develop, and make available to early childhood care and education programs and providers developmental readiness modules, in accordance with the requirements of the bill; (ii) designate three pilot regions for initial implementation of the Program, with implementation beginning no later than January 1, 2027; and (iii) submit to the Governor and the General Assembly by November 1 of each year a report on the implementation and outcomes of the Program for each pilot region selected for initial implementation. The provisions of the bill relating to initial implementation of the Program in the pilot regions shall expire on July 1, 2029.

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.

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 SB 513.

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 HB 1337.

State Health Commissioner; training materials for restaurant personnel; celiac disease. Directs the State Health Commissioner to add celiac disease awareness and safety to the topics included in written materials provided for the training of restaurant personnel.

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 SB 128.

Department of Fire Programs; mental health awareness training. Provides that the Department of Fire Programs shall develop a standardized, two-hour virtual asynchronous training program on mental health awareness tailored to firefighters that includes training on each subject matter set forth in current law. The bill provides the option for each fire department to use such standardized training program as guidance in developing its own mental health awareness training for its personnel. This bill is identical to HB 325.

Health insurance; pharmacy benefits managers; requirements and prohibited conduct; retail pharmacy network access standards; enforcement; civil penalty. Amends the definition of "pharmacy benefits management" to exclude certain activities and amends certain provisions related to prohibited conduct by health carriers and pharmacy benefits managers (PBMs). The bill prohibits a health carrier or PBM from denying a pharmacy the opportunity to participate in a network at preferred status if the pharmacy is willing to accept the same terms and conditions as other pharmacies that receive preferred status. The bill prohibits a health carrier or PBM from retroactively denying or reducing reimbursement for a covered service claim, except in certain circumstances. The bill also prohibits health carriers and PBMs from failing to make a payment due to a pharmacy or pharmacist upon termination from a network and from charging a pharmacist or pharmacy a fee related to participation in a PBM's network. Under the bill, no PBM shall restrict a pharmacy from informing an individual of any differential between the individual's out-of-pocket costs and the amount the individual would pay to purchase the drug directly or through the individual's health insurance coverage. The bill also requires PBMs to establish and maintain an electronic claim inquiry processing system using national standards to provide certain disclosures and to maintain records of network development activities. The bill prohibits a PBM from including the name of any pharmacy or hospital in any material issued by the PBM unless it lists all pharmacies participating in the preferred and nonpreferred pharmacy and health networks. Under the bill, the Attorney General is authorized to issue civil investigative demands regarding violations of the provisions of the bill and to bring an action in circuit court to enjoin any violation of such provisions. If the court finds that a person has willfully violated the provisions of the bill, the Attorney General may assess a civil penalty of up to 5,000 per violation.

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.