Health insurance; association health plan for real estate salespersons. Provides that a licensed insurer may issue a policy of group accident and sickness insurance to an association of real estate salespersons (association), which association shall be deemed the policyholder, and that such association health plan is not considered to be insurance and is not subject to the existing requirements for insurance if certain requirements are met. The bill requires that (i) all members of the association be eligible for coverage and membership, including employer members with at least one employee that is domiciled in the Commonwealth or self-employed individuals; (ii) membership in the association not be conditioned on any health status–related factor; (iii) the coverage offered through the association be available to all members regardless of any health status–related factor; (iv) the association not make health insurance coverage offered through the association available other than in connection with a member of the association; and (v) premiums for the policy be paid from funds contributed by the association or associations, or by employer members, or by both, or from funds contributed by the covered persons or from both the covered persons and the association, associations, or employer members. The bill also requires that the association (a) has at the outset a minimum of 25,000 members; (b) has been organized and maintained in good faith for purposes other than that of obtaining insurance; (c) has been in active existence for at least five years; and (d) has a constitution and bylaws that provide that the association hold regular meetings not less than annually to further purposes of the members, that the association collects dues or solicits contributions from members, and that the members have voting privileges and representation on the governing board and committees.The bill provides that any such policy shall (1) be considered a large group market plan subject to all coverage mandates applicable to a large group market plan, (2) be subject to the group health plan coverage requirements under the federal Patient Protection and Affordable Care Act, (3) be prohibited from denying coverage under the policy on the basis of a pre-existing condition, (4) be guaranteed issue and guaranteed renewable, (5) provide essential health benefits and cost-sharing requirements, and (6) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan.The bill requires an insurer issuing such policy to an association to (A) treat all of the members and employees of employer members who are enrolled in coverage under the policy as a single risk pool; (B) set premiums on the basis of the collective group experience of the members and employees of employer members who are enrolled in coverage under the policy; (C) not vary premiums by age, except that the rate shall not vary by more than four to one for adults; (D) not vary premiums on the basis of gender; (E) not vary premiums on the basis of the health status of an individual employee of an employer member or a self-employed individual member; and (F) not establish discriminatory rules based on the health status of an employer member, an individual employee of an employer member, or a self-employed individual for eligibility or contribution.Finally, the bill provides that a policy that meets certain requirements of the bill is considered to be compliant with the large group market insurance regulations under the federal Public Health Service Act and, as such, the Commonwealth is considered to be substantially enforcing the federal Patient Protection and Affordable Care Act with regard to such policy. The bill requires the State Corporation Commission to regulate the policy in a manner that is consistent with such provisions. The bill provides that, in any case in which a federal agency renders a decision that is contrary to such provisions, notwithstanding any other provision of law, the Attorney General may resolve any difference between federal law and the laws of the Commonwealth. This bill is identical to SB 335.
Del. Bobby Orrock
Sponsored bills
Hospital emergency department severity codedata reporting. Requires every hospital in the Commonwealth withan emergency department to report monthly to the Department of Health(the Department) the total number of visits to the hospital's emergencydepartment and the total number of visits to the hospital's emergencydepartment by severity cod. The bill directs the Department to (i)determine the average number of hospital emergency department visitsfor each severity code statewide and by region for each month, (ii)identify hospitals that report a number of hospital emergency departmentvisits for the highest severity code that is greater than the regionalaverage for such severity code for each month, and (iii) work withsuch hospitals to determine why the hospital is reporting a numberof emergency department visits coded at the highest severity codethat exceed the regional average. The bill also requires the Departmentto develop guidelines for the use of severity codes in emergencydepartments to facilitate accurate coding of emergency departmentvisits by severity.
Aging services; allocation of resources; individualswith the greatest economic need. Provides that in allocatingresources for aging services, the Department for Aging and RehabilitativeServices (i) shall prioritize providing services to those with the greatest economic need and (ii) among individuals with comparablelevels of economic need, may prioritize providing services to individualswith the greatest social need.
Military personnel; leaves of absence. Increases,from 15 to 21 days, the number of days a member of the armed services,reserves, National Guard, Virginia Defense Force, or National DefenseExecutive Reserve shall be entitled to paid leave for military duties.The bill applies only to individuals who are employed by the Commonwealthor a political subdivision of the Commonwealth.
Group health benefit plans; bona fide associations; formation of benefits consortium. Provides that certain trusts constitute a benefits consortium and are authorized to sell health benefit plans to members of a sponsoring association that (i) has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; (ii) does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of a member of the sponsoring association or a dependent of such an employee; (iii) makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through a member; (iv) does not make any health benefit plan available to any person who is not a member of the association; (v) makes available health plans or health benefit plans that meet requirements provided for in the bill; (vi) operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; and (vii) has been in active existence for at least five years. The bill replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."The bill requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers; (f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member's premiums.The bill prohibits a self-funded MEWA from issuing health benefit plans in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the State Corporation Commission. The bill authorizes the Commission to adopt regulations applicable to self-funded MEWAs, including regulations addressing financial condition, solvency requirements, and the exclusion of self-funded MEWAs from the Virginia Life, Accident and Sickness Insurance Guaranty Association. This bill is identical to SB 195.
Academic year Governor's Schools; certain practices prohibited and permitted. Prohibits any academic year Governor's School or governing board member, director, administrator, or employee thereof from (i) discriminating against or granting preferential treatment to any individual or group on the basis of race, sex, color, ethnicity, or national origin; (ii) engaging in proxy discrimination, as defined in the bill, in student admissions; or (iii) seeking information on students' race, sex, color, ethnicity, or national origin during the application process for admission to such school unless expressly required by federal law, and to the extent it is required by federal law, the bill requires such information to be withheld to the maximum extent practicable from any individual involved in admissions decisions to the end that admissions decisions are blind as to the applicants' race, sex, color, ethnicity, and national origin. The bill permits any academic year Governor's School or governing board member, director, administrator, or employee thereof to use traditional academic success factors, as defined in the bill, in student admissions and provides that such use presumptively does not constitute proxy discrimination. The bill also contains provisions relating to evidentiary burdens of proof in certain causes of action involving such proxy discrimination or traditional academic success factors. The bill requires each local school board that jointly manages and controls a regional academic year Governor's school to collaborate to ensure that each public middle school that is eligible to send students to attend such Governor's school offers coursework, curriculum, and instruction that is comparable in content and in rigor in order to provide each student in each such middle school with the opportunity to gain admission to and excel academically at such Governor's school.
Board of Health; regulations; maximum contaminant levels in water supplies and waterworks; effective date. Provides that the Board of Health shall review the recommendations of any work group convened by the Commissioner of Health after July 1, 2022, to study the occurrence of certain contaminants in public drinking water prior to adopting regulations establishing maximum contaminant levels (MCLs) in all water supplies and waterworks in the Commonwealth for (i) perfluorooctanoic acid, perfluorooctane sulfonate, and such other perfluoroalkyl and polyfluoroalkyl substances as the Board deems necessary, (ii) chromium-6, and (iii) 1,4-dioxane. The bill also provides the Commissioner the option of establishing a work group to study the occurrence of such contaminants and to report to the Governor and the Chairmen of the House Committees on Agriculture, Chesapeake and Natural Resources and Health, Welfare and Institutions and the Senate Committees on Agriculture, Conservation and Natural Resources and Education and Health by December 1, 2022.
Secretary of Health and Human Resources; study consolidating oversight and regulation of nursing homes, assistedliving facilities, and other congregate living settings under a singlestate agency; report. Directs the Secretary of Health and Human Resources to study the feasibility of consolidating oversight andregulation of nursing homes, assisted living facilities, and othercongregate living settings under a single state agency to improveefficiency and effectiveness of regulation and oversight, providebetter transparency for members of the public navigating the processof receiving services from such facilities, and better protect thehealth and safety of the public and to develop recommendations forconsolidation of such oversight and regulation and to report hisfindings and recommendations to the Governor and the Chairmen ofthe Senate Committees on Education and Health and Finance and Appropriationsand the House Committees on Appropriations and Health, Welfare andInstitutions by October 1, 2022.
Health insurance; health care provider panels;termination of provider. Requires a carrier, when the carrierterminates a provider from the carrier's provider panel, to permitthe provider to render health care services to any of the carrier'senrollees who request to continue receiving health care servicesfrom the provider for a period of at least 180 days. Under currentlaw, a carrier is required to permit the provider to render healthcare services to any of the carrier's enrollees who are in an activecourse of treatment and request to continue receiving health careservices from the provider for a period of at least 90 days.
Virginia Literacy Act; early student literacy; evidence-based literacy instruction; science-based reading research. Makes several changes relating to early student literacy, including requiring (i) each education preparation program offered by a public institution of higher education or private institution of higher education or alternative certification program that provides training for any individual seeking initial licensure with an endorsement in a certain area, including as a reading specialist, to demonstrate mastery of science-based reading research and evidence-based literacy instruction, as such terms are defined in the bill; (ii) the literacy assessment required of individuals seeking initial teacher licensure with endorsements in certain areas to include a rigorous test of science-based reading research and evidence-based literacy instruction; (iii) each local school board to establish a divisionwide literacy plan; (iv) each local school board to employ one reading specialist for each 550 students in kindergarten through grade three; and (v) each local school board to provide a program of literacy instruction whereby, among other things, (a) the program provides reading intervention services to students in kindergarten through grade three who demonstrate deficiencies based on their individual performance on the Standards of Learning reading assessment or an early literacy screener provided or approved by the Department of Education; (b) a reading specialist, in collaboration with the teacher of any student who receives such reading intervention services, develops, oversees implementation of, and monitors student progress on a student reading plan; and (c) each student who receives such reading intervention services is assessed utilizing either the early literacy screener provided or approved by the Department or the grade-level reading Standards of Learning assessment again at the end of that school year. The provisions of the bill become effective beginning with the 2024–2025 school year. This bill is identical to SB 616.