Healthcare

State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.

Medical malpractice; limitation on recovery; certain actions. Eliminates the cap on the recovery in actions against health care providers for medical malpractice where the act or acts of malpractice occurred on or after July 1, 2026, and occurred against a patient age 10 or younger.

Constitutional amendment (voter referendum); fundamental right to reproductive freedom. Provides for a referendum at the November 3, 2026, election to approve or reject an amendment to the Constitution of Virginia relating to the right to make one's own decisions related to reproductive health care, including access to abortion. The amendment protects patients and their doctors and nurses from being punished for making such decisions. The amendment allows the state to place restrictions on access to abortion during the third trimester of pregnancy except when the patient's life or physical or mental health is at risk or the pregnancy cannot survive. This bill is identical to SB 449.

Virginia Fire Personnel and Equipment Grant Program established; report. Establishes the Virginia Fire Personnel and Equipment Grant Program (the Program) for the purpose of awarding grants to localities to hire additional firefighters and to improve their firefighting and emergency medical services. The bill specifies that the Department of Fire Programs (the Department) shall administer the Program and two types of grants shall be made from the Program. The first shall provide grants to localities to increase the number of firefighters. Such grants shall be made for up to three years and shall be used by localities for programs to (i) hire new, additional full-time firefighters; (ii) convert part-time or volunteer firefighters to full-time firefighters; or (iii) recruit and retain volunteer firefighters. The second shall award grants to localities for improving firefighting and emergency medical services, including by acquiring firefighting and emergency medical services vehicles and equipment and modifying facilities. For both grants, the bill provides that funds shall not be used to supplant any funds currently provided by the Commonwealth or by the locality and shall be used to increase the total amount of funds available for the provision of firefighting or emergency medical services. The bill requires the Department to submit a report annually, beginning November 1, 2027, to the Governor and the General Assembly containing a list of grants, the amount of each approved grant, information on the performance assessment system that the bill directs the Department to create, an evaluation of each grant based on such system, and any other criteria deemed relevant by the Department.

Department of Behavioral Health and Developmental Services; Early Childhood Mental Health Consultation Program established; pilot programs; development of modules; report. Establishes the Early Childhood Mental Health Consultation Program, to be administered by the Department of Behavioral Health and Developmental Services (the Department) in coordination with the Department of Education and the Department of Health, for the purpose of providing and expanding the accessibility of early childhood mental health consultation services, as that term is defined in the bill. The bill requires, pursuant to the Program, early childhood mental health consultation services shall be provided to families of children three through five years of age who exhibit developmental delays and behavioral health concerns and to early childhood care and education programs as enumerated in the bill. The bill requires the Department, in administering the Program, to (i) develop, or contract with community services boards to develop, and make available to early childhood care and education programs and providers developmental readiness modules, in accordance with the requirements of the bill; (ii) designate three pilot regions for initial implementation of the Program, with implementation beginning no later than January 1, 2027; and (iii) submit to the Governor and the General Assembly by November 1 of each year a report on the implementation and outcomes of the Program for each pilot region selected for initial implementation. The provisions of the bill relating to initial implementation of the Program in the pilot regions shall expire on July 1, 2029.

Health Care Decisions Act; patients incapable of making informed decisions; absence of next of kin. Authorizes, for purposes of the Health Care Decisions Act, the patient care consulting committee to make health care decisions for a patient incapable of making informed decisions when no next of kin is reasonably available.

Health care; decision-making; end of life; penalties. Allows an adult diagnosed with a terminal disease to request and an attending health care provider to prescribe self-administered aid in dying medication for the purpose of ending the patient's life. The bill requires that a patient's request for self-administered aid in dying medication to end his life be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind his request at any time. The bill makes it a Class 2 felony (i) to willfully and deliberately alter, forge, conceal, or destroy a patient's request, or rescission of request, for self-administered aid in dying medication to end his life with the intent and effect of causing the patient's death; (ii) to coerce, intimidate, or exert undue influence on a patient to request self-administered aid in dying medication for the purpose of ending his life or to destroy the patient's rescission of such request with the intent and effect of causing the patient's death; or (iii) to coerce, intimidate, or exert undue influence on a patient to forgo self-administered aid in dying medication for the purpose of ending the patient's life. The bill also grants immunity from civil or criminal liability and professional disciplinary action to any person who complies with the provisions of the bill and allows health care providers to refuse to participate in the provision of self-administered aid in dying medication to a patient for the purpose of ending the patient's life.

Emergency custody orders; transportation to treatment center or to residence of the person subject to emergency custody order. Provides that transportation provided pursuant to an emergency custody order shall include, upon completion of emergency medical evaluation or treatment, transportation to an approved treatment center or to the residence of the person subject to the emergency custody order.

Department of Medical Assistance Services; managed care organization contracts; notice to providers. Requires the Department of Medical Assistance Services to include in all of its managed care organization contracts provisions requiring that the managed care organization notify all known providers of any new enrollee who was previously enrolled in a fee-for-service plan or another managed care plan under the state plan for medical assistance services that such enrollee has changed health plans.

Department of Medical Assistance Services; consultation with federally recognized tribes. Establishes a Tribal Medicaid Advisory Group to work collaboratively on (i) plan amendments, waiver requests, and policies affecting tribal health programs at least 60 days prior to submitting them for public notice and comment and (ii) a tribal health program billing manual. The advisory group is required to meet in person on at least a quarterly basis. The bill also requires the Department of Medical Assistance Services to (a) recognize the eligibility of any tribal health program to participate as a provider in the state plan, (b) consult with any tribal health program participating in the state plan at least 60 days prior to taking any adverse action, including suspension of payments or investigation regarding the participation of any tribal health program in the state plan, and (c) engage in ongoing consultation with federally recognized tribes and tribal health programs to address the needs of the state and tribal governments. This bill is a recommendation of the Commission on Updating Virginia Law to Reflect Federal Recognition of Virginia Tribes.