Health insurance; prior authorization. Requires that any provider contract between a carrier and a participating health care provider contain specific provisions that require that if a prior authorization request is approved for prescription drugs and such prescription drugs have been scheduled, provided, or delivered to the patient consistent with the authorization, the carrier shall not revoke, limit, condition, modify, or restrict that authorization unless (i) there is evidence that the authorization was obtained based on fraud or misrepresentation; (ii) final actions by the U.S. Food and Drug Administration, other regulatory agencies, or the manufacturer remove the drug from the market, limit its use in a manner that affects the authorization, or communicate a patient safety issue that would affect the authorization alone or in combination with other authorizations; (iii) a combination of drugs prescribed would cause a drug interaction; or (iv) a generic or biosimilar is added to the prescription drug formulary. The bill provides that such provisions do not require a carrier to cover any benefit not otherwise covered or cover a prescription drug if the enrollee is no longer covered by a health plan on the date the prescription drug was scheduled, provided, or delivered. This bill is identical to HB 1134.
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Department of Human Resource Management; employee designation and payment policies; nursing staff at state psychiatric hospitals. Directs the Department of Human Resource Management to amend its policies to authorize the Department of Behavioral Health and Developmental Services and state psychiatric hospitals to designate as full-time employees nursing staff and psychiatric technicians who work at least 36 hours per week to permit state hospitals to use 12-hour shifts for such staff. The bill prohibits the Department from requiring reductions in pay or other benefits for such employees based solely on the fact that the employee works 36 hours per week. The bill also directs the Department to examine whether the policy change should be extended to comparable direct care positions in other executive branch agencies to improve recruitment and retention. As introduced, this bill is a recommendation of the Joint Legislative Audit and Review Commission and the Behavioral Health Commission. The bill has a delayed effective date of January 1, 2025.
Health insurance; ethics and fairness in carrier business practices. Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim." The bill prohibits a carrier from imposing any retroactive denial of a previously paid claim or in any other way seeking recovery or refund of a previously paid claim unless the carrier specifies in writing the specific claim or claims for which the retroactive denial is to be imposed or the recovery or refund is sought and the carrier has provided a written explanation of why the claim is being retroactively adjusted. The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12-month limit. The bill requires carriers, beginning no later than July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan that is subject to the State Corporation Commission's jurisdiction. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically. This bill is identical to HB 123.
Early childhood care and education; publiclyfunded providers; exemption from licensure for certain child day programs. Excepts military child care fee assistance or any childcare subsidy paid by a branch of the Armed Forces of the United Statesfrom the federal funds that would otherwise render a child day programas a "publicly funded provider," as that term is defined and usedin relevant law relating to early childhood care and education. Thebill also exempts from licensure by the Superintendent of PublicInstruction any child day program that (i) serves only dependentchildren of military personnel and (ii) (a) is located on a militarybase or federal property or (b) is certified as a family child careprovider by a branch of the Armed Forces of the United States and provides that any branch of the Armed Forces of the United Statesor its agent, including an installation commander of a military baseon which a child day program is located, may assume responsibilityfor approving or determining which children may be served by theprogram that is so exempted from licensure.
Board of Education; child day programs; licensureand use of office buildings. Directs the Board of Education toamend its regulations to permit any child day program to operatein an office building, defined as any building containing more thantwo rental units that are rented primarily for retail, commercial,or professional use, provided such office building satisfies thelegal and regulatory requirements for licensure as a child day program.
Center for Rural Virginia; name change. Renames the Center for Rural Virginia as the Senator Frank M. Ruff, Jr. Center for Rural Virginia. This bill is identical to HB 1381.
State hospitals; discharge planning; report. Provides that (i) when an individual is to be discharged from Central State Hospital, Southwestern Virginia Mental Health Institute, or Southern Virginia Mental Health Institute in 30 days or less after admission, the appropriate community services board shall implement the discharge plan developed by the state facility and (ii) when an individual is to be discharged from any other state facility in 30 days or less after admission, or from a state hospital more than 30 days after admission, the appropriate community services board or behavioral health authority shall be responsible for the individual's discharge planning. Under current law, community services boards and behavioral health authorities provide discharge planning for all individuals discharged from state hospitals, regardless of the duration of their stay. The bill requires the Department of Behavioral Health and Developmental Services to make certain annual reports by August 1 to the Governor and the General Assembly and to provide the General Assembly with a one-time evaluation of the impacts of the changes to discharge planning implemented by the bill by November 1, 2025. The bill has a delayed effective date of January 1, 2025. This bill is identical to HB 314.
Use of canines in correctional and juvenile correctional facilities; prohibited acts. Makes it unlawful for any correctional officer or other employee of a state correctional facility who is permitted to handle canines to use a patrol or security canine in any state correctional facility unless such correctional officer or other employee (i) reasonably believes that the use of a patrol or security canine is immediately necessary to protect any prisoner or any officer or employee from the threat of serious bodily injury or death or (ii) has the prior approval of the warden or a supervisor to use a patrol or security canine to intervene in an altercation, fight, or other incident between three or more prisoners. The bill also makes it unlawful for any juvenile correctional officer or other employee of a juvenile correctional facility to use a patrol or security canine in any juvenile correctional facility. The bill specifies that such provisions shall not apply to the training or use of detector canines or detector canine handlers.
Commending Buta Biberaj.
Commending the Honorable L. Kaye Kory.