Provides that prior authorization requirements currently applicable to drug benefits are applicable to the process for a carrier's approval of surgical procedures. The measure requires contracts between an insurance carrier and a participating health care provider that require the carrier's prior authorization to include provisions that prohibit the carrier, after it has approved a prior authorization request submitted by a participating health care provider, from (i) withdrawing or retracting its approval of the request or (ii) declining or refusing to pay a claim submitted for the drug benefit or surgical procedure. The measure provides that if a health plan or provider contract states that prior authorization is not required for a specific drug benefit or surgical procedure, the carrier shall not refuse to pay a claim submitted for the drug benefit or surgical procedure. The measure addresses the standards applicable to electronic submissions of requests for prior authorization and specifies that requests may be submitted in paper if the provider meets certain criteria. Finally, the measure exempts a drug benefit from prior authorization requirements if prior authorization has been approved for the drug benefit in 90 percent or more of the requests for prior authorization submitted by the provider in the preceding 12 months or if the drug is a generic medication. These provisions apply to provider contracts entered into, amended, extended, or renewed on or after January 1, 2019.
Sponsored bills
Expands the education improvement scholarships tax credits program by including as eligible scholarship recipients children who are eligible to enter pre-kindergarten. In addition, the bill reduces the penalty for failure to fully disburse all donations received from 200 percent of the difference between 90 percent of the value of the donations it received and the amount disbursed to 100 percent of the difference. Under current law, foundations must spend at least 90 percent of donations on scholarships in order to avoid the penalty. This bill was incorporated into
Provides that direct agreement between a patient, the patient's legal representative, or the patient's employer and a health care provider for ongoing primary care services in exchange for the payment of a monthly periodic fee is not health insurance or a health maintenance organization, if patients are not required to pay monthly periodic fees prior to initiation of the direct agreement coverage period. The measure also provides that a health care provider who participates in a direct primary care practice may participate in a health insurance carrier network so long as the provider is willing and able to meet the terms and conditions of network membership set by the health insurance carrier. The measure establishes requirements for disclosures regarding direct primary care agreements, including a list of the services covered under the agreement. This bill is identical to
Authorizes an investor-owned electric utility to petition the State Corporation Commission for approval of a rate adjustment clause for recovery of the costs of one or more pumped hydroelectricity generation and storage facilities that utilize associated on-site or off-site renewable energy resources as all or a portion of their power source and such facilities and associated resources are located in the coalfield region of the Commonwealth. The measure provides that the requirement that a utility demonstrate that it has considered and weighed alternative options, including third-party market alternatives, in its selection process does not apply to these generation and storage facilities. The construction of these generation and storage facilities is declared to be in the public interest, and in determining whether to approve such facility, the Commission is directed to liberally construe the provisions of Title 56.
Establishes the Board of the Virginia Virtual School (the Board) as a policy agency in the executive branch of state government for the purpose of governing the full-time virtual school programs offered to students enrolled in the Virginia Virtual School (the School). The Secretary of Education is responsible for such agency. The 14-member Board is given operational control of the School and assigned powers and duties. Beginning with the 2019-2020 school year, the bill requires the School to be open to any school-age person in the Commonwealth and to provide an educational program meeting the Standards of Quality for grades kindergarten through 12, with a maximum enrollment of 5,000 students statewide. The bill requires the average state share of Standards of Quality per pupil funding for each enrolled student to be transferred to the School. This bill is identical to
Defines "qualified advance directive facilitator" as a person who has successfully completed a training program approved by the Department of Health for providing assistance in completing and executing a written advance directive; establishes requirements for training programs for qualified advance directive facilitators; and provides that distribution of a form for an advance directive that meets the requirements of § 54.1-2984 and the provision of ministerial assistance to a person with regard to the completion or execution of such form shall not constitute the unauthorized practice of law. This bill is identical to
Provides that any doctor of medicine, osteopathy, chiropractic, or podiatry or any nurse practitioner, physician assistant, optometrist, physical therapist, or clinical psychologist who reports to the Department of Motor Vehicles the existence, or probable existence, of a mental or physical disability or infirmity of any person licensed to operate a motor vehicle that the reporting individual believes affects such person's ability to operate a motor vehicle safely is not subject to civil liability or deemed to have violated the practitioner-patient privilege unless he has acted in bad faith or with malicious intent. This bill is identical to
Directs the Boards of Dentistry and Medicine to adopt regulations for the prescribing of opioids and products containing buprenorphine. The bill requires the Prescription Monitoring Program at the Department of Health Professions to annually provide a report to the Joint Commission on Health Care and the Chairmen of the House Committee on Health, Welfare and Institutions and the Senate Committee on Education and Health on the prescribing of opioids and benzodiazepines in the Commonwealth that includes data on reporting of unusual patterns of prescribing or dispensing of a covered substance by an individual prescriber or dispenser or on potential misuse of a covered substance by a recipient. The bill contains an emergency clause.