VA HB1251 | 2020 | Regular Session
Status
Completed Legislative Action
Spectrum: Partisan Bill (Democrat 8-0)
Status: Passed on April 10 2020 - 100% progression
Action: 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1080)
Text: Latest bill text (Chaptered) [HTML]
Spectrum: Partisan Bill (Democrat 8-0)
Status: Passed on April 10 2020 - 100% progression
Action: 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1080)
Text: Latest bill text (Chaptered) [HTML]
Summary
Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes that includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation with health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021.
Title
Health insurance; definitions, payment to out-of-network providers, emergency services.
Sponsors
Del. Luke Torian [D] | Del. Dawn Adams [D] | Sen. Lamont Bagby [D] | Del. Mark Levine [D] |
Del. Wendy Gooditis [D] | Del. Mark Sickles [D] | Sen. Suhas Subramanyam [D] | Del. Rodney Willett [D] |
Roll Calls
2020-03-05 - House - House: VOTE: Adoption (98-Y 0-N) (Y: 98 N: 0 NV: 2 Abs: 0) [PASS]
2020-03-05 - Senate - Senate: Passed Senate with substitute (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-04 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-02 - Senate - Senate: Reported from Finance and Appropriations (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-24 - Senate - Senate: Reported from Commerce and Labor with substitute (13-Y 2-N) (Y: 13 N: 2 NV: 0 Abs: 0) [PASS]
2020-02-11 - House - House: VOTE: Passage (94-Y 5-N) (Y: 94 N: 5 NV: 1 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-04 - House - House: Reported from Labor and Commerce with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-01-30 - House - House: Subcommittee recommends reporting with substitute (8-Y 0-N) (Y: 8 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-05 - Senate - Senate: Passed Senate with substitute (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-04 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-02 - Senate - Senate: Reported from Finance and Appropriations (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-24 - Senate - Senate: Reported from Commerce and Labor with substitute (13-Y 2-N) (Y: 13 N: 2 NV: 0 Abs: 0) [PASS]
2020-02-11 - House - House: VOTE: Passage (94-Y 5-N) (Y: 94 N: 5 NV: 1 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-04 - House - House: Reported from Labor and Commerce with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-01-30 - House - House: Subcommittee recommends reporting with substitute (8-Y 0-N) (Y: 8 N: 0 NV: 0 Abs: 0) [PASS]
History
Date | Chamber | Action |
---|---|---|
2020-04-10 | Governor: Acts of Assembly Chapter text (CHAP1080) | |
2020-04-10 | Governor: Approved by Governor-Chapter 1080 (effective - see bill) | |
2020-03-17 | Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020 | |
2020-03-17 | House | Enrolled Bill communicated to Governor on March 17, 2020 |
2020-03-12 | Senate | Signed by President |
2020-03-12 | House | Signed by Speaker |
2020-03-12 | House | Bill text as passed House and Senate (HB1251ER) |
2020-03-12 | House | Enrolled |
2020-03-05 | House | VOTE: Adoption (98-Y 0-N) |
2020-03-05 | House | Senate substitute agreed to by House 20109073D-S1 (98-Y 0-N) |
2020-03-05 | Senate | Passed Senate with substitute (40-Y 0-N) |
2020-03-05 | Senate | Engrossed by Senate - committee substitute HB1251S2 |
2020-03-05 | Senate | Substitute by Senator Favola agreed to 20109579D-S2 |
2020-03-05 | Senate | Reading of substitute waived |
2020-03-05 | Senate | Committee substitute rejected 20109073D-S1 |
2020-03-05 | Senate | Read third time |
2020-03-05 | Senate | Floor substitute printed 20109579D-S2 (Favola) |
2020-03-04 | Senate | Constitutional reading dispensed (40-Y 0-N) |
2020-03-02 | Senate | Reported from Finance and Appropriations (14-Y 0-N) |
2020-02-24 | Senate | Rereferred to Finance and Appropriations |
2020-02-24 | Senate | Committee substitute printed 20109073D-S1 |
2020-02-24 | Senate | Reported from Commerce and Labor with substitute (13-Y 2-N) |
2020-02-12 | Senate | Referred to Committee on Commerce and Labor |
2020-02-12 | Senate | Constitutional reading dispensed |
2020-02-11 | House | VOTE: Passage (94-Y 5-N) |
2020-02-11 | House | Read third time and passed House (94-Y 5-N) |
2020-02-10 | House | Printed as engrossed 20108018D-EH1 |
2020-02-10 | House | Engrossed by House - committee substitute with amendments HB1251EH1 |
2020-02-10 | House | Amendments by Delegate Torian agreed to |
2020-02-10 | House | Committee on Appropriations substitute agreed to 20108018D-H2 |
2020-02-10 | House | Committee Labor and Commerce substitute rejected 20107376D-H1 |
2020-02-10 | House | Read second time |
2020-02-09 | House | Read first time |
2020-02-07 | House | Reported from Appropriations with substitute (22-Y 0-N) |
2020-02-07 | House | Incorporates HB58 (Ware) |
2020-02-07 | House | Incorporates HB901 (Sickles) |
2020-02-07 | House | Incorporates HB189 (Levine) |
2020-02-07 | House | Incorporates HB1494 (Bagby) |
2020-02-07 | House | Incorporates HB1546 (Adams) |
2020-02-07 | House | Committee substitute printed 20108018D-H2 |
2020-02-04 | House | Incorporates HB58 (Ware) |
2020-02-04 | House | Incorporates HB1494 (Bagby) |
2020-02-04 | House | Incorporates HB1546 (Adams) |
2020-02-04 | House | Committee substitute printed 20107376D-H1 |
2020-02-04 | House | Referred to Committee on Appropriations |
2020-02-04 | House | Reported from Labor and Commerce with substitute (22-Y 0-N) |
2020-01-30 | House | Subcommittee recommends referring to Committee on Appropriations |
2020-01-30 | House | Subcommittee recommends reporting with substitute (8-Y 0-N) |
2020-01-23 | House | Assigned L & C sub: Subcommittee #2 |
2020-01-16 | House | Referred to Committee on Labor and Commerce |
2020-01-16 | House | Referred from General Laws by voice vote |
2020-01-08 | House | Referred to Committee on General Laws |
2020-01-08 | House | Prefiled and ordered printed; offered 01/08/20 20102088D |
Same As/Similar To
SB172 (Same As) 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1081)
HB58 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB189 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB901 (Same As) 2020-02-07 - Incorporated by Appropriations
HB1494 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB1546 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB58 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB189 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB901 (Same As) 2020-02-07 - Incorporated by Appropriations
HB1494 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB1546 (Same As) 2020-02-04 - Incorporated by Labor and Commerce