Healthcare

Prior authorization; requiring physician review for denial. Prohibits a health insurance carrier from making an adverse determination of a prior authorization request (i) for prescription drugs unless such denial has been reviewed and approved by a licensed physician or, if a licensed physician is not available, by a licensed pharmacist or (ii) for health care services unless such adverse determination has been reviewed and approved by (a) a licensed physician; (b) in the case of mental health services, a licensed mental health provider if a licensed physician is unavailable; or (c) in the case of dental services, a licensed dentist if a licensed physician is unavailable.

Commonwealth Health Reinsurance Program; extension of program; percentage goal to decrease premium. Directs the State Corporation Commission to apply to the appropriate federal agencies under the federal Patient Protection and Affordable Care Act for an extension of the existing State Innovation Waiver authorizing the Commonwealth to implement a reinsurance program. The existing State Innovation Waiver is set to expire on January 1, 2028. Additionally, the bill removes the 20 percent upper limit of the premium reduction goal under the Commonwealth Health Reinsurance Program. As introduced, this bill was a recommendation of the Health Insurance Reform Commission.

Health insurance; prohibited restrictions on in-network referrals. Prohibits a health insurance carrier from prohibiting an in-network provider, as defined in the bill, from referring any enrollee or specimen to any in-network clinical laboratory or in-network pathology service provider under the terms of such insurance unless such referral would constitute a violation of certain laws. This bill is identical to SB 745.

Department of Medical Assistance Services; state plan for medical assistance; provider-to-provider consultation; telemedicine. Specifies that the Medicaid provision for provider-to-provider consultation includes payment for consultations provided through telemedicine services. This bill incorporates HB 87.

Medicare supplement policies; regulations establishing minimum standards; work group; report. Amends provisions related to the State Corporation Commission's issuance of regulations to establish minimum standards regarding Medicare supplement policies to include minimum standards for the disclosure of methodology used in coverage decisions. The bill directs the Bureau of Insurance to convene a work group to review and make recommendations related to minimum standards regarding Medicare supplement policies, implementation of risk adjustment mechanisms, ways to eliminate waste and abuse from overpayments, methodologies used in coverage decisions, ways to improve care under such policies, and the effectiveness and utilization of existing consumer protections related to Medicare supplement policies and to submit a report of its findings and recommendations by December 1, 2026.

Sickle Cell Coordinated Access Network established. Directs the State Health Commissioner, in coordination with the Virginia Commonwealth University Health Systems Authority, to establish and maintain the Sickle Cell Coordinated Access Network to provide health care providers in the Commonwealth with real-time consultation and support from sickle cell specialists. The bill has a delayed effective date of July 1, 2027. This bill is identical to HB 1391.

Sickle Cell Coordinated Access Network established. Directs the State Health Commissioner, in coordination with the Virginia Commonwealth University Health Systems Authority, to establish and maintain the Sickle Cell Coordinated Access Network to provide health care providers in the Commonwealth with real-time consultation and support from sickle cell specialists. The bill has a delayed effective date of July 1, 2027. This bill is identical to SB 813.

Medical cannabis; administration to terminally ill patients; report. Directs the Department of Health to promulgate regulations specifying that hospital staff may store, dispense, and administer cannabis oil when a patient has valid certification and exempts such staff from criminal penalties for possession of cannabis oil. The bill directs the Department of Health to convene a work group to discuss the implementation process for providing cannabis products to patients in medical care facilities and report on its discussion to the Chairs of the House Committee on Health and Human Services and the Senate Committee on Education and Health by November 1, 2026. This bill incorporates HB 486. This bill is identical to SB 332.

Workers' compensation; employer's offset in event of recovery. Amends provisions related to an employer's offset for recovery in certain actions brought under the Virginia Workers' Compensation Act. The bill requires that lifetime medical award benefits and ongoing indemnity award benefits shall remain in full force and effect if the claimant is under such an award at the time that recovery is effected, subject to the employer offset provisions. Under the bill, an employer's credit shall be applied as a continuing, pro rata reduction to benefits otherwise payable under an existing award until the employer's required credit is exhausted. The bill also removes language limiting an employee's entitlement to compensation and expenses for medical, surgical, and hospital attention and funeral expenses.

Medical cannabis program; product labels; delivery. Changes the requirements for what is included on medical cannabis product labels affixed by pharmaceutical processors to include (i) the total milligrams of tetrahydrocannabinol (THC) and cannabidiol (CBD) included in the edible cannabis product or topical cannabis product, both defined in the bill; (ii) the number of milligrams of THC and CBD in each serving of the edible cannabis product or topical cannabis product; and (iii) the total percentage of THC and CBD included in the inhalable cannabis product, defined in the bill. Under current law, the product label of any medical cannabis product is required to include the total percentage and milligrams of THC and CBD included in the product and the number of milligrams of THC and CBD in each serving.The bill also allows a pharmaceutical processor or cannabis dispensing facility to dispense or deliver cannabis products in person to a patient or such patient's registered agent, parent, or legal guardian at any residence, including a temporary residence or business. However, the bill prohibits dispensing or delivering cannabis products to (a) any military base, child day center, school, or correctional facility; (b) the State Capitol; or (c) any public gathering places, including sporting events, festivals, fairs, races, concerts, and terminals of public transportation companies. The bill also specifies that all transportation or delivery of usable cannabis, botanical cannabis, cannabis oil, or cannabis products, whether by an employee or delivery agent, shall comply with all relevant laws and regulations and provides that the Board of Directors of the Virginia Cannabis Control Authority may suspend or revoke the privileges of any employee or delivery agent to transport or deliver such products for failure to comply. The bill also provides that the 12-month stability testing period for medical cannabis products begins on the date the cannabis product is tested, rather than the date of product registration approval and that any medical cannabis product with an expiration date exceeding 12 months shall be supported by stability testing measured from the testing date, rather than the date of product registration approval. The bill contains technical amendments.