Virginia operates an All-Payer Claims Database and provides other datasets online relating to cost and quality, including the average charge data for 25 of the most frequently reported health care services. All medical facilities and health maintenance organizations are required to submit utilization data to the Commissioner to populate the database. Virginia has been active in passing many legislations to increase healthcare transparency, for both the 2015-2016 and 2017-2018 legislative terms.
In the 2018 legislative session, Virginia passed HB 1177/SB 933, which prohibits pharmacy benefit managers from collecting a fee more than the applicable co-payment for a covered prescription and enables them to disclose the availability of a more affordable equivalent of the drug to consumers. The Legislature sought to offer short-term insurance plans through SB 844, but the Governor vetoed the measured after it passed in the House and Senate.
The State Database
The Source tracks state activities impacting healthcare price and competition in both legislation and litigation in a searchable database to help stakeholders at the state level understand their legal and regulatory environment as they make efforts to improve access, quality, and efficiency, and reduce costs in healthcare.
LEGISLATION: The Database of State Laws Impacting Healthcare Cost and Quality (SLIHCQ), created by The Source on Healthcare Price & Competition and Catalyst for Payment Reform, catalogues state legislation governing price transparency, provider market power, provider payment, provider networks, and benefit design. The database also includes pharmaceutical legislation beginning in the 2017-2018 legislative session. *Note: Current legislative session bill updates are ongoing. Check back weekly for updates.
LITIGATION: The Source tracks major litigation and antitrust enforcement action by federal entities (FTC or DOJ), state attorney generals, and private parties in the main provider and insurer markets, particularly legal challenges of healthcare consolidation and anticompetitive contract provisions. Additionally, the database contains major pharmaceutical cases including legislation challenges and significant appellate cases.
Search the database across all jurisdictions on the State Overview page, or view and filter existing legislation or litigation on individual state pages. The database allows customized search and filter by keyword, status, and/or key issue category. *Multiple filter/selections enabled. Click here for User Guide.
LEGISLATIVE CALENDARVirginia’s latest legislative session ran from 1/9/2019 – 2/23/2019. Bills from 2018 were carried over to 2019 as part of the 2018-2019 legislative term.
2018-2020 BUDGETVirginia’s biennial budget is enacted into law in even-numbered years, and amendments to it are enacted in odd-numbered years. Virginia enacted its 2018-2020 Biennial Budget during the regular legislative session in 2018. To view Virginia’s Office of Health and Human Resources 2018-2020 Biennial Budget, click here (See executive amendments to the budget here).
REGULATION & ENFORCEMENT
- On March 21, 2014, The Virginia Attorney General, Mark R. Herring, filed an amicus brief on behalf of the Commonwealth in support of the federal government in the case of King v. Sebelius. Plaintiffs alleged that the premium assistance tax credits are only available to purchasers on state-operated exchange, not federally-operated exchanges. The Fourth Circuit Court of Appeals ultimately affirmed the lower court’s decision in King v. Burrell that purchasers on federally-operated exchanges are eligible for financial assistance.