SB 750 — Behavioral Health Hospital Authority; created, report.

5.

Provide oversight of the Department of Behavioral Health and Developmental Services and community-based providers to identify system-level issues and conditions affecting quality of care and safety and provide recommendations to alleviate such issues and conditions;

6.

Implement a program to promote awareness of the complaints line operated by the Office of the State Inspector General among residents of facilities operated by the Department of Behavioral Health and Developmental Services and persons receiving services from community-based providers regulated by the Department of Behavioral Health and Developmental Services;

7.

Review, comment on, and make recommendations about, as appropriate, any reports prepared by the Department of Behavioral Health and Developmental Services and the critical incident data collected by the Department of Behavioral Health and Developmental Services in accordance with regulations adopted under § 37.2-400 to identify issues related to quality of care, seclusion and restraint, medication usage, abuse and neglect, staff recruitment and training, and other systemic issues;

8.

As deemed necessary, monitor, review, and comment on regulations adopted by the Board of Behavioral Health and Developmental Services;

and 9.

Receive reports, information, and complaints from the Commonwealth's designated protection and advocacy system concerning issues related to quality of care provided in state facilities and by providers, including licensed mental health treatment units in state correctional facilities, and conduct independent reviews and investigations.

§ 2.2-507.

Legal service in civil matters.

A.

All legal service in civil matters for the Commonwealth, the Governor, and every state department, institution, division, commission, board, bureau, agency, entity, official, court, or judge, including the conduct of all civil litigation in which any of them are interested, shall be rendered and performed by the Attorney General, except as provided in this chapter and except for any litigation concerning a justice or judge initiated by the Judicial Inquiry and Review Commission.

No regular counsel shall be employed for or by the Governor or any state department, institution, division, commission, board, bureau, agency, entity, or official.

The Attorney General may represent personally or through one or more of his assistants any number of state departments, institutions, divisions, commissions, boards, bureaus, agencies, entities, officials, courts, or judges that are parties to the same transaction or that are parties in the same civil or administrative proceeding and may represent multiple interests within the same department, institution, division, commission, board, bureau, agency, or entity.

The soil and water conservation district directors or districts may request legal advice from local, public, or private sources;

however, upon request of the soil and water conservation district directors or districts, the Attorney General shall provide legal service in civil matters for such district directors or districts.

B.

The Attorney General may represent personally or through one of his assistants any of the following persons who are made defendant in any civil action for damages arising out of any matter connected with their official duties:

1.

Members, agents, or employees of the Virginia Alcoholic Beverage Control Authority;

2.

Agents inspecting or investigators appointed by the State Corporation Commission;

3.

Agents, investigators, or auditors employed by the Department of Taxation;

4.

Members, agents, or employees of the State Board of Behavioral Health and Developmental Services, the Department of Behavioral Health and Developmental Services, the State Board of Health, the State Department of Health, the Department of General Services, the State Board of Social Services, of 50 the Department of Social Services, the State Board of Local and Regional Jails, the Department of Corrections, the State Board of Juvenile Justice, the Department of Juvenile Justice, the VirgiIia Parole Board, or the Department of Agriculture and Consumer Services;

N or the Department of Rail and Public Transportation;ation Board, the Department of Transportation, 6.

Persons employed by the Commissioner of Motor Vehicles;

T 7.

Persons appointed by the Commissioner of Marine Resources;

R 8.

Police officers appointed by the Superintendent of State Police;

9.

Conservation police officers appointed by the Department of Wildlife Resources;

O 10.

Hearing officers appointed to hear a teacher's grievance pursuant to § 22.1-311;

D 11.

Staff members or volunteers participating in a court-appointed special advocate program pursuant to 12.

Any emergency medical services agency that is a licensee of the Department of Health in any civil matter and any guardian ad litem appointed by a court in a civil matter brought against him for alleged errors or omissions in the discharge of his court-appointed duties;

E 13.

Conservation officers of the Department of Conservation and Recreation;

or 14.

A person appointed by written order of a circuit court judge to run an existing corporation or company as the judge's representative, when that person is acting in execution of a lawful order of the court and the order specifically refers to this section and appoints such person to serve as an agent of the15.

Members or employees of the Behavioral Health Hospital Authority.

Upon request of the affected individual, the Attorney General may represent personally or through one of his assistants (i) any basic or advanced emergency medical care attendant or technician possessing a valid certificate issued by authority of the State Board of Health in any civil matter in which a defense of immunity from liability is raised pursuant to § 8.01-225 or (ii) any member Sf the General Assembly in any civil matter alleging that such member in his official capacity violate7 the Virginia Freedom of Information Act (§ 2.2-3700 et seq.) pursuant to § 2.2-3713 or 2.2-3714.

0 service to be rendered by him or one of his assistants, he may employ special counsel for this purpose, whose compensation shall be fixed by the Attorney General.

The compensation for such special counsel shall be paid out of the funds appropriated for the administration of the board, commission, division, or department being represented or whose members, officers, inspectors, investigators, or other employees are being represented pursuant to this section.

Notwithstanding any provision of this section to the contrary, the Supreme Court may employ its own counsel in any matter arising out of its official duties in which it, or any justice, is a party.

§ 2.2-1124.

Disposition of surplus materials.ted in § 16.1-88.03.

A.

For purposes of this section, "surplus materials" means personal property, including materials, supplies, equipment, and recyclable items, but does not include property as defined in § 2.2-1147 that is determined to be surplus.

"Surplus materials" does not include finished products that a state hospital operated by the Behavioral Health Hospital Authority or training center operated by the Department of Behavioral Health and Developmental Services sells for the benefit of individuals receiving services in the state hospital or training center, provided that (i) most of the supplies, equipment, or products have center have substantially altered the supplies, equipment, or products in the course of occupational oraining other therapy;

and (iii) the substantial alterations have resulted in a finished product.

B.

The Department shall establish procedures for the disposition of surplus materials from departments, divisions, institutions, and agencies of the Commonwealth.

Such procedures shall:

1.

Permit surplus materials to be transferred between or sold to departments, divisions, institutions, or agencies of the Commonwealth;

2.

Permit surplus materials to be sold to Virginia charitable corporations granted tax-exempt status that are organized for the delivery of primary health care services (i) as federally qualified health centers designated by the Health Care Financing Administration or (ii) at a reduced or sliding fee scale or without charge;

3.

Permit public sales or auctions, including online public auctions;

4.

Permit surplus motor vehicles to be sold prior to public sale or auction to local social service departments for the purpose of resale at cost to TANF recipients;

5.

Permit surplus materials to be sold to Virginia charitable corporations granted tax-exempt status und6.

Permit donations to political subdivisions of the Commonwealth under the circumstances specified SB750 4 of 50 in this section;

7.

Permit other methods of disposal when (a) the cost of the sale will exceed the potential revenue to be derived therefrom or (b) the surplus material is not suitable for sale;

8.

Permit any animal especially trained for police work to be sold at a price of $1 to the handler who last was in control of the animal.

The agency or institution may allow the immediate survivor of any full-time sworn law-enforcement officer who (i) is killed in the line of duty or (ii) dies in service and has at least 10 years of service to purchase the service animal at a price of $1.

Any such sale shall not be deemed a violation of the State and Local Government Conflict of Interests Act (§ 2.2-3100 et seq.);

9.

Permit the transfer of surplus clothing to an appropriate department, division, institution, or agency of the Commonwealth for distribution to needy individuals by and through local social services boards;

10.

Encourage the recycling of paper products, beverage containers, electronics, and used motor oil;

11.

Require the proceeds from any sale or recycling of surplus materials be promptly deposited into the state treasury in accordance with § 2.2-1802 and report the deposit to the State Comptroller;

12.

Permit donations of surplus computers and related equipment to:

a.

Public schools in the Commonwealth;

b.

Virginia charitable corporations granted tax-exempt status under § 501(c)(3) of the Internal Revenue Code and providing services to persons with disabilities, at-risk youths, or low-income families.

For the purposes of this subdivision, "at-risk youths" means school-age children approved eligible to receive free or reduced price meals in the federally funded lunch program;

and c.

Organizations in the Commonwealth granted tax-exempt status under § 501(c)(3) of the Internal Revenue Code that refurbish computers and related equipment for donation to veterans and active military, naval, or air service members, as defined in § 2.2-2000.1.

Any donation to an organization under this subdivision shall be conditioned upon, and in consideration of, the organization's promise to refurbish the donated equipment and distribute it free of charge to such veterans or active military, naval, or air service members.

13.

Permit surplus materials to be transferred or sold, prior to public sale or auction, to public television stations located in the state and other nonprofit organizations approved for the distribution of federal surplus materials;

14.

Permit a public institution of higher education to dispose of its surplus materials at the location where the surplus materials are held and to retain any proceeds from such disposal, provided that the institution meets the conditions prescribed in subsection A of § 23.1-1002 and § 23.1-1019 (regardless of whether or not the institution has been granted any authority under Article 4 (§ 23.1-1004 et seq.) of Chapter 10 of Title 23.1);

15.

Permit surplus materials from (i) the Department of Defense Excess Property Program or (ii) other surplus property programs administered by the Commonwealth to be transferred or sold to Virginia charitable corporations granted tax-exempt status under § 501(c)(3) of the Internal Revenue Code and operating as an educational institution devoted to emergency management training, preparedness, and response;

16.

Require, to the extent practicable, the recycling and disposal of computers and other information technology assets.

Additionally, for computers or information technology assets that may contain confidential state data or personal identifying information of citizens of the Commonwealth, the Department shall ensure all policies for the transfer or other disposition of computers or information technology assets are consistent with data and information security policies developed by the Virginia Information Technologies Agency;

and 17.

Permit surplus materials to be sold, prior to public sale or auction, to (i) service disabled veteran-owned businesses, (ii) veterans service organizations, (iii) active military-owned businesses, and (iv) military spouse-owned businesses.

For purposes of this subdivision:

"Active military" means military service members who perform full-time duty in the Armed Forces of the United States, or a reserve component thereof, including the National Guard.

"Military spouse" means a person whose spouse is an active military, naval, or air service member or veteran as those terms are defined in § 2.2-2000.1.

"Military spouse-owned business" means a business concern that is at least 51 percent owned by one or more military spouses or, in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more individuals who are military spouses and both the management and daily business operations are controlled by one or more individuals who are military spouses.

"Service disabled veteran" means the same as that term is defined in § 2.2-2000.1.

"Service disabled veteran-owned business" means the same as that term is defined in § 2.2-2000.1.

"Veterans service organization" means an association or other entity organized for the benefit of of 50 veterans that has been recognized by the U.S.

Department of Veterans Affairs or chartered by Congress.

C.

The Department shall dispose of surplus materials pursuant to the procedures established In subsection B or permit any department, division, institution, or agency of the Commonwealth to Nispose disposed of without prior consent of the head of the department, division, institution, or agency of the Commonwealth in possession of such surplus materials or the Governor.

T D.

Departments, divisions, institutions, or agencies of the Commonwealth or the Governor mayR donate surplus materials only under the following circumstances:

1.

Emergencies declared in accordance with § 44-146.18:2 or 44-146.28;

O 2.

As set forth in the budget bill as defined by § 2.2-1509, provided that (a) the budget biDl contains a description of the surplus materials, the method by which the surplus materials shall be distributed, Department of Planning and Budget in sufficient time for inclusion in the budget bill;rtment toUthe 3.

When the market value of the surplus materials, which shall be donated for a public purpose, is less than $500;

however, the total market value of all surplus materials so donated by any depaEtment, division, institution, or agency shall not exceed 25 percent of the revenue generated by such department's, division's, institution's, or agency's sale of surplus materials in the fiscal year, except these limits shall not apply in the case of surplus computer equipment and related items donated to Virginia public schools;

or subdivision in the Commonwealth to the head of a department, division, institution, or agency.litical E.

On or before October 1 of each year, the Department shall prepare, and file with the Secretary of the Commonwealth, a plan that describes the expected disposition of surplus materials in the upcoming fiscal year pursuant to subdivision B 6.

F.

The Department may make available to any local public body of the Commonwealth the servicSs or facilities authorized by this section;

however, the furnishing of any such services shall no7 limit or impair any services normally rendered any department, division, institution, or agency of the 0 Property Program under the guidelines established pursuant to this section and the surplus property policies and procedures of the Department.

Proceeds from the sale of the surplus property shall be returned to the local body minus a service fee.

The service fee charged by the Department shall be consistent with the fee charged by the Department to state public bodies.

§ 2.2-1839.

Risk management plans administered by the Department of the Treasury's Risk Management Division for political subdivisions, constitutional officers, etc.

A.

The Division shall establish one or more risk management plans specifying the terms and insurance, self-insurance or a combination of self-insurance and purchased insurance to providesed protection against liability imposed by law for damages and against incidental medical payments resulting from any claim made against any county, city or town;

authority, board, or commission;

sanitation, soil and water, planning or other district;

public service corporation owned, operated or controlled by a locality or local government authority;

constitutional officer;

state court-appointed attorney;

any attorney for any claim arising out of the provision of pro bono legal services for custody and visitation to an eligible indigent person under a program approved by the Supreme Court of Virginia 54.1-3936;

any attorney authorized by the Virginia State Bar for any claim arising out of the provision of pro bono legal services in a Virginia State Bar approved program;

affiliate or foundation of a state department, agency or institution;

any clinic that is organized in whole or primarily for the delivery of health care services without charge;

volunteer drivers for any nonprofit organization providing transportation for persons who are elderly, disabled, or indigent to medical treatment and services, provided the volunteer driver has successfully completed training approved by the Division;

any local chapter or program of the Meals on Wheels Association of America or any area agency on aging, volunteer drivers for such entities who have successfully completed training approved by the Division;

any individual serving as a guardian or limited guardian as defined in § 64.2-2000 for any individual receiving services from a community services board or behavioral health authority or from a state facility hospital operated by the Behavioral Health Hospital Authority or training center operated by the Department of Behavioral Health and Developmental Services;

for nontransportation-related state construction contracts less than $500,000, where the bid bond requirements are waived, prospective contractors shall be prequalified for each individual project in accordance with § 2.2-4317;

or the authorized governmental or proprietary capacity and in the course and scope of employment orile in an SB750 6 of 50 authorization.

For the purposes of this section, "delivery of health care services without charge" shall be deemed to include the delivery of dental, medical or other health services when a reasonable minimum fee is charged to cover administrative costs.

For purposes of this section, a sheriff or deputy sheriff shall be considered to be acting in the scope of employment or authorization when performing any law-enforcement-related services authorized by the sheriff, and coverage for such service by the Division shall not be subject to any prior notification to or authorization by the Division.

B.

In any case in which the coverage provided by one or more risk management plans established pursuant to this section applies, no sheriff or deputy shall be liable for any verdict or civil judgment in his individual capacity in excess of the approved maximum coverage amount as established by the Division and set forth in the respective coverage plans, which shall be at least $1.5 million for sheriffs and deputies.

If a jury returns an award in excess of $1.5 million, the judge shall reduce the award and enter judgment against the sheriff or deputy for such damages in the amount of $1.5 million, provided that this shall not affect the ability of a court to order a remittitur.

Nothing in this subsection shall be construed to limit the ability of a plaintiff to pursue the full amount of any judgment against a sheriff or deputy from any available insurance coverage.

To the extent that any such award exceeds the coverage available under such risk management plans, the sheriff and any deputy shall be considered immune defendants under subsection F of § 38.2-2206.

Automobile insurance carried by a sheriff or deputy in his personal capacity shall not be available to satisfy any verdict or civil judgment under the circumstances in which coverage is provided by one or more risk management plans.

C.

Participation in the risk management plan shall be voluntary and shall be approved by the participant's respective governing body or by the State Compensation Board in the case of constitutional officers;

by the office of the Executive Secretary of the Virginia Supreme Court in the case of state court-appointed attorneys, including attorneys appointed to serve as receivers under § 54.1-3900.01 or 54.1-3936, or attorneys under Virginia Supreme Court approved programs;

by the Virginia State Bar in the case of attorneys providing pro bono services under Virginia State Bar approved programs;

by the Chief Executive Officer of the Behavioral Health Hospital Authority for any individual serving as a guardian or limited guardian for any individual receiving services in a state hospital operated by the Behavioral Health Hospital Authority, the Commissioner of the Department of Behavioral Health and Developmental Services for any individual serving as a guardian or limited guardian for any individual receiving services from a state facility training center operated by the Department, or by the executive director of a community services board or behavioral health authority for any individual serving as a guardian or limited guardian for any individual receiving services from the board or authority;

and by the Division.

Upon such approval, the Division shall assume sole responsibility for plan management, compliance, or removal.

The Virginia Supreme Court shall pay the cost for coverage of eligible persons performing services in approved programs of the Virginia Supreme Court.

The Virginia State Bar shall pay the cost for coverage of eligible attorneys providing pro bono services in Virginia State Bar approved programs.

The Behavioral Health Hospital Authority shall be responsible for paying the cost of coverage for eligible persons performing services as a guardian or limited guardian for any individual receiving services from a state hospital operated by the Behavioral Health Hospital Authority.

The Department of Behavioral Health and Developmental Services shall be responsible for paying the cost of coverage for eligible persons performing services as a guardian or limited guardian for any individual receiving services from a state facility training center operated by the Department.

The applicable community services board or behavioral health authority shall be responsible for paying the cost of coverage for eligible persons performing services as a guardian or limited guardian for individuals receiving services from the board or authority.

D.

The Division shall provide for the legal defense of participating entities and shall reserve the right to settle or defend claims presented under the plan.

All prejudgment settlements shall be approved in advance by the Division.

E.

The risk management plan established pursuant to this section shall provide for the establishment of a trust fund for the payment of claims covered under such plan.

The funds shall be invested in the manner provided in § 2.2-1806 and interest shall be added to the fund as earned.

The trust fund shall also provide for payment of legal defense costs, actuarial costs, administrative costs, contractual costs and all other expenses related to the administration of such plan.

F.

The Division shall, in its sole discretion, set the premium and administrative cost to be paid to it for providing a risk management plan established pursuant to this section.

The premiums and administrative costs set by the Division shall be payable in the amounts at the time and in the manner that the Division in its sole discretion shall require.

The premiums and administrative costs need not be uniform among participants, but shall be set so as to best ensure the financial stability of the plan.

G.

Notwithstanding any provision to the contrary, a sheriff's department of any city or county, or a regional jail shall not be precluded from securing excess liability insurance coverage beyond the of 50 coverage provided by the Division pursuant to this section.

§ 2.2-2818.

Health and related insurance for state employees.

I A.

The Department of Human Resource Management shall establish a plan, subject to the approvNl hospitalization, medical, surgical and major medical coverage, for state employees and retired state employees with the Commonwealth paying the cost thereof to the extent of the coverage included in such plan.

The same plan shall be offered to all part-time state employees, but the total cost Rhall be paid by such part-time employees.

The Department of Human Resource Management shall administer this section.

The plan chosen shall provide means whereby coverage for the families or dependents of state employees may be purchased.

Except for part-time employees, the Commonwealth may pay all Dr a portion of the cost thereof, and for such portion as the Commonwealth does not pay, the employee, of coverage for an employee.ee, may purchase the coverage by paying the additional cost over thU cost Such contribution shall be financed through appropriations provided by law.

C B.

The plan shall:

E 1.

Include coverage for low-dose screening mammograms for determining the presence of occult breast cancer.

Such coverage shall make available one screening mammogram to persons age 35 through 39, one such mammogram biennially to persons age 40 through 49, and one such mammogram annually to persons age 50 and over and may be limited to a benefit of $50 per mammogram subject to such generally.its, deductibles, and coinsurance factors as are no less favorable than for physical illness The term "mammogram" shall mean an X-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the X-ray tube, filter, compression device, screens, film, and cassettes, with an average radiation exposure of less than one rad mid-breast, two views of each breast.

S In order to be considered a screening mammogram for which coverage shall be made available u7der this section:

0 licensure and, in the case of an enrollee of a health maintenance organization, by the health maintenance organization provider;

(ii) performed by a registered technologist;

(iii) interpreted by a qualified radiologist;

and (iv) performed under the direction of a person licensed to practice medicine and surgery and certified by the American Board of Radiology or an equivalent examining body.

A copy of the mammogram report shall be sent or delivered to the health care practitioner who ordered it;

b.

The equipment used to perform the mammogram shall meet the standards set forth by the Virginia Department of Health in its radiation protection regulations;

and accordance with the American College of Radiology guidelines or state law.rforming the examination in 2.

Include coverage for postpartum services providing inpatient care and a home visit or visits that shall be in accordance with the medical criteria, outlined in the most current version of or an official update to the "Guidelines for Perinatal Care" prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or the "Standards for Obstetric-Gynecologic Services" prepared by the American College of Obstetricians and Gynecologists.

Such coverage shall be provided incorporating any changes in such Guidelines or Standards within six months of the publication of 3.

Include an appeals process for resolution of complaints that shall provide reasonable procedures for the resolution of such complaints and shall be published and disseminated to all covered state employees.

The appeals process shall be compliant with federal rules and regulations governing nonfederal, self-insured governmental health plans.

The appeals process shall include a separate expedited emergency appeals procedure that shall provide resolution within time frames established by federal law.

For appeals involving adverse decisions as defined in § 32.1-137.7, the Department shall contract with one or more independent review organizations to review such decisions.

Independent determinations.

The Department shall adopt regulations to assure that the independent reviewt organization conducting the reviews has adequate standards, credentials and experience for such review.

The independent review organization shall examine the final denial of claims to determine whether the decision is objective, clinically valid, and compatible with established principles of health care.

The decision of the independent review organization shall (i) be in writing, (ii) contain findings of fact as to the material issues in the case and the basis for those findings, and (iii) be final and binding if consistent with law and policy.

the independent review organization conducting the review of a denial of claims has no relationship ort SB750 8 of 50 association with (i) the covered person or the covered person's authorized representative;

(ii) the treating health care provider, or any of its employees or affiliates;

(iii) the medical care facility at which the covered service would be provided, or any of its employees or affiliates;

or (iv) the development or manufacture of the drug, device, procedure or other therapy that is the subject of the final denial of a claim.

The independent review organization shall not be a subsidiary of, nor owned or controlled by, a health plan, a trade association of health plans, or a professional association of health care providers.

There shall be no liability on the part of and no cause of action shall arise against any officer or employee of an independent review organization for any actions taken or not taken or statements made by such officer or employee in good faith in the performance of his powers and duties.

4.

Include coverage for early intervention services.

For purposes of this section, "early intervention services" means medically necessary speech and language therapy, occupational therapy, physical therapy and assistive technology services and devices for dependents from birth to age three who are certified by the Department of Behavioral Health and Developmental Services as eligible for services under Part H of the Individuals with Disabilities Education Act (20 U.S.C.

§ 1471 et seq.).

Medically necessary early intervention services for the population certified by the Department of Behavioral Health and Developmental Services shall mean those services designed to help an individual attain or retain the capability to function age-appropriately within his environment, and shall include services that enhance functional ability without effecting a cure.

For persons previously covered under the plan, there shall be no denial of coverage due to the existence of a preexisting condition.

The cost of early intervention services shall not be applied to any contractual provision limiting the total amount of coverage paid by the insurer to or on behalf of the insured during the insured's lifetime.

5.

Include coverage for prescription drugs and devices approved by the United States Food and Drug Administration for use as contraceptives.

6.

Not deny coverage for any drug approved by the United States Food and Drug Administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed, if the drug has been recognized as safe and effective for treatment of that specific type of cancer in one of the standard reference compendia.

7.

Not deny coverage for any drug prescribed to treat a covered indication so long as the drug has been approved by the United States Food and Drug Administration for at least one indication and the drug is recognized for treatment of the covered indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature.

8.

Include coverage for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin-using diabetes if prescribed by a health care professional legally authorized to prescribe such items under law.

To qualify for coverage under this subdivision, diabetes outpatient self-management training and education shall be provided by a certified, registered or licensed health care professional.

9.

Include coverage for reconstructive breast surgery.

For purposes of this section, "reconstructive breast surgery" means surgery performed on and after July 1, 1998, (i) coincident with a mastectomy performed for breast cancer or (ii) following a mastectomy performed for breast cancer to reestablish symmetry between the two breasts.

For persons previously covered under the plan, there shall be no denial of coverage due to preexisting conditions.

10.

Include coverage for annual pap smears, including coverage, on and after July 1, 1999, for annual testing performed by any FDA-approved gynecologic cytology screening technologies.

11.

Include coverage providing a minimum stay in the hospital of not less than 48 hours for a patient following a radical or modified radical mastectomy and 24 hours of inpatient care following a total mastectomy or a partial mastectomy with lymph node dissection for treatment of breast cancer.

Nothing in this subdivision shall be construed as requiring the provision of inpatient coverage where the attending physician in consultation with the patient determines that a shorter period of hospital stay is appropriate.

12.

Include coverage (i) to persons age 50 and over and (ii) to persons age 40 and over who are at high risk for prostate cancer, according to the most recent published guidelines of the American Cancer Society, for one PSA test in a 12-month period and digital rectal examinations, all in accordance with American Cancer Society guidelines.

For the purpose of this subdivision, "PSA testing" means the analysis of a blood sample to determine the level of prostate specific antigen.

13.

Permit any individual covered under the plan direct access to the health care services of a participating specialist (i) authorized to provide services under the plan and (ii) selected by the covered individual.

The plan shall have a procedure by which an individual who has an ongoing special condition may, after consultation with the primary care physician, receive a referral to a specialist for such condition who shall be responsible for and capable of providing and coordinating the individual's of 50 primary and specialty care related to the initial specialty care referral.

If such an individual's care would most appropriately be coordinated by such a specialist, the plan shall refer the individual to I specialist.

For the purposes of this subdivision, "special condition" means a condition or disease that is Ni) period of time.

Within the treatment period authorized by the referral, such specialist shall be permitted to treat the individual without a further referral from the individual's primary care provider and may authorize such referrals, procedures, tests, and other medical services related to the initial Referral as the individual's primary care provider would otherwise be permitted to provide or authorize.

The plan shall have a procedure by which an individual who has an ongoing special condition that requires ongoing care from a specialist may receive a standing referral to such specialist for the treatment of Dhe special condition.

If the primary care provider, in consultation with the plan and the specialist, if any, specialist.

Nothing contained herein shall prohibit the plan from requiring a participating specialist to a provide written notification to the covered individual's primary care physician of any visit to such specialist.

Such notification may include a description of the health care services rendered atEthe time of the visit.

14.

Include provisions allowing employees to continue receiving health care services for a period of up to 90 days from the date of the primary care physician's notice of termination from any of the plan's provider panels.

The plan shall notify any provider at least 90 days prior to the date of termination of theFor a period of at least 90 days from the date of the notice of a provider's termination from any of the plan's provider panels, except when a provider is terminated for cause, a provider shall be permitted by the plan to render health care services to any of the covered employees who (i) were in an active course of treatment from the provider prior to the notice of termination and (ii) request to continue receiving health care services from the provider.

S Notwithstanding the provisions of this subdivision, any provider shall be permitted by the p7an to continue rendering health services to any covered employee who has entered the second trimester0of for cause.

Such treatment shall, at the covered employee's option, continue through the provision ofinated postpartum care directly related to the delivery.

Notwithstanding the provisions of this subdivision, any provider shall be permitted to continue rendering health services to any covered employee who is determined to be terminally ill (as defined under § 1861(dd)(3)(A) of the Social Security Act) at the time of a provider's termination of participation, except when a provider is terminated for cause.

Such treatment shall, at the covered employee's option, continue for the remainder of the employee's life for care directly related to the treA provider who continues to render health care services pursuant to this subdivision shall be reimbursed in accordance with the carrier's agreement with such provider existing immediately before the provider's termination of participation.

15.

Include coverage for patient costs incurred during participation in clinical trials for treatment studies on cancer, including ovarian cancer trials.

The reimbursement for patient costs incurred during participation in clinical trials for treatment studies on cancer shall be determined in the same manner as reimbursement is determined for other copayments and coinsurance factors that are no less favorable than for physical illness generally.ibles, For purposes of this subdivision:

"Cooperative group" means a formal network of facilities that collaborate on research projects and have an established NIH-approved peer review program operating within the group.

"Cooperative group" includes (i) the National Cancer Institute Clinical Cooperative Group and (ii) the National Cancer Institute Community Clinical Oncology Program.

"FDA" means the Federal Food and Drug Administration.

Department of Health and Human Services that defines the relationship of the institution to the federal Department of Health and Human Services and sets out the responsibilities of the institution and the procedures that will be used by the institution to protect human subjects.

"NCI" means the National Cancer Institute.

"NIH" means the National Institutes of Health.

"Patient" means a person covered under the plan established pursuant to this section.

"Patient cost" means the cost of a medically necessary health care service that is incurred as a result include (i) the cost of nonhealth care services that a patient may be required to receive as a result of the SB750 10 of 50 treatment being provided for purposes of a clinical trial, (ii) costs associated with managing the research associated with the clinical trial, or (iii) the cost of the investigational drug or device.

Coverage for patient costs incurred during clinical trials for treatment studies on cancer shall be provided if the treatment is being conducted in a Phase II, Phase III, or Phase IV clinical trial.

Such treatment may, however, be provided on a case-by-case basis if the treatment is being provided in a Phase I clinical trial.

The treatment described in the previous paragraph shall be provided by a clinical trial approved by:

a.

The National Cancer Institute;

b.

An NCI cooperative group or an NCI center;

c.

The FDA in the form of an investigational new drug application;

d.

The federal Department of Veterans Affairs;

or e.

An institutional review board of an institution in the Commonwealth that has a multiple project assurance contract approved by the Office of Protection from Research Risks of the NCI.

The facility and personnel providing the treatment shall be capable of doing so by virtue of their experience, training, and expertise.

Coverage under this subdivision shall apply only if:

(1) There is no clearly superior, noninvestigational treatment alternative;

(2) The available clinical or preclinical data provide a reasonable expectation that the treatment will be at least as effective as the noninvestigational alternative;

and (3) The patient and the physician or health care provider who provides services to the patient under the plan conclude that the patient's participation in the clinical trial would be appropriate, pursuant to procedures established by the plan.

16.

Include coverage providing a minimum stay in the hospital of not less than 23 hours for a covered employee following a laparoscopy-assisted vaginal hysterectomy and 48 hours for a covered employee following a vaginal hysterectomy, as outlined in Milliman & Robertson's nationally recognized guidelines.

Nothing in this subdivision shall be construed as requiring the provision of the total hours referenced when the attending physician, in consultation with the covered employee, determines that a shorter hospital stay is appropriate.

17.

Include coverage for biologically based mental illness.

For purposes of this subdivision, a "biologically based mental illness" is any mental or nervous condition caused by a biological disorder of the brain that results in a clinically significant syndrome that substantially limits the person's functioning;

specifically, the following diagnoses are defined as biologically based mental illness as they apply to adults and children:

schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism, and drug and alcoholism addiction.

Coverage for biologically based mental illnesses shall neither be different nor separate from coverage for any other illness, condition or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of usual and customary procedures to determine the appropriateness of, and medical necessity for, treatment of biologically based mental illnesses under this option, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations made for the treatment of any other illness, condition or disorder covered by such policy or contract.

18.

Offer and make available coverage for the treatment of morbid obesity through gastric bypass surgery or such other methods as may be recognized by the National Institutes of Health as effective for the long-term reversal of morbid obesity.

Such coverage shall have durational limits, dollar limits, deductibles, copayments and coinsurance factors that are no less favorable than for physical illness generally.

Access to surgery for morbid obesity shall not be restricted based upon dietary or any other criteria not approved by the National Institutes of Health.

For purposes of this subdivision, "morbid obesity" means (i) a weight that is at least 100 pounds over or twice the ideal weight for frame, age, height, and gender as specified in the 1983 Metropolitan Life Insurance tables, (ii) a body mass index (BMI) equal to or greater than 35 kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes, or (iii) a BMI of 40 kilograms per meter squared without such comorbidity.

As used herein, "BMI" equals weight in kilograms divided by height in meters squared.

19.

Include coverage for colorectal cancer screening, specifically screening with an annual fecal occult blood test, flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging, in accordance with the most recently published recommendations established by the American College of Gastroenterology, in consultation with the American Cancer Society, for the ages, family histories, and frequencies referenced in such recommendations.

The coverage for colorectal cancer of 50 screening shall not be more restrictive than or separate from coverage provided for any other illness, condition or disorder for purposes of determining deductibles, benefit year or lifetime duratioIal limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coNnsurance fac20.

On and after July 1, 2002, require that a prescription benefit card, health insurance benefit card, or other technology that complies with the requirements set forth in § 38.2-3407.4:2 be issued to each employee provided coverage pursuant to this section, and shall upon any changes in the requiredRdata elements set forth in subsection A of § 38.2-3407.4:2, either reissue the card or provide employees covered under the plan such corrective information as may be required to electronically process a prescription claim.

D 21.

Include coverage for infant hearing screenings and all necessary audiological examinations Administration, and as recommended by the national Joint Committee on Infant Hearing in its mostg current position statement addressing early hearing detection and intervention programs.

Such coverage shall include follow-up audiological examinations as recommended by a physician, physician assiEtant, nurse practitioner or audiologist and performed by a licensed audiologist to confirm the existence or absence of hearing loss.

D 22.

Notwithstanding any provision of this section to the contrary, every plan established in accordance with this section shall comply with the provisions of § 2.2-2818.2.

such funds as shall be appropriated by law.

Appropriations, premiums and other payments shall bed from deposited in the employee health insurance fund, from which payments for claims, premiums, cost containment programs and administrative expenses shall be withdrawn from time to time.

The funds of the health insurance fund shall be deemed separate and independent trust funds, shall be segregated from all other funds of the Commonwealth, and shall be invested and administered solely in the interSsts of the employees and their beneficiaries.

Neither the General Assembly nor any public officer, emp7oyee, or agency shall use or authorize the use of such trust funds for any purpose other than as prov0ded in of the health insurance fund.d administrative expenses, including but not limited to legislative oversight D.

For the purposes of this section:

"Peer-reviewed medical literature" means a scientific study published only after having been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts in a journal that has been determined by the International Committee of Medical Journal Editors to have met the Uniform Requirements for Manuscripts submitted to biomedical journals.

Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant ext"Standard reference compendia" means:

company or health carrier.

1.

American Hospital Formulary Service –– Drug Information;

2.

National Comprehensive Cancer Network's Drugs & Biologics Compendium;

or 3.

Elsevier Gold Standard's Clinical Pharmacology.

"State employee" means state employee as defined in § 51.1-124.3;

employee as defined in § 51.1-201;

the Governor, Lieutenant Governor and Attorney General;

judge as defined in § 51.1-301 and judges, clerks and deputy clerks of regional juvenile and domestic relations, county juvenile and School of Medicine and Hospital of the University of Virginia, and interns, residents, and employees of the Virginia Commonwealth University Health System Authority as provided in § 23.1-2415;

employees of the Behavioral Health Hospital Authority as provided in § 37.2-1205;

and employees of the Virginia Alcoholic Beverage Control Authority as provided in § 4.1-101.05.

E.

Provisions shall be made for retired employees to obtain coverage under the above plan, including, as an option, coverage for vision and dental care.

The Commonwealth may, but shall not be obligated to, pay all or any portion of the cost thereof.

Management that utilizes a network of preferred providers shall not exclude any physician solely on the basis of a reprimand or censure from the Board of Medicine, so long as the physician otherwise meets the plan criteria established by the Department.

G.

The plan shall include, in each planning district, at least two health coverage options, each sponsored by unrelated entities.

No later than July 1, 2006, one of the health coverage options to be available in each planning district shall be a high deductible health plan that would qualify for a health savings account pursuant to § 223 of the Internal Revenue Code of 1986, as amended.

shall voluntarily enter into negotiations at any time with any health coverage provider who seeks toment SB750 12 of 50 provide coverage under the plan.

This subsection shall not apply to any state agency authorized by the Department to establish and administer its own health insurance coverage plan separate from the plan established by the Department.

H.

Any self-insured group health insurance plan established by the Department of Human Resource Management that includes coverage for prescription drugs on an outpatient basis may apply a formulary to the prescription drug benefits provided by the plan if the formulary is developed, reviewed at least annually, and updated as necessary in consultation with and with the approval of a pharmacy and therapeutics committee, a majority of whose members are actively practicing licensed (i) pharmacists, (ii) physicians, and (iii) other health care providers.

If the plan maintains one or more drug formularies, the plan shall establish a process to allow a person to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs in the plan, a specific, medically necessary nonformulary prescription drug if, after reasonable investigation and consultation with the prescriber, the formulary drug is determined to be an inappropriate therapy for the medical condition of the person.

The plan shall act on such requests within one business day of receipt of the request.

Any plan established in accordance with this section shall be authorized to provide for the selection of a single mail order pharmacy provider as the exclusive provider of pharmacy services that are delivered to the covered person's address by mail, common carrier, or delivery service.

As used in this subsection, "mail order pharmacy provider" means a pharmacy permitted to conduct business in the Commonwealth whose primary business is to dispense a prescription drug or device under a prescriptive drug order and to deliver the drug or device to a patient primarily by mail, common carrier, or delivery service.

I.

Any plan established in accordance with this section requiring preauthorization prior to rendering medical treatment shall have personnel available to provide authorization at all times when such preauthorization is required.

J.

Any plan established in accordance with this section shall provide to all covered employees written notice of any benefit reductions during the contract period at least 30 days before such reductions become effective.

K.

No contract between a provider and any plan established in accordance with this section shall include provisions that require a health care provider or health care provider group to deny covered services that such provider or group knows to be medically necessary and appropriate that are provided with respect to a covered employee with similar medical conditions.

L.

The Department of Human Resource Management shall appoint an Ombudsman to promote and protect the interests of covered employees under any state employee's health plan.

The Ombudsman shall:

1.

Assist covered employees in understanding their rights and the processes available to them according to their state health plan.

2.

Answer inquiries from covered employees by telephone and electronic mail.

3.

Provide to covered employees information concerning the state health plans.

4.

Develop information on the types of health plans available, including benefits and complaint procedures and appeals.

5.

Make available, either separately or through an existing Internet web site utilized by the Department of Human Resource Management, information as set forth in subdivision 4 and such additional information as he deems appropriate.

6.

Maintain data on inquiries received, the types of assistance requested, any actions taken and the disposition of each such matter.

7.

Upon request, assist covered employees in using the procedures and processes available to them from their health plan, including all appeal procedures.

Such assistance may require the review of health care records of a covered employee, which shall be done only in accordance with the federal Health Insurance Portability and Accountability Act privacy rules.

The confidentiality of any such medical records shall be maintained in accordance with the confidentiality and disclosure laws of the Commonwealth.

8.

Ensure that covered employees have access to the services provided by the Ombudsman and that the covered employees receive timely responses from the Ombudsman or his representatives to the inquiries.

9.

Report annually on his activities to the standing committees of the General Assembly having jurisdiction over insurance and over health and the Joint Commission on Health Care by December 1 of each year.

M.

The plan established in accordance with this section shall not refuse to accept or make reimbursement pursuant to an assignment of benefits made to a dentist or oral surgeon by a covered employee.

For purposes of this subsection, "assignment of benefits" means the transfer of dental care coverage of 50 reimbursement benefits or other rights under the plan.

The assignment of benefits shall not be effective until the covered employee notifies the plan in writing of the assignment.

I N.

Beginning July 1, 2006, any plan established pursuant to this section shall provide for aN employee's social security number.

be assigned to the covered employee and shall not be the same as the O.

Any group health insurance plan established by the Department of Human Resource Management that contains a coordination of benefits provision shall provide written notification to any elRgible employee as a prominent part of its enrollment materials that if such eligible employee is covered under another group accident and sickness insurance policy, group accident and sickness subscription contract, or group health care plan for health care services, that insurance policy, subscription contracD or health care plan may have primary responsibility for the covered expenses of other family members enrolled the other coverage would be primary for dependent children enrolled under the eligible employee'sn which coverage and the method by which the eligible enrollee may verify from the plan that coverage would have primary responsibility for the covered expenses of each family member.

E P.

Any plan established by the Department of Human Resource Management pursuant to this section shall provide that coverage under such plan for family members enrolled under a participating state employee's coverage shall continue for a period of at least 30 days following the death of such state employee.

to the covered employee or covered family member for a claim for services received from ang its payment nonparticipating physician or osteopath shall (i) include language in the member handbook that notifies the covered employee of the responsibility to apply the plan payment to the claim from such nonparticipating provider, (ii) include this language with any such payment sent to the covered employee or covered family member, and (iii) include the name and any last known address of the S nonparticipating provider on the explanation of benefits statement.

7 R.

The Department of Human Resource Management shall report annually, by November 30 of each0 including any mandated benefit made applicable, pursuant to subdivision B 22, to any plan established, pursuant to this section.

The report shall be in the same detail and form as required of reports submitted pursuant to § 38.2-3419.1, with such additional information as is required to determine the financial impact, including the costs and benefits, of the particular mandated benefit.

§ 2.2-2905.

Certain officers and employees exempt from chapter.

The provisions of this chapter shall not apply to:

1.

Officers and employees for whom the Constitution specifically directs the manner of selection;

3.

Officers appointed by the Governor, whether confirmation by the General Assembly or by either house thereof is required or not;

4.

Officers elected by popular vote or by the General Assembly or either house thereof;

5.

Members of boards and commissions however selected;

6.

Judges, referees, receivers, arbiters, masters and commissioners in chancery, commissioners of accounts, and any other persons appointed by any court to exercise judicial functions, and jurors and notaries public;

special inquiries, investigations, or examinations on its behalf;employed to conduct temporary or 8.

The presidents and teaching and research staffs of state educational institutions;

9.

Commissioned officers and enlisted personnel of the National Guard;

10.

Student employees at institutions of higher education and patient or inmate help in other state institutions;

11.

Upon general or special authorization of the Governor, laborers, temporary employees, and employees compensated on an hourly or daily basis;

13.

The employees of the Virginia Workers' Compensation Commission;, and employees;

14.

The officers and employees of the Virginia Retirement System;

15.

Employees whose positions are identified by the State Council of Higher Education and the boards of the Virginia Museum of Fine Arts, The Science Museum of Virginia, the Jamestown-Yorktown Foundation, the Frontier Culture Museum of Virginia, the Virginia Museum of Natural History, the New College Institute, the Southern Virginia Higher Education Center, and The Library of Virginia, and approved by the Director of the Department of Human Resource Management as 16.

Employees of the Virginia Lottery;

training;

SB750 14 of 50 17.

Employees of the Department for the Blind and Vision Impaired's rehabilitative manufacturing and service industries who have a human resources classification of industry worker;

18.

Employees of the Virginia Commonwealth University Health System Authority;

19.

Employees of the University of Virginia Medical Center.

Any changes in compensation plans for such employees shall be subject to the review and approval of the Board of Visitors of the University of Virginia.

The University of Virginia shall ensure that its procedures for hiring University of Virginia Medical Center personnel are based on merit and fitness.

Such employees shall remain subject to the provisions of the State Grievance Procedure (§ 2.2-3000 et seq.);

20.

In executive branch agencies the employee who has accepted serving in the capacity of chief deputy, or equivalent, and the employee who has accepted serving in the capacity of a confidential assistant for policy or administration.

An employee serving in either one of these two positions shall be deemed to serve on an employment-at-will basis.

An agency may not exceed two employees who serve in this exempt capacity;

21.

Employees of Virginia Correctional Enterprises.

Such employees shall remain subject to the provisions of the State Grievance Procedure (§ 2.2-3000 et seq.);

22.

Officers and employees of the Virginia Port Authority;

23.

Employees of the Virginia College Savings Plan;

24.

Directors of state facilities operated by the Department of Behavioral Health and Developmental Services employed or reemployed by the Commissioner after July 1, 1999, under a contract pursuant to § 37.2-707.

Such employees shall remain subject to the provisions of the State Grievance Procedure (§ 2.2-3000 et seq.);

25.

Employees of the Virginia Foundation for Healthy Youth.

Such employees shall be treated as state employees for purposes of participation in the Virginia Retirement System, health insurance, and all other employee benefits offered by the Commonwealth to its classified employees;

26.

Employees of the Virginia Indigent Defense Commission;

27.

Any chief of a campus police department that has been designated by the governing body of a public institution of higher education as exempt, pursuant to § 23.1-809;

28.

The Chief Executive Officer, agents, officers, and employees of the Virginia Alcoholic Beverage Control Authority;

and 29.

Officers and employees of the Fort Monroe Authority;

and 30.

Employees of the Behavioral Health Hospital Authority.

§ 2.2-3114.