Virginia Senate Bill 1261 (Prior Session Legislation)

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Completed Legislative Action
Spectrum: Partisan Bill (Republican 1-0)
Status: Passed on March 24 2023 - 100% progression
Action: 2023-03-24 - Governor: Acts of Assembly Chapter text (CHAP0475)
Text: Latest bill text (Chaptered) [HTML]

Health insurance; electronic prior authorization and disclosure of certain information; out-of-pocket costs; report. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to all e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests (a) for which no additional information is needed by the carrier to process the prior authorization request, (b) for which no clinical review is required, and (c) that meet the carrier's criteria for approval; (iv) links directly to real-time patient out-of-pocket costs for the office visit; and (v) otherwise meets the requirements for contracts between carriers and participating health care providers. The bill prohibits a carrier from (a) imposing a fee or charge on any person for accessing the required online process who is required to do so or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill also requires carriers, no later than July 1, 2024, to provide contact information of any third-party vendor or other entity the carrier will use to meet the requirements of the bill to any provider that requests such information. The carrier may post such information on its website to meet such requirement. Health insurance; electronic prior authorization and disclosure of certain information; out-of-pocket costs; report. Requires each health insurance carrier, beginning July 1, 2025, to establish and maintain an online process that (i) links directly to all e-prescribing systems and electronic health record systems that utilize the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve electronic prior authorization requests (a) for which no additional information is needed by the carrier to process the prior authorization request, (b) for which no clinical review is required, and (c) that meet the carrier's criteria for approval; (iv) links directly to real-time patient out-of-pocket costs for the office visit; and (v) otherwise meets the requirements for contracts between carriers and participating health care providers. The bill prohibits a carrier from (a) imposing a fee or charge on any person for accessing the required online process who is required to do so or (b) accessing, absent provider consent, provider data via the online process other than for the enrollee. The bill also requires carriers, no later than July 1, 2024, to provide contact information of any third-party vendor or other entity the carrier will use to meet the requirements of the bill to any provider that requests such information. The carrier may post such information on its website to meet such requirement. The bill requires participating health care providers, beginning July 1, 2025, to ensure that any e-prescribing system or electronic health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access, at the point of prescribing, the electronic prior authorization process established by a carrier and real-time patient-specific benefit information, including out-of-pocket costs and more affordable medication alternatives made available by a carrier. The bill provides that a provider may request a waiver of compliance for undue hardship for a period not to exceed 12 months. The bill requires any carrier or its pharmacy benefits manager to provide real-time patient-specific information to enrollees and contracted providers for the office visit, including any out-of-pocket costs and more affordable medication alternatives or prior authorization requirements, and to ensure that the data is accurate. The bill requires that such cost information data be available to the provider at the point of prescribing in an accessible and understandable format, such as through the provider's e-prescribing system or electronic health record system that the carrier or pharmacy benefits manager or its designated subcontractor has adopted that utilizes the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard from which the provider makes the request. The bill requires the State Corporation Commission's Bureau of Insurance to, in coordination with the Secretary of Health and Human Resources, establish a work group to assess implementation and develop recommendations for electronic prior authorization and real-time cost benefit information for prescription drugs, to evaluate and make recommendations to establish a process for electronic prior authorization for surgery and other procedures, and to evaluate and make recommendations to establish an online process for a real-time link at the point of prescribing for any available prescription coupons. The work group shall report its findings and recommendations to the Chairmen of the Senate Committees on Commerce and Labor and Education and Health and the House Committees on Commerce and Energy and Health, Welfare and Institutions annually by November 1 and shall make its final report by November 1, 2025.

Health insurance; electronic prior authorization and disclosure of certain information.

Sen. Siobhan Dunnavant [R]

2023-02-20 - Senate - Senate: House amendment agreed to by Senate (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-17 - House - House: VOTE: Block Vote Passage (99-Y 0-N) (Y: 99 N: 0 NV: 0 Abs: 1) [PASS]
2023-02-14 - House - House: Reported from Commerce and Energy with amendment(s) (21-Y 0-N) (Y: 21 N: 0 NV: 0 Abs: 1) [PASS]
2023-02-02 - Senate - Senate: Passed Senate (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-02 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-01 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-31 - Senate - Senate: Reported from Finance and Appropriations with substitute (15-Y 0-N) (Y: 15 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-23 - Senate - Senate: Reported from Commerce and Labor with amendments (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]

Date	Chamber	Action
2023-03-24		Governor: Acts of Assembly Chapter text (CHAP0475)
2023-03-24		Governor: Approved by Governor-Chapter 475 (effective 7/1/23)
2023-03-02		Governor: Governor's Action Deadline 11:59 p.m., March 27, 2023
2023-03-02	Senate	Enrolled Bill Communicated to Governor on March 2, 2023
2023-02-25	Senate	Signed by President
2023-02-23	House	Signed by Speaker
2023-02-23	Senate	Bill text as passed Senate and House (SB1261ER)
2023-02-23	Senate	Enrolled
2023-02-20	Senate	House amendment agreed to by Senate (40-Y 0-N)
2023-02-17	House	VOTE: Block Vote Passage (99-Y 0-N)
2023-02-17	House	Passed House with amendment BLOCK VOTE (99-Y 0-N)
2023-02-17	House	Engrossed by House as amended
2023-02-17	House	Committee amendment agreed to
2023-02-17	House	Read third time
2023-02-16	House	Read second time
2023-02-14	House	Reported from Commerce and Energy with amendment(s) (21-Y 0-N)
2023-02-10	House	Referred to Committee on Commerce and Energy
2023-02-10	House	Read first time
2023-02-10	House	Placed on Calendar
2023-02-02	Senate	Passed Senate (40-Y 0-N)
2023-02-02	Senate	Constitutional reading dispensed (40-Y 0-N)
2023-02-02	Senate	Engrossed by Senate - committee substitute SB1261S1
2023-02-02	Senate	Committee substitute agreed to 23105922D-S1
2023-02-02	Senate	Reading of substitute waived
2023-02-02	Senate	Commerce and Labor Committee amendments rejected
2023-02-02	Senate	Read second time
2023-02-01	Senate	Constitutional reading dispensed (40-Y 0-N)
2023-01-31	Senate	Committee substitute printed 23105922D-S1
2023-01-31	Senate	Reported from Finance and Appropriations with substitute (15-Y 0-N)
2023-01-23	Senate	Rereferred to Finance and Appropriations
2023-01-23	Senate	Reported from Commerce and Labor with amendments (14-Y 0-N)
2023-01-10	Senate	Referred to Committee on Commerce and Labor
2023-01-10	Senate	Prefiled and ordered printed; offered 01/11/23 23103745D

HB1471 (Same As) 2023-03-24 - Governor: Acts of Assembly Chapter text (CHAP0474)

Chapter	Article	Section	Citation Type	Statute Text
38	2	3407.15:2	(n/a)	See Bill Text
38	2	3407.15:7	(n/a)	See Bill Text

Type	Source
Summary	https://lis.virginia.gov/cgi-bin/legp604.exe?231+sum+SB1261
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?231+ful+SB1261+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?231+ful+SB1261S1+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?231+ful+SB1261ER+hil
Text	https://lis.virginia.gov/cgi-bin/legp604.exe?231+ful+CHAP0475+hil
Amendment	https://committees.lis.virginia.gov/pdfs/drafts/23105131A.pdf
Amendment	https://lis.virginia.gov/cgi-bin/legp604.exe?231+amd+SB1261AS
Amendment	https://lis.virginia.gov/cgi-bin/legp604.exe?231+amd+SB1261ASR
Amendment	https://lis.virginia.gov/cgi-bin/legp604.exe?231+amd+SB1261AH
Amendment	https://lis.virginia.gov/cgi-bin/legp604.exe?231+amd+SB1261AHE
Supplement	https://lis.virginia.gov/cgi-bin/legp604.exe?231+oth+SB1261F122+PDF
Supplement	https://lis.virginia.gov/cgi-bin/legp604.exe?231+oth+SB1261FS1122+PDF
Supplement	https://lis.virginia.gov/cgi-bin/legp604.exe?231+oth+SB1261FER122+PDF
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+S02V0033+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+S05V0162+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+SV0193SB1261+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+SV0209SB1261+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+SV0210SB1261+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+H23V0140+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+HV1955+SB1261
Roll Call	https://lis.virginia.gov/cgi-bin/legp604.exe?231+vot+SV0646SB1261+SB1261