SB 1154 — Health insurance; online credentialing system, processing of new applications.

SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2023 SESSION CHAPTER E377 An Act to amend and reenact § 38.2-3407.10:1 of the Code of Virginia, relating to health insurance;

R O [S 1154] Approved LMarch L23, 2023 Be it enacted by the General Assembly of Virginia:

E § 38.2-3407.10:1.

Processing of new provider applications and reimbursement for services Drendered renA.during pendency of a participating provider's credentialing application.

AsA. used in this section:participating provider's credentialing application.

"Carrier"As meansused anin entitythis subjectsection: to the insurance laws and regulations of the Commonwealth and subject to the jurisdiction of the Commission that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services or mental health services, including an insurer licensed to sell accident and sickness insurance, a health maintenance organization, a health services plan, or any other entity providing a plan of health insurance, health benefits, health care services, or mental health services.

B"Carrier" "Coveredmeans person"an meansentity asubject policyholder,to subscriber,the enrollee,insurance participant,laws orand otherregulations individua1of coveredthe byCommonwealth "Healthand benefitsubject plan"to meansthe ajurisdiction policy,of contract,the certificate,Commission orthat agreementcontracts offeredor byoffers ato carri4rcontract to provide, deliver, arrangeincluding for,an payinsurer for,licensed orto reimbursesell accident and sickness insurance, a health maintenance organization, a health services plan, or any ofother theentity costsproviding a plan of health insurance, health benefits, health care services, or mental health services.

E"Covered "Mentalperson" healthmeans professional"a haspolicyholder, thesubscriber, meaningenrollee, ascribedparticipant, theretoor inother §individual 54.1-2400.1.covered by a health benefit plan.

R"Health "Mentalbenefit healthplan" services" means benefitsa withpolicy, respectcontract, tocertificate, items or servicesagreement providedoffered by mentala healthcarrier professionalsto forprovide, mentaldeliver, healtharrange conditionsfor, aspay definedfor, underor thereimburse termsany of athe costs of health benefitcare plan.services.

"Mental health professional" has the meaning ascribed thereto in § 54.1-2400.1.

"Mental health services" means benefits with respect to items or services provided by mental health professionals for mental health conditions as defined under the terms of a health benefit plan.

submitted"New aprovider completedapplicant" credentialingmeans applicationa tophysician, amental carrier.professional,health professional, or other provider who has "Othersubmitted provider" means a person,completed corporation,credentialing facility,application or institution licensed by the Commonwealth under Title 32.1 or 54.1 to provide health care or professional health-related services on a feecarrier. basis.

"Other provider" means a person, corporation, facility, or institution licensed by the Commonwealth under Title 32.1 or 54.1 to provide health care or professional health-related services on a fee basis.

"Participating other provider" means an other provider who is managed, under contract with, or employed by a carrier and who has agreed to provide such health care or professional services to covered persons with an expectation of receiving payments, other than coinsurance, copayments, or deductibles, directly or indirectly from the carrier.

Board"Physician" ofmeans Medicine.ns a doctor of medicine or osteopathic medicine holding an active license from the B.Board of Medicine.

B.

provider2. applicant's completed credentialing application is received for consideration by the carrier;

Permit reimbursement to a new provider applicant for services rendered from the date the new provider applicant's completed credentialing application is received for consideration by the carrier;

Notwithstanding the provisions of subdivision 1 or 4, if the carrier accepts applications through an of 3 online credentialing system, require the carrier to recognize notification to a new provider applicant through the online credentialing system that the provider has submitted and attested to the application as of 3 notice by the carrier that the application is received.

of 3 7.

and years.Current,8. adequate malpractice insurance and malpractice history covering at least the pasE five Your health insurance carrier is in the process of obtaining and verifying the above information in order to determine if your physician, mental health professional, or other provider will be creRentialed or notH.

TheCurrent, provisionsadequate ofmalpractice thisinsurance sectionand shallmalpractice nothistory applycovering toat coveragesleast issuedthe bypast afive Medicareyears. AdvantagO plan, but shall apply to health maintenance organizations that issue coverage pursuant to Title XIX of the SocI.

Your health insurance carrier is in the process of obtaining and verifying the above information in order to determine if your physician, mental health professional, or other provider will be credentialed or of 3 not." H.

The provisions of this section shall not apply to coverages issued by a Medicare Advantage plan, but shall apply to health maintenance organizations that issue coverage pursuant to Title XIX of the Social Security Act, 42 U.S.C.

§ 1396 et seq.

(Medicaid).

I.

L 2.

That the Virginia Department of Health shall promulgate regulations to implement the E provisions of this act to be effective within 280 days of its enactment.

D B E R