Health insurance; balance billing protection; emergency medical services vehicle transportation. Prohibits an out-of-network health insurance provider from balance billing any enrollee for transportation provided by an emergency medical services vehicle, defined in the bill as any vehicle, vessel, or aircraft that holds a valid permit issued by the Office of Emergency Medical Services and that is equipped, maintained, or operated to provide emergency medical care or transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless.
Health care providers; required estimate for nonemergency health care services. Requires health care providers to provide a good faith estimate of the payment amount for which the patient will be responsible for such nonemergency health care service, including any fees or other charges for an item or service the patient may reasonably be expected to receive in connection with the nonemergency health care service. The bill requires the good faith estimate to include (i) description of the scheduled nonemergency health care service, (ii) the provider's standard charge for the service and any related item or service, (iii) the provider's standard charges and any contracted rates known at the time the estimate is prepared, and (iv) a statement that the estimate is not binding and the actual amount billed may differ depending on changes in the scope of services or the health carrier's processing of the claim.
Public institutions of higher education; financial assistance; Medical Education Service Grant Program established; report. Establishes the Medical Education Service Grant Program (the Program) for the purpose of providing grants to any person enrolled in or admitted to an eligible institution, as defined in the bill, that shall be awarded in whole or in part upon satisfactory completion of a service agreement entered into by a recipient to engage in clinical practice in a designated service area, as defined in the bill, for the requisite period and in accordance with the requirements set forth by the bill. The bill directs the State Council of Higher Education for Virginia (the Council), in partnership with the Virginia Health Workforce Development Authority (the Authority), to administer the Program. The bill also (i) establishes requirements for the administration of the Program, including (a) requirements for eligibility to apply to and receive a grant under the Program and the prioritization of Program applications and (b) terms and conditions governing the awarding of grants under the Program; (ii) directs the Council and the Authority to establish policies and procedures for the administration of the Program relating to monitoring and enforcing compliance of recipients with Program requirements and terms and conditions; and (iii) directs the program administrator to annually collect data on the activities of the Program for the preceding fiscal year and submit to the Governor and the Chairs of the House Committees on Education, Health and Human Services, and Appropriations and the Senate Committees on Education and Health and Finance and Appropriations a report on such data by January 1 of each year in which funds are made available for the Program.
Newborn screening requirements; Gaucher disease. Directs the Department of Health to amend regulations to include Gaucher disease under the Commonwealth's newborn screening panel.
Health insurance; treatment of cancer and certain diseases; coverage of certain medications. Requires an insurer, corporation providing preferred provider subscription contracts, or health maintenance organization that provides coverage for drugs approved by the Food and Drug Administration and prescribed for the treatment of cancer or diseases of the blood to allow, at the patient's direction, (i) provider-administered drugs for such treatment to be dispensed by an in-network treating provider consistent with a provider agreement; (ii) provider-administered drugs for such treatment to be dispensed by an in-network treating provider when there is a documented delay of at least three days in the delivery of a medication from the designated specialty pharmacy; and (iii) self-administered drugs for such treatment to be sent to the pharmacy of the patient's choosing.
Use of artificial intelligence system by mental health service providers; civil penalty. Permits the use of an artificial intelligence system by mental health service providers to assist in providing therapy or counseling services if such mental health service provider maintains full responsibility for all interactions, outputs, and data use associated with the system. The bill prohibits the use of an artificial intelligence system to provide therapy or counseling services without a mental health service provider. The bill specifies that records kept by mental health service providers must comply with health records privacy requirements; creates an exception for religious counseling, peer support, or self-help materials and educational resources; and establishes a civil penalty not to exceed $10,000 for violations of the statute.
Nursing homes; periodic medical visits and resident assessments. Requires all nursing homes to notify the resident of a nursing home, the resident's family, and the Department of Health if a federally required physician visit does not take place. The bill also requires each nursing home to conduct a comprehensive assessment on an annual basis to determine each resident's needs and describe each resident's capability to perform daily life functions. Such assessments must be reviewed at least once every 92 days, and more frequently in the event of a significant change in the resident's physical or mental condition.
Health carriers; use of artificial intelligence; disclosures. Requires health carriers to disclose to the State Corporation Commission's Bureau of Insurance how artificial intelligence is used to manage claims coverage and to submit all information enabling decisions made by artificial intelligence to the Bureau upon request. The bill also requires health carriers to provide notice to enrollees and health care providers when artificial intelligence has been used to issue an adverse determination and to provide a clear and timely process for appeal of such determination.
Line of Duty Act; transitional coverage. Requires the Department of Human Resource Management to acquire and provide temporary transitional health insurance coverage to disabled persons, eligible spouses, and eligible dependents during the period of transition into the LODA (Line of Duty Act) Health Benefits Plans. Current law authorizes but does not require the Department to acquire and provide such temporary transitional health insurance coverage to disabled persons, eligible spouses, and eligible dependents during such period.
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.
