Healthcare

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans. Requires each carrier that offers a health plan in either the individual or small group market to ensure that at least one health plan in each of the bronze, silver, gold, and platinum levels of coverage in each rating area in the individual and small group market conform with the following: (i) a plan that offers a platinum level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug; (ii) a plan that offers a gold level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $200 per 30-day supply of the prescription drug; (iii) a plan that offers a silver level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $250 per 30-day supply of the prescription drug; and (iv) a plan that offers a bronze level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $300 per 30-day supply of the prescription drug. The bill requires that any plans offered to meet its requirements are (a) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (b) marketed in the same manner as other plans offered by the carrier. The bill's provisions apply to any individual or group accident and sickness insurance policy, any individual or group accident and sickness subscription contract, and any health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on or after January 1, 2028. This bill is identical to HB 625.

Mental health and substance abuse disorders; network adequacy standards; comparative analyses; report; emergency regulations. Directs the Department of Health to issue regulations that include quantitative network adequacy standards for timely access to care, travel time, and geographical distance that are at least as stringent as those imposed for qualified health plans and qualified dental plans. The bill amends the definitions of "mental health services" and "substance abuse services" for the purposes of health insurance coverage.The bill requires health carriers to submit all comparative analyses prepared pursuant to federal law to the Bureau of Insurance on the date and frequency as specified by the Bureau and includes additional information to include in such submission. Under the bill, the Bureau may impose a penalty not to exceed $100,000 for a noncompliant or insufficient comparative analysis or require a carrier to remove, revise, or remedy noncompliant treatment limitations. The bill also amends the contents of the annual report submitted by the Bureau to the General Assembly to cover enforcement efforts with respect to the federal Mental Health Parity and Addiction Equity Act of 2008.The bill authorizes the Bureau to promulgate regulations as necessary to implement the provisions of the bill and directs the Department of Health to adopt emergency regulations to implement the provisions of the bill. The bill directs the Department of Human Resource Management to evaluate the impact of the proposed changes to the provisions of the bill related to health insurance. The provisions of the bill related to health insurance have a delayed effective date of July 1, 2027. This bill is identical to HB 656.

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.

Health insurance; coverage for maternal mental health screenings. Requires health insurance carriers to provide coverage for maternal mental health screenings. The bill requires such coverage to include at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks of the postpartum period, and additional medically necessary postpartum screenings. Additionally, the bill provides that coverage for a prescription drug for the treatment of a maternal mental health condition shall not be subject to prior authorization requirements unless there are clinically significant safety or efficacy concerns.

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.

Department of Veterans Services; Department of Health Professions; military medical personnel; program; work group; report. Expands the definition of "military medical personnel" for the purposes of the program established by the Department of Veterans Services (the Department), in collaboration with the Department of Health Professions, that allows such military medical personnel to practice and perform certain delegated acts that constitute the practice of medicine or nursing to include other enlisted service members who have successfully completed appropriate technical training and any required certifications and who were discharged or released from such service under conditions other than dishonorable. Under current law, "military medical personnel" means an individual who has recently served as a medic in the United States Army, medical technician in the United States Air Force, medical personnel in the United States Space Force, or corpsman in the United States Navy or the United States Coast Guard.The bill allows such military medical personnel participating in the program to be supervised by any licensed practitioner, as defined in the bill. Current law allows such personnel to be supervised by a physician or podiatrist. The bill directs the Department of Veterans Services to convene a work group to provide guidance on the implementation and further development of the Military Medics and Corpsmen program and to report its findings to the Chairs of the House Committee on Health and Human Services and the Senate Committee on Education and Health by November 1, 2026.

Nonemergency medical transportation providers; fee disclosure. Requires a nonemergency medical transportation provider or the medical care facility prearranging transport through such a provider, prior to providing such transportation services to a patient, to provide the patient or the patient's representative with a standardized disclosure form of all associated fees or other charges for which the patient will be responsible for such transportation services. The bill also requires that nonemergency medical transportation providers provide the medical care facility with the required form. Such provisions have a delayed effective date of January 1, 2027. Finally, effective July 1, 2026, the bill directs the Department of Health to develop and publish a standardized disclosure form on its website by October 1, 2026.

Department of Social Services; Department of Behavioral Health and Developmental Services; Department of Health; prenatal and postnatal substance use; work group; report. Directs the Department of Social Services, Department of Behavioral Health and Developmental Services, and Department of Health to convene a work group to evaluate the Commonwealth's response to parental prenatal and postnatal substance use, the services available to address such substance use, and the effects of such substance use on newborns and children. The bill requires the work group to submit a written report of its findings and recommendations to the Chairs of the Senate Committees on Education and Health and Rehabilitation and Social Services and the House Committee on Health and Human Services by December 1, 2026. This bill is identical to HB 652.

Pharmaceutical Substance Manufacturing Grant Fund. Establishes the Pharmaceutical Substance Manufacturing Grant Fund to provide grant installment awards between July 1, 2026, and July 1, 2045, in an amount not to exceed $34 million per fiscal year and in an aggregate amount not to exceed $191,255,000, to a qualified company that (i) engages in the manufacture of pharmaceutical substances, (ii) executes a memorandum of understanding with the Commonwealth, and (iii) is expected to make a capital investment of at least $4 billion and create and maintain at least 500 new full-time jobs. This bill is identical to HB 1076.

Health insurance; claims experience information. Provides that provisions requiring insurers to provide policyholders with certain claims experience information apply to all employee welfare benefit plans and include pharmacy benefits claims.