VIRGINIA

Overview

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. We currently cover bills from the 2017-2018 legislative term and key statutes from each state. Search the database for specific bills, statutes or cases by using keyword, key issue category, and/or jurisdiction.

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Additional Resources

LEGISLATIVE CALENDAR

Virginia’s most recent legislative session ran from 1/10/2018 – 3/10/2018. Bills from 2018 will carry over to 2019 for the 2018-2019 legislative term.

2016-2018 BUDGET

Virginia’s biennial budget is enacted into law in even-numbered years, and amendments to it are enacted in odd-numbered years. Virginia enacted its 2016-2018 Biennial Budget during the regular legislative session in 2016. To view Virginia’s Office of Health and Human Resources 2016-2018 Biennial Budget, click 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.

KEY RESOURCES