Virginia House Bill 1251 (Prior Session Legislation)

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Completed Legislative Action
Spectrum: Partisan Bill (Democrat 8-0)
Status: Passed on April 10 2020 - 100% progression
Action: 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1080)
Text: Latest bill text (Chaptered) [HTML]

Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes that includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation with health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021.

Health insurance; definitions, payment to out-of-network providers, emergency services.

Del. Luke Torian [D]	Del. Dawn Adams [D]	Sen. Lamont Bagby [D]	Del. Mark Levine [D]
Del. Wendy Gooditis [D]	Del. Mark Sickles [D]	Sen. Suhas Subramanyam [D]	Del. Rodney Willett [D]

2020-03-05 - House - House: VOTE: Adoption (98-Y 0-N) (Y: 98 N: 0 NV: 2 Abs: 0) [PASS]
2020-03-05 - Senate - Senate: Passed Senate with substitute (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-04 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-02 - Senate - Senate: Reported from Finance and Appropriations (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-24 - Senate - Senate: Reported from Commerce and Labor with substitute (13-Y 2-N) (Y: 13 N: 2 NV: 0 Abs: 0) [PASS]
2020-02-11 - House - House: VOTE: Passage (94-Y 5-N) (Y: 94 N: 5 NV: 1 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-04 - House - House: Reported from Labor and Commerce with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-01-30 - House - House: Subcommittee recommends reporting with substitute (8-Y 0-N) (Y: 8 N: 0 NV: 0 Abs: 0) [PASS]

Date	Chamber	Action
2020-04-10		Governor: Acts of Assembly Chapter text (CHAP1080)
2020-04-10		Governor: Approved by Governor-Chapter 1080 (effective - see bill)
2020-03-17		Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020
2020-03-17	House	Enrolled Bill communicated to Governor on March 17, 2020
2020-03-12	Senate	Signed by President
2020-03-12	House	Signed by Speaker
2020-03-12	House	Bill text as passed House and Senate (HB1251ER)
2020-03-12	House	Enrolled
2020-03-05	House	VOTE: Adoption (98-Y 0-N)
2020-03-05	House	Senate substitute agreed to by House 20109073D-S1 (98-Y 0-N)
2020-03-05	Senate	Passed Senate with substitute (40-Y 0-N)
2020-03-05	Senate	Engrossed by Senate - committee substitute HB1251S2
2020-03-05	Senate	Substitute by Senator Favola agreed to 20109579D-S2
2020-03-05	Senate	Reading of substitute waived
2020-03-05	Senate	Committee substitute rejected 20109073D-S1
2020-03-05	Senate	Read third time
2020-03-05	Senate	Floor substitute printed 20109579D-S2 (Favola)
2020-03-04	Senate	Constitutional reading dispensed (40-Y 0-N)
2020-03-02	Senate	Reported from Finance and Appropriations (14-Y 0-N)
2020-02-24	Senate	Rereferred to Finance and Appropriations
2020-02-24	Senate	Committee substitute printed 20109073D-S1
2020-02-24	Senate	Reported from Commerce and Labor with substitute (13-Y 2-N)
2020-02-12	Senate	Referred to Committee on Commerce and Labor
2020-02-12	Senate	Constitutional reading dispensed
2020-02-11	House	VOTE: Passage (94-Y 5-N)
2020-02-11	House	Read third time and passed House (94-Y 5-N)
2020-02-10	House	Printed as engrossed 20108018D-EH1
2020-02-10	House	Engrossed by House - committee substitute with amendments HB1251EH1
2020-02-10	House	Amendments by Delegate Torian agreed to
2020-02-10	House	Committee on Appropriations substitute agreed to 20108018D-H2
2020-02-10	House	Committee Labor and Commerce substitute rejected 20107376D-H1
2020-02-10	House	Read second time
2020-02-09	House	Read first time
2020-02-07	House	Reported from Appropriations with substitute (22-Y 0-N)
2020-02-07	House	Incorporates HB58 (Ware)
2020-02-07	House	Incorporates HB901 (Sickles)
2020-02-07	House	Incorporates HB189 (Levine)
2020-02-07	House	Incorporates HB1494 (Bagby)
2020-02-07	House	Incorporates HB1546 (Adams)
2020-02-07	House	Committee substitute printed 20108018D-H2
2020-02-04	House	Incorporates HB58 (Ware)
2020-02-04	House	Incorporates HB1494 (Bagby)
2020-02-04	House	Incorporates HB1546 (Adams)
2020-02-04	House	Committee substitute printed 20107376D-H1
2020-02-04	House	Referred to Committee on Appropriations
2020-02-04	House	Reported from Labor and Commerce with substitute (22-Y 0-N)
2020-01-30	House	Subcommittee recommends referring to Committee on Appropriations
2020-01-30	House	Subcommittee recommends reporting with substitute (8-Y 0-N)
2020-01-23	House	Assigned L & C sub: Subcommittee #2
2020-01-16	House	Referred to Committee on Labor and Commerce
2020-01-16	House	Referred from General Laws by voice vote
2020-01-08	House	Referred to Committee on General Laws
2020-01-08	House	Prefiled and ordered printed; offered 01/08/20 20102088D

SB172 (Same As) 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1081)
HB58 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB189 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB901 (Same As) 2020-02-07 - Incorporated by Appropriations
HB1494 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB1546 (Same As) 2020-02-04 - Incorporated by Labor and Commerce

Chapter	Article	Section	Citation Type	Statute Text
38	2	3438	(n/a)	See Bill Text
38	2	3445	(n/a)	See Bill Text

Type	Source
Summary	https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+HB1251
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251H1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251H2+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251EH1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251S1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251S2+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1251ER+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP1080+hil
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H1402V0019+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H14V0165+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H02V0212+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H02V0255+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+HV0788+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+S02V0199+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+S05V0511+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV1529HB1251+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV1604HB1251+HB1251
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+HV1924+HB1251