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.
In 2024, Virginia passed legislation amending prior authorization language, and legislation that directed the Board of Health to convene the State Health Services Plan Task Force to make recommendations on expedited review of projects subject to certificate of public need requirements.
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.
A 193 – Virginia
Introduced: 2016 Status: Inactive / Dead
Creates a two-phase process to sunset certificate of public need requirements for many categories of medical care facilities and projects, with the requirement for a certificate of public need (i) for ambulatory and outpatient surgery …
HB 1001 – Virginia
Introduced: 2018 Status: Inactive / Dead
Health care shared savings; incentive programs. 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 health care …
HB 1003 – Virginia
Introduced: 2018 Status: Enacted
Health care data reporting; penalty for failure to report. Provides that any medical care facility that fails to report data on utilization of services for which a certificate of public need is required or data …
HB 1018 – Virginia
Introduced: 2020 Status: Inactive / Dead
Virginia Health Benefit Exchange. Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of …
HB 1037 (see companion bill SB 404) – Virginia
Introduced: 2020 Status: Enacted
Health insurance; short-term limited-duration medical plans. Prohibits carriers from issuing in the Commonwealth, on or after July 1, 2021, any short-term limited-duration medical plan with a duration that exceeds three months or that can be …
Va. Code Ann. § 38.2-316.1. Premium rates: Provisions Relating to Insurance Policies and Contracts – Virginia
Introduced: Status: Enacted
Mandates that accident and sickness insurance premium rates applicable to health benefit plans must be approved prior to issuance.
Download
Va. Code Ann. § 38.2-3418.16. Coverage for telemedicine services: Mandated Benefits – Virginia
Introduced: Status: Enacted
States that each health maintenance organization providing a health care plan for health care services shall provide coverage for the cost of such health care services provided through telemedicine services.
Download
Va. Code Ann. § 38.2-3419.1. Report of costs and utilization of mandated benefits: Mandated Benefits – Virginia
Introduced: Status: Enacted
Beginning with the calendar year 1991, every insurer, health services plan, and health maintenance organization from which a report is deemed necessary under regulations adopted by the Commission shall report to the Commission cost and …
Download
Va. Code Ann. § 54.1-111. Unlawful acts; prosecution; proceedings in equity; civil penalty: Professions and Occupations — General Provisions Relating to Regulatory Boards – Virginia
Introduced: Status: Enacted
Code section permits professional corporations and similar entities (defined in the statute) to enforce non-competes and other contract terms in employment contracts when the entitiy has “a legitimate interest in enforcing the terms of employment …
Download
Va. Code Ann. § 54.1-2952. Supervision of assistants by licensed physician, or podiatrist; services that may be performed by assistants; responsibility of licensee; employment of assistants: Licensure and Certification of Other Practitioners of the Healing Arts – Virginia
Introduced: Status: Enacted
A physician or a podiatrist licensed under this chapter may supervise physician assistants and delegate certain acts which constitute the practice of medicine to the extent and in the manner authorized by the Board.
Download
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