SB 1215

Abstract

Health insurance; carrier contracts; required provisions regarding prior authorization for health care services; work group; report. Requires certain health insurance contracts under which an insurance carrier has the right or obligation to require prior authorization for a health care service, as defined in the bill, to include provisions governing the prior authorization process. Such required provisions include (i) time limits for a carrier to respond to prior authorization requests, (ii) a prohibition on revoking, limiting, making conditional, modifying, or restricting a previously approved prior authorization except under certain circumstances, and (iii) a requirement that a carrier shall provide the reasons for denial of a request. The bill requires a carrier to make publicly available on its website a list of health care services and codes for which prior authorization is required. The foregoing provisions have a delayed effective date of January 1, 2027. The bill requires the State Corporation Commission's Bureau of Insurance to establish a work group to develop and deliver a report related to the bill's provisions by November 1, 2025. This bill is identical to HB 2099.

An Act to amend and reenact § 38.2-3407.15:2 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3407.15:8, relating to health insurance; carrier contracts; required provisions regarding prior authorization for health care services; work group; report.