VA HB1471 | 2023 | Regular Session
Status
Completed Legislative Action
Spectrum: Slight Partisan Bill (Democrat 3-1)
Status: Passed on March 24 2023 - 100% progression
Action: 2023-03-24 - Governor: Acts of Assembly Chapter text (CHAP0474)
Text: Latest bill text (Chaptered) [HTML]
Spectrum: Slight Partisan Bill (Democrat 3-1)
Status: Passed on March 24 2023 - 100% progression
Action: 2023-03-24 - Governor: Acts of Assembly Chapter text (CHAP0474)
Text: Latest bill text (Chaptered) [HTML]
Summary
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.
Title
Health insurance; electronic prior authorization and disclosure of certain information.
Sponsors
Roll Calls
2023-02-20 - House - House: VOTE: Adoption (99-Y 0-N) (Y: 99 N: 0 NV: 0 Abs: 1) [PASS]
2023-02-16 - Senate - Senate: Passed Senate with amendments (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-15 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-13 - Senate - Senate: Reported from Commerce and Labor with amendments (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-30 - House - House: VOTE: (100-Y 0-N) (Y: 100 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-24 - House - House: Reported from Commerce and Energy with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-19 - House - House: Subcommittee recommends reporting with substitute (10-Y 0-N) (Y: 10 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-16 - Senate - Senate: Passed Senate with amendments (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-15 - Senate - Senate: Constitutional reading dispensed (40-Y 0-N) (Y: 40 N: 0 NV: 0 Abs: 0) [PASS]
2023-02-13 - Senate - Senate: Reported from Commerce and Labor with amendments (14-Y 0-N) (Y: 14 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-30 - House - House: VOTE: (100-Y 0-N) (Y: 100 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-24 - House - House: Reported from Commerce and Energy with substitute (22-Y 0-N) (Y: 22 N: 0 NV: 0 Abs: 0) [PASS]
2023-01-19 - House - House: Subcommittee recommends reporting with substitute (10-Y 0-N) (Y: 10 N: 0 NV: 0 Abs: 0) [PASS]
History
| Date | Chamber | Action |
|---|---|---|
| 2023-03-24 | Governor: Acts of Assembly Chapter text (CHAP0474) | |
| 2023-03-24 | Governor: Approved by Governor-Chapter 474 (effective 7/1/23) | |
| 2023-03-02 | Governor: Governor's Action Deadline 11:59 p.m., March 27, 2023 | |
| 2023-03-02 | House | 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 | House | Bill text as passed House and Senate (HB1471ER) |
| 2023-02-23 | House | Enrolled |
| 2023-02-20 | House | VOTE: Adoption (99-Y 0-N) |
| 2023-02-20 | House | Senate amendments agreed to by House (99-Y 0-N) |
| 2023-02-20 | House | Placed on Calendar |
| 2023-02-16 | Senate | Passed Senate with amendments (40-Y 0-N) |
| 2023-02-16 | Senate | Engrossed by Senate as amended |
| 2023-02-16 | Senate | Committee amendment #3 rejected |
| 2023-02-16 | Senate | Committee amendments #1 and #2 agreed to |
| 2023-02-16 | Senate | Reading of amendments waived |
| 2023-02-16 | Senate | Passed by temporarily |
| 2023-02-16 | Senate | Read third time |
| 2023-02-15 | Senate | Constitutional reading dispensed (40-Y 0-N) |
| 2023-02-13 | Senate | Reported from Commerce and Labor with amendments (14-Y 0-N) |
| 2023-01-31 | Senate | Referred to Committee on Commerce and Labor |
| 2023-01-31 | Senate | Constitutional reading dispensed |
| 2023-01-30 | House | VOTE: (100-Y 0-N) |
| 2023-01-30 | House | Read third time and passed House BLOCK VOTE (100-Y 0-N) |
| 2023-01-27 | House | Printed as engrossed 23104853D-EH1 |
| 2023-01-27 | House | Engrossed by House - committee substitute with amendment HB1471EH1 |
| 2023-01-27 | House | Amendment by Delegate Fowler agreed to |
| 2023-01-27 | House | Committee substitute agreed to 23104853D-H1 |
| 2023-01-27 | House | Read second time |
| 2023-01-26 | House | Read first time |
| 2023-01-24 | House | Committee substitute printed 23104853D-H1 |
| 2023-01-24 | House | Reported from Commerce and Energy with substitute (22-Y 0-N) |
| 2023-01-19 | House | Subcommittee recommends reporting with substitute (10-Y 0-N) |
| 2023-01-16 | House | Assigned sub: Subcommittee #2 |
| 2022-12-30 | House | Referred to Committee on Commerce and Energy |
| 2022-12-30 | House | Prefiled and ordered printed; offered 01/11/23 23101242D |
Same As/Similar To
SB1261 (Same As) 2023-03-24 - Governor: Acts of Assembly Chapter text (CHAP0475)
Subjects
Code Citations
| Chapter | Article | Section | Citation Type | Statute Text |
|---|---|---|---|---|
| 38 | 2 | 3407.15:2 | (n/a) | See Bill Text |
| 38 | 2 | 3407.15:8 | (n/a) | See Bill Text |
