VIRGINIA

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


Current Legislative Session: 1/13/2021 - 2/27/2021 (2020-2021 term). *Current session bill updates are ongoing. Check back weekly for updates.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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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

 

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