Healthcare

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.

Sickle cell disease education and screening program; cancer risk. Requires the sickle cell screening and treatment program to include the offering of educational resources to health care providers on the increased risks for certain cancers among individuals with sickle cell disease or the sickle cell trait.

Health Coordination Network Program; patient data collection. Renames the Smartchart Network Program as the Health Coordination Network Program and relocates it within the Code. The bill expands patient level data elements and requires the Commissioner of Health to enter into contract with an authorized nonprofit organization to create, operate, maintain, and administer the Health Coordination Network Program.

Department of Medical Assistance Services; state plan for medical assistance services; doula care. Adds provisions related to the provision of doula care under the state plan for medical assistance services specifying that such care includes support during labor and delivery and up to two linkage-to-care incentive payments for doulas.

Certificate of public need; expedited review of certain projects; duties of the State Health Services Plan Task Force. Directs the State Health Services Plan Task Force to develop recommendations for designating areas of the state with an identifiable need for additional projects, taking into account numerous barriers of access to health care. The bill also directs the Board of Health to promulgate updated regulations for expedited application and review processes for certain projects. This bill is identical to HB 1337.

Victims of crime; reimbursement for expenses; work group. Provides that all medical fees expended in the gathering of evidence through anonymous trace evidence collection kit examinations conducted on victims complaining of strangulation pursuant to relevant law shall be paid by the Commonwealth through the Criminal Injuries Compensation Fund (also known as the Virginia Victims Fund) administered by the Virginia Workers' Compensation Commission. The bill states that such victims shall not be required to participate in the criminal justice system or cooperate with law-enforcement authorities in order to be provided with such medical exams. Under current law, all medical fees expended in the gathering of evidence through physical evidence recovery kit examinations conducted on victims complaining of sexual assault are paid by the Commonwealth via the Fund, and victims complaining of sexual assault are not required to participate in the criminal justice system or cooperate with law-enforcement authorities in order to be provided with such forensic medical exams. The bill expands the powers and duties of the Commission to adopt, promulgate, amend, and rescind suitable rules and regulations to include a distinct policy for the payment of anonymous trace evidence collection kit examinations. Lastly, the bill directs the Director of the Department of Criminal Justice Services to convene a work group of relevant stakeholders to discuss and submit recommendations for certain matters related to the reimbursement process for forensic medical examinations, enumerated in the bill. The bill directs the work group to submit a report with recommendations to the Chairs of the House Committee on Health and Human Services, the House Committee on Appropriations, the Senate Committee on Education and Health, and the Senate Committee on Finance and Appropriations by November 1, 2026. This bill is identical to HB 1464.

SB 822 requires school nurses in public schools to complete training on sickle cell disease. This directly affects school nurses and aims to better support students with sickle cell disease or those at risk. The key provision mandates this training to help nurses recognize symptoms and manage care during health crises. The bill's abstract focuses solely on implementing this training requirement for school health staff.

Health insurance; mandated benefits; treatment of menopause and perimenopause. Requires each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services to provide coverage for medically necessary treatment and care for menopause and perimenopause, as described in the bill.

Department of Health; reduction of opioid overdose and opioid overdose deaths; report. Directs the Department of Health to develop a strategic plan for opioid overdose response to reduce rates of drug overdose and drug overdose deaths in the Commonwealth and to provide a report on the status of such strategic plan and its implementation to the Governor, the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Education and Health and Finance and Appropriations, and the Joint Commission on Health Care by November 1, 2026, and annually thereafter. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to SB 308.

School nurses; sickle cell disease training. Directs local school divisions to require school nurses to complete, within six months of employment and at least every three years thereafter, an online or in-person course of instruction approved by the Board in collaboration with the Department of Health regarding recognition and management of sickle cell disease. This bill is identical to SB 822.