VA SB428 | 2022 | Regular Session
Status
Completed Legislative Action
Spectrum: Partisan Bill (Republican 1-0)
Status: Passed on April 8 2022 - 100% progression
Action: 2022-04-08 - Governor: Acts of Assembly Chapter text (CHAP0285)
Text: Latest bill text (Chaptered) [HTML]
Spectrum: Partisan Bill (Republican 1-0)
Status: Passed on April 8 2022 - 100% progression
Action: 2022-04-08 - Governor: Acts of Assembly Chapter text (CHAP0285)
Text: Latest bill text (Chaptered) [HTML]
Summary
Health insurance; carrier disclosure of certain information. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests for which no additional information is needed by the carrier to process the prior authorization request, no clinical review is required, and that meet the carrier's criteria for approval; and (iv) otherwise meets the requirements of the relevant Code of Virginia section. The bill prohibits a carrier from (a) imposing a charge or fee on a participating health care provider for accessing the required online process required or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill requires participating health care providers, beginning July 1, 2025, to ensure that any e-prescribing system or electronic health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access the electronic prior authorization process established by a carrier and real-time cost information data for a covered prescription drug made available by a carrier. The bill provides that a provider may request a waiver of compliance for undue hardship for a period not to exceed 12 months. The bill requires any carrier or its pharmacy benefits manager to provide real-time cost information data to enrollees and contracted providers for a covered prescription drug, including any cost-sharing requirement or prior authorization requirements, and to ensure that the data is accurate. The bill requires that such cost information data is available to the provider in a format that a provider can access and understand such as through the provider's e-prescribing system or electronic health record system for which the carrier or pharmacy benefits manager or its designated subcontractor has adopted that utilizes the National Council for Prescription Drug Programs SCRIPT standard from which the provider makes the request. Health insurance; carrier disclosure of certain information. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests for which no additional information is needed by the carrier to process the prior authorization request, no clinical review is required, and that meet the carrier's criteria for approval; and (iv) otherwise meets the requirements of the relevant Code of Virginia section. The bill prohibits a carrier from (a) imposing a charge or fee on a participating health care provider for accessing the required online process required or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill requires participating health care providers, beginning July 1, 2025, to ensure that any e-prescribing system or electronic health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access the electronic prior authorization process established by a carrier and real-time cost information data for a covered prescription drug made available by a carrier. The bill provides that a provider may request a waiver of compliance for undue hardship for a period not to exceed 12 months. The bill requires any carrier or its pharmacy benefits manager to provide real-time cost information data to enrollees and contracted providers for a covered prescription drug, including any cost-sharing requirement or prior authorization requirements, and to ensure that the data is accurate. The bill requires that such cost information data is available to the provider in a format that a provider can access and understand such as through the provider's e-prescribing system or electronic health record system for which the carrier or pharmacy benefits manager or its designated subcontractor has adopted that utilizes the National Council for Prescription Drug Programs SCRIPT standard from which the provider makes the request. The bill requires the State Corporation Commission's Bureau of Insurance (the Bureau) to, in coordination with the Secretary of Health and Human Resources, establish a work group to evaluate and make recommendations to modify the process for prior authorization for drug benefits in order to maximize efficiency and minimize delays that include a single standardized process and any recommendations for necessary statutory or regulatory changes. The bill requires the work group to include relevant stakeholders, including representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the National Council for Prescription Drug Programs, the Virginia Pharmacists Association, and the Virginia Hospital and Healthcare Association, and other parties with an interest in the underlying technology. The bill requires the work group to report its findings and recommendations to the Chairmen of the Senate Committee on Commerce and Labor and the House Committee on Commerce and Energy by November 1, 2022. The provisions of the bill other than the requirement for the Bureau to establish the work group will not become effective unless reenacted by the 2023 Session of the General Assembly.
Title
Health insurance; carrier contracts, carrier provision of certain prescription drug information.
Sponsors
Roll Calls
2022-03-03 - Senate - Senate: House amendments agreed to by Senate (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2022-03-01 - House - House: VOTE: Block Vote Passage (100-Y 0-N) (Y: 100 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-24 - House - House: Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-10 - Senate - Senate: Read third time and passed Senate (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-08 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-07 - Senate - Senate: Reported from Commerce and Labor with substitute (15-Y 0-N) (Y: 15 N: 0 NV: 0 Abs: 0) [PASS]
2022-03-01 - House - House: VOTE: Block Vote Passage (100-Y 0-N) (Y: 100 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-24 - House - House: Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-10 - Senate - Senate: Read third time and passed Senate (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-08 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2022-02-07 - Senate - Senate: Reported from Commerce and Labor with substitute (15-Y 0-N) (Y: 15 N: 0 NV: 0 Abs: 0) [PASS]
History
| Date | Chamber | Action |
|---|---|---|
| 2022-04-08 | Governor: Acts of Assembly Chapter text (CHAP0285) | |
| 2022-04-08 | Governor: Approved by Governor-Chapter 285 (effective - see bill) | |
| 2022-03-22 | Governor: Governor's Action Deadline 11:59 p.m., April 11, 2022 | |
| 2022-03-22 | Senate | Enrolled Bill Communicated to Governor on March 22, 2022 |
| 2022-03-08 | House | Signed by Speaker |
| 2022-03-08 | Senate | Signed by President |
| 2022-03-08 | Senate | Bill text as passed Senate and House (SB428ER) |
| 2022-03-08 | Senate | Enrolled |
| 2022-03-03 | Senate | House amendments agreed to by Senate (40-Y 0-N) |
| 2022-03-01 | House | VOTE: Block Vote Passage (100-Y 0-N) |
| 2022-03-01 | House | Passed House with amendments BLOCK VOTE (100-Y 0-N) |
| 2022-03-01 | House | Engrossed by House as amended |
| 2022-03-01 | House | Committee amendments agreed to |
| 2022-03-01 | House | Read third time |
| 2022-02-28 | House | Read second time |
| 2022-02-24 | House | Reported from Health, Welfare and Institutions with amendment(s) (22-Y 0-N) |
| 2022-02-21 | House | Referred to Committee on Health, Welfare and Institutions |
| 2022-02-21 | House | Read first time |
| 2022-02-21 | House | Placed on Calendar |
| 2022-02-10 | Senate | Read third time and passed Senate (40-Y 0-N) |
| 2022-02-09 | Senate | Engrossed by Senate - committee substitute SB428S1 |
| 2022-02-09 | Senate | Committee substitute agreed to 22106220D-S1 |
| 2022-02-09 | Senate | Reading of substitute waived |
| 2022-02-09 | Senate | Read second time |
| 2022-02-08 | Senate | Constitutional reading dispensed (40-Y 0-N) |
| 2022-02-07 | Senate | Committee substitute printed 22106220D-S1 |
| 2022-02-07 | Senate | Reported from Commerce and Labor with substitute (15-Y 0-N) |
| 2022-01-11 | Senate | Referred to Committee on Commerce and Labor |
| 2022-01-11 | Senate | Prefiled and ordered printed; offered 01/12/22 22101437D |
Same As/Similar To
HB360 (Same As) 2022-04-08 - Governor: Acts of Assembly Chapter text (CHAP0284)
