Overview
Virginia is an active state in promoting price transparency in health care. 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 law provides prohibition against surprise and balance billing for both emergency and non-emergency healthcare services. The state also enacted legislation that requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered comparable health care service from a lower-cost provider.
In healthcare market competition, the state requires notice to the attorney general for all mergers, acquisitions, and other transactions involving nonprofit hospitals. The merger review criteria for the AG includes factors such as how the transaction will impact access to care and the affordability or cost of care. The legislature also introduced legislation to prohibit anticompetitive contracting practices in provider contracts, including the use of most-favored nation, all-or-nothing, and anti-tiering/anti-steering clauses.
Virginia has considered state system reform initiatives including single payer and public option proposals, and its state-run health insurance marketplace will launch by 2023. Additionally, Virginia’s telehealth parity law encouraged the expansion of telehealth well before the COVID-19 pandemic, as health maintenance organizations are mandated to provide parity in coverage, reimbursement, and cost-sharing for telemedicine services in the state.
See below for an overview of existing Virginia state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 2/25/2023 (2022-2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1041 – Virginia
Introduced: 2024 Status: In Process
Health insurance; cost-sharing, pharmacy benefits managers’ compensation and duties, civil penalty.
HB 1057 – Virginia
Introduced: 2020 Status: Enacted
Health insurance; clinical nurse specialists. Prohibits health insurers and health service plan providers whose policies or contracts cover services that may be legally performed by a licensed clinical nurse specialist from denying reimbursement because the …
HB 1059 – Virginia
Introduced: 2024 Status: In Process
Allows patients, if a hospital is not in compliance with hospital price transparency laws on the date that an elective procedure, test, or service is provided to a patient by the hospital, and the noncompliance …
HB 1075 – Virginia
Introduced: 2022 Status: Inactive / Dead
Health care provider panels; vertically integrated Health care provider panels; vertically integrated carriers; reimbursements to providers. Requires any vertically integrated carrier, upon written request, to offer participation in each requested provider panel or network established …
HB 1081 (see companion bill SB 433) – Virginia
Introduced: 2022 Status: Enacted
Health insurance; calculation of enrollee’s contribution; high deductible health plan. Provides that if the application of the requirement that a carrier, when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement …
HB 1177 (see companion bill SB 933) – Virginia
Introduced: 2018 Status: Enacted
PHARMACISTS AND PHARMACY PRACTICES. Provides that no provider contract between a health carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision (i) authorizing the carrier or its …
HB 1450 – Virginia
Introduced: 2017 Status: Enacted
Pharmacy freedom of choice. Requires a health insurer or health maintenance organization, or its intermediary (the carrier), when it receives notice from a pharmacy’s intermediary of the pharmacy’s agreement to accept reimbursement for its services …
HB 234 – Virginia
Introduced: 2018 Status: Enacted
Health insurance; synchronization of medications. Requires any health plan providing prescription drug coverage to permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply …
HB 2515 (see companion bill SB 1596) – Virginia
Introduced: 2019 Status: Enacted
Health plans; calculation of enrollee’s contribution: Requires any carrier issuing a health plan in the Commonwealth to count any payments made by another person on the enrollee’s behalf, as well as payments made by the …
HB 520 – Virginia
Introduced: 2018 Status: Enacted
Board of Pharmacy; nonresident warehousers and nonresident third-party logistics providers. Requires warehouser or third-party logistics providers that are located outside the Commonwealth and that ship prescription drugs or devices into the Commonwealth to register with …
United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Virginia operates under a two-year (biennial) budget cycle. Each year the Governor prepares the proposed budget bill for introduction by the General Assembly. The biennial budget is enacted into law in even-numbered years, and amendments to it are enacted in odd-numbered years. The budget cycle begins in July.
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
- Virginia General Assembly
- Virginia Office of the Attorney General
- Virginia Bureau of Insurance
- Virginia Department of Planning and Budget