VA HB1251 | 2020 | Regular Session


Completed Legislative Action
Spectrum: Partisan Bill (Democrat 8-0)
Status: Passed on April 10 2020 - 100% progression
Action: 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1080)
Text: Latest bill text (Chaptered) [HTML]


Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes that includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation with health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021.

Tracking Information

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Health insurance; definitions, payment to out-of-network providers, emergency services.


Roll Calls

2020-03-05 - House - House: VOTE: Adoption (98-Y 0-N) (Y: 97 N: 0 NV: 2 Abs: 0) [PASS]
2020-03-05 - Senate - Senate: Passed Senate with substitute (40-Y 0-N) (Y: 39 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-04 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 39 N: 0 NV: 0 Abs: 0) [PASS]
2020-03-02 - Senate - Senate: Reported from Finance and Appropriations (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-24 - Senate - Senate: Reported from Commerce and Labor with substitute (13-Y 2-N) (Y: 12 N: 2 NV: 0 Abs: 0) [PASS]
2020-02-11 - House - House: VOTE: Passage (94-Y 5-N) (Y: 93 N: 5 NV: 1 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-07 - House - House: Reported from Appropriations with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-02-04 - House - House: Reported from Labor and Commerce with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2020-01-30 - House - House: Subcommittee recommends reporting with substitute (8-Y 0-N) (Y: 8 N: 0 NV: 0 Abs: 0) [PASS]


2020-04-10 Governor: Acts of Assembly Chapter text (CHAP1080)
2020-04-10 Governor: Approved by Governor-Chapter 1080 (effective - see bill)
2020-03-17 Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020
2020-03-17HouseEnrolled Bill communicated to Governor on March 17, 2020
2020-03-12SenateSigned by President
2020-03-12HouseSigned by Speaker
2020-03-12HouseBill text as passed House and Senate (HB1251ER)
2020-03-05HouseVOTE: Adoption (98-Y 0-N)
2020-03-05HouseSenate substitute agreed to by House 20109073D-S1 (98-Y 0-N)
2020-03-05SenatePassed Senate with substitute (40-Y 0-N)
2020-03-05SenateEngrossed by Senate - committee substitute HB1251S2
2020-03-05SenateSubstitute by Senator Favola agreed to 20109579D-S2
2020-03-05SenateReading of substitute waived
2020-03-05SenateCommittee substitute rejected 20109073D-S1
2020-03-05SenateRead third time
2020-03-05SenateFloor substitute printed 20109579D-S2 (Favola)
2020-03-04SenateConstitutional reading dispensed (40-Y 0-N)
2020-03-02SenateReported from Finance and Appropriations (14-Y 0-N)
2020-02-24SenateRereferred to Finance and Appropriations
2020-02-24SenateCommittee substitute printed 20109073D-S1
2020-02-24SenateReported from Commerce and Labor with substitute (13-Y 2-N)
2020-02-12SenateReferred to Committee on Commerce and Labor
2020-02-12SenateConstitutional reading dispensed
2020-02-11HouseVOTE: Passage (94-Y 5-N)
2020-02-11HouseRead third time and passed House (94-Y 5-N)
2020-02-10HousePrinted as engrossed 20108018D-EH1
2020-02-10HouseEngrossed by House - committee substitute with amendments HB1251EH1
2020-02-10HouseAmendments by Delegate Torian agreed to
2020-02-10HouseCommittee on Appropriations substitute agreed to 20108018D-H2
2020-02-10HouseCommittee Labor and Commerce substitute rejected 20107376D-H1
2020-02-10HouseRead second time
2020-02-09HouseRead first time
2020-02-07HouseReported from Appropriations with substitute (22-Y 0-N)
2020-02-07HouseIncorporates HB58 (Ware)
2020-02-07HouseIncorporates HB901 (Sickles)
2020-02-07HouseIncorporates HB189 (Levine)
2020-02-07HouseIncorporates HB1494 (Bagby)
2020-02-07HouseIncorporates HB1546 (Adams)
2020-02-07HouseCommittee substitute printed 20108018D-H2
2020-02-04HouseIncorporates HB58 (Ware)
2020-02-04HouseIncorporates HB1494 (Bagby)
2020-02-04HouseIncorporates HB1546 (Adams)
2020-02-04HouseCommittee substitute printed 20107376D-H1
2020-02-04HouseReferred to Committee on Appropriations
2020-02-04HouseReported from Labor and Commerce with substitute (22-Y 0-N)
2020-01-30HouseSubcommittee recommends referring to Committee on Appropriations
2020-01-30HouseSubcommittee recommends reporting with substitute (8-Y 0-N)
2020-01-23HouseAssigned L & C sub: Subcommittee #2
2020-01-16HouseReferred to Committee on Labor and Commerce
2020-01-16HouseReferred from General Laws by voice vote
2020-01-08HouseReferred to Committee on General Laws
2020-01-08HousePrefiled and ordered printed; offered 01/08/20 20102088D

Same As/Similar To

SB172 (Same As) 2020-04-10 - Governor: Acts of Assembly Chapter text (CHAP1081)
HB58 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB189 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB901 (Same As) 2020-02-07 - Incorporated by Appropriations
HB1494 (Same As) 2020-02-04 - Incorporated by Labor and Commerce
HB1546 (Same As) 2020-02-04 - Incorporated by Labor and Commerce

Code Citations

ChapterArticleSectionCitation TypeStatute Text
3823438(n/a)See Bill Text
3823445(n/a)See Bill Text

Virginia State Sources

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Bill Comments