HB 1251

  • Virginia House Bill
  • 2020 Regular Session
  • Introduced in House Jan 08, 2020
  • Passed House Feb 11, 2020
  • Passed Senate Mar 05, 2020
  • Governor

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

Abstract

Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also establishes a standard for calculating the health carrier's required payment to the out-of-network provider of the services. If such provider determines that the amount to be paid by the health carrier does not comply with the applicable requirements, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request the State Corporation Commission to review the disputed reimbursement amount and determine if the amount complies with applicable requirements. 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 requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly. The measure requires the nonprofit data services organization contracting with the Department of Health to operate the All Payer Claims Database to convene an advisory work group to make recommendations for a methodology to be used for identifying codes for comparable emergency services and statistical adjustments to account for outlier payment amounts for each health planning region to be used for the market-based value calculation and submit its recommendations to the Commissioner of Insurance no later than December 31, 2020.

Bill Sponsors (8)

Luke E. Torian

  • Democratic
  • lower
  • 52
Primary

Dawn M. Adams

  • Democratic
  • lower
  • 68
Cosponsor

Lamont Bagby

  • Democratic
  • lower
  • 74
Cosponsor

Mark H. Levine

  • Democratic
  • lower
  • 45
Cosponsor

Wendy W. Gooditis

  • Democratic
  • lower
  • 10
Cosponsor

Mark D. Sickles

  • Democratic
  • lower
  • 43
Cosponsor

Suhas Subramanyam

  • Democratic
  • lower
  • 87
Cosponsor

Rodney T. Willett

  • Democratic
  • lower
  • 73
Cosponsor

Votes


Actions


Mar 05, 2020

Senate

Floor substitute printed 20109579D-S2 (Favola)

House

Senate substitute agreed to by House 20109073D-S1 (98-Y 0-N)

Senate

Passed Senate with substitute (40-Y 0-N)

Senate

Engrossed by Senate - committee substitute HB1251S2

Senate

Substitute by Senator Favola agreed to 20109579D-S2

Senate

Reading of substitute waived

Senate

Committee substitute rejected 20109073D-S1

Senate

Read third time

Mar 04, 2020

Senate

Constitutional reading dispensed (40-Y 0-N)

Mar 02, 2020

Senate

Reported from Finance and Appropriations (14-Y 0-N)

Feb 24, 2020

Senate

Committee substitute printed 20109073D-S1

Senate

Rereferred to Finance and Appropriations

Senate

Reported from Commerce and Labor with substitute (13-Y 2-N)

Feb 12, 2020

Senate

Constitutional reading dispensed

Senate

Referred to Committee on Commerce and Labor

Feb 11, 2020

House

Read third time and passed House (94-Y 5-N)

Feb 10, 2020

House

Printed as engrossed 20108018D-EH1

House

Read second time

House

Committee Labor and Commerce substitute rejected 20107376D-H1

House

Committee on Appropriations substitute agreed to 20108018D-H2

House

Amendments by Delegate Torian agreed to

House

Engrossed by House - committee substitute with amendments HB1251EH1

Feb 09, 2020

House

Read first time

Feb 07, 2020

House

Reported from Appropriations with substitute (22-Y 0-N)

House

Incorporates HB58 (Ware)

House

Incorporates HB901 (Sickles)

House

Incorporates HB189 (Levine)

House

Incorporates HB1494 (Bagby)

House

Committee substitute printed 20108018D-H2

House

Incorporates HB1546 (Adams)

Feb 04, 2020

House

Referred to Committee on Appropriations

House

Incorporates HB58 (Ware)

House

Incorporates HB1494 (Bagby)

House

Incorporates HB1546 (Adams)

House

Committee substitute printed 20107376D-H1

House

Reported from Labor and Commerce with substitute (22-Y 0-N)

Jan 30, 2020

House

Subcommittee recommends reporting with substitute (8-Y 0-N)

House

Subcommittee recommends referring to Committee on Appropriations

Jan 23, 2020

House

Assigned L & C sub: Subcommittee #2

Jan 16, 2020

House

Referred from General Laws by voice vote

House

Referred to Committee on Labor and Commerce

Jan 08, 2020

House

Prefiled and ordered printed; offered 01/08/20 20102088D

House

Referred to Committee on General Laws

Bill Text

Bill Text Versions Format
House amendments adopted HTML
House subcommittee amendments and substitutes adopted HTML
House: Prefiled and ordered printed; offered 01/08/20 20102088D HTML
House: Committee substitute printed 20107376D-H1 HTML
House: Committee substitute printed 20108018D-H2 HTML
House: Printed as engrossed 20108018D-EH1 HTML
Senate: Committee substitute printed 20109073D-S1 HTML
Senate: Floor substitute printed 20109579D-S2 (Favola) HTML

Related Documents

Document Format
No related documents.

Sources

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