Virginia Senate Bill 172 (Prior Session Legislation)

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Completed Legislative Action
Spectrum: Bipartisan Bill
Status: Passed on April 10 2020 - 100% progression
Action: 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1081)
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 which 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 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 to 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.

Sen. Barbara Favola [D]	Sen. Amanda Chase [R]	Sen. Jennifer McClellan [D]	Sen. Ryan McDougle [R]
Sen. Jennifer Boysko [D]	Sen. Siobhan Dunnavant [R]	Sen. John Edwards [D]	Sen. Jennifer Kiggans [R]
Sen. Bryce Reeves [R]	Sen. Jill Vogel [R]

2020-03-05 - Senate - Senate: House substitute agreed to by Senate (39-Y 0-N) (Y: 39 N: 0 NV: 1 Abs: 0) [PASS]
2020-03-05 - House - House: VOTE: Passage (99-Y 0-N) (Y: 99 N: 0 NV: 1 Abs: 0) [PASS]
2020-02-28 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-28 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-28 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-26 - House - House: Subcommittee recommends reporting with substitute (8-Y 0-N) (Y: 8 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-11 - Senate - Senate: Passed Senate (36-Y 4-N) (Y: 36 N: 4 NV: 0 Abs: 0) [PASS]
2020-02-11 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-11 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-10 - Senate - Senate: Reported from Finance and Appropriations with amendments (11-Y 5-N) (Y: 11 N: 5 NV: 0 Abs: 0) [PASS]
2020-02-09 - Senate - Senate: Reported from Commerce and Labor with substitute (8-Y 7-N) (Y: 8 N: 7 NV: 0 Abs: 0) [FAIL]

Date	Chamber	Action
2020-04-10		Governor: Acts of Assembly Chapter text (CHAP1081)
2020-04-10		Governor: Approved by Governor-Chapter 1081 (effective - see bill)
2020-03-17		Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020
2020-03-17	Senate	Enrolled Bill Communicated to Governor on March 17, 2020
2020-03-12	House	Signed by Speaker
2020-03-12	Senate	Signed by President
2020-03-12	Senate	Bill text as passed Senate and House (SB172ER)
2020-03-12	Senate	Enrolled
2020-03-05	Senate	Title replaced 20109578D-H2
2020-03-05	Senate	House substitute agreed to by Senate (39-Y 0-N)
2020-03-05	House	VOTE: Passage (99-Y 0-N)
2020-03-05	House	Passed House with substitute (99-Y 0-N)
2020-03-05	House	Engrossed by House - floor substitute SB172H2
2020-03-05	House	Substitute by Delegate Torian agreed to 20109578D-H2
2020-03-05	House	Committee substitute rejected 20109092D-H1
2020-03-05	House	Read third time
2020-03-04	House	Passed by for the day
2020-03-04	House	Floor substitute printed 20109578D-H2 (Torian)
2020-03-03	House	Read second time
2020-02-28	Senate	Incorporates SB522
2020-02-28	House	Reported from Appropriations with substitute (22-Y 0-N)
2020-02-28	House	Committee substitute printed 20109092D-H1
2020-02-26	House	Subcommittee recommends reporting with substitute (8-Y 0-N)
2020-02-23	House	Assigned App. sub: Health & Human Resources
2020-02-18	House	Referred to Committee on Appropriations
2020-02-18	House	Referred from Labor and Commerce by voice vote
2020-02-14	House	Referred to Committee on Labor and Commerce
2020-02-14	House	Read first time
2020-02-14	House	Placed on Calendar
2020-02-11	Senate	Passed Senate (36-Y 4-N)
2020-02-11	Senate	Constitutional reading dispensed (40-Y 0-N)
2020-02-11	Senate	Printed as engrossed 20107408D-ES1
2020-02-11	Senate	Engrossed by Senate - committee substitute with amendments SB172ES1
2020-02-11	Senate	Committee amendments agreed to
2020-02-11	Senate	Reading of amendments waived
2020-02-11	Senate	Committee substitute agreed to 20107408D-S1
2020-02-11	Senate	Reading of substitute waived
2020-02-11	Senate	Read second time
2020-02-11	Senate	Constitutional reading dispensed (40-Y 0-N)
2020-02-10	Senate	Reported from Finance and Appropriations with amendments (11-Y 5-N)
2020-02-09	Senate	Rereferred to Finance and Appropriations
2020-02-09	Senate	Committee substitute printed 20107408D-S1
2020-02-09	Senate	Reported from Commerce and Labor with substitute (8-Y 7-N)
2020-01-15	Senate	Assigned C&L sub: Health Insurance
2019-12-20	Senate	Referred to Committee on Commerce and Labor
2019-12-20	Senate	Prefiled and ordered printed; offered 01/08/20 20101733D

HB1251 (Same As) 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1080)
SB522 (Same As) 2020-02-09 - Incorporated by Commerce and Labor

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+SB172
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172S1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172ES1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172H1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172H2+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+SB172ER+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP1081+hil
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+S02V0116+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+S05V0293+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV0591SB0172+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV0599SB0172+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV0602SB0172+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H0205V0079+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H02V0433+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H02V0473+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+H02V0513+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+HV2010+SB0172
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?201+vot+SV1630SB0172+SB0172