Healthcare

Weapons; possession prohibited in a hospital that provides mental health services or developmental services; penalty. Makes it a Class 1 misdemeanor for any person to knowingly and intentionally possess in the building of any hospital that provides mental health services or developmental services in the Commonwealth, including an emergency department or other facility rendering emergency medical care, a (i) firearm, (ii) knife with a blade over three and one-half inches, or (iii) other dangerous weapon, including explosives and stun weapons. The bill also provides that notice of such prohibitions shall be posted conspicuously at each public entrance of any hospital and that no person shall be convicted of the offense if such notice is not posted, unless such person had actual notice of the prohibitions. The bill provides that such firearm, knife, explosive, or weapon shall be subject to seizure by a law-enforcement officer and forfeited to the Commonwealth and specifies certain exceptions to the prohibition. This bill is identical to SB 173.

Fantasy contests; regulation and taxation. Imposes (i) a 10 percent tax on a fantasy contest operator's fantasy contest revenue, with 2.5 percent of the tax revenue being allocated to the Problem Gambling Treatment and Support Fund and the remaining 97.5 percent being allocated to the general fund, and (ii) a 2.6 percent fee on a fantasy contests operator's fantasy contest revenue to be utilized by the Virginia Lottery to cover the costs of administration and regulation of fantasy contests in the Commonwealth. The bill also limits the definition of "fantasy contest" and requires fantasy contest operators to apply to the Virginia Lottery for a permit before offering any fantasy contest in the Commonwealth. This bill is identical to SB 129.

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 is identical to HB 75.

Board of Medicine; breast implant educational materials; work group. Directs the Board of Medicine to convene a work group to create educational materials for patients considering breast implants and distribute such materials to its licensees by January 1, 2027.

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 SB 524.

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.

Continuing care providers; quarterly meeting requirements. Amends the quarterly meeting requirements for continuing care facilities to provide that at least two of such meetings per year shall be open to all residents and that certain individuals shall participate in at least two of such meetings per year. The bill also requires, if requested by the resident council or a majority of the independent living residents of a continuing care facility, the provider to include as a participant in the meetings of its board of directors or other governing body a resident representative elected by a majority of such residents, who shall participate in a non-voting, advisory capacity. This bill is identical to SB 358.

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 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 SB 161.

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 SB 133.