SB 1397 — Health Insurance Reform Commission; review of essential health benefits benchmark plan.

SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2023 SESSION CHAPTER E699 An Act to amend and reenact §§ 30-342 and 30-343 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 30-343.1, relating to the Health Insurance Reform Commission;

Health Insurance Reform R O [S 1397] L Approved LMarch 27, 2023 Be it enacted by the General Assembly of Virginia:

E 1.

That §§ 30-342 and 30-343 of the Code of Virginia are amended and reenacted and that the DCode Cod§of 30-342.Virginia is amended by adding a section numbered 30-343.1 as follows:

Powers§ and30-342. duties.adding a section numbered 30-343.1 as follows:

Powers and duties.

Monitor the work of appropriate federal and state agencies in implementing the provisions of the federalregulations Patientpromulgated Protectionthereunder;rdable and Affordable Care Act (the Act), including amendments thereto and regulations2. promulgated thereunder;

2.Receive information provided to the Commission pursuant to § 30-343 and, on the basis of such information, assess the implications of the Act's implementation on residents of the Commonwealth, businesses operating within the Commonwealth, and the general fund of the Commonwealth;

Receive3. information provided to the Commission pursuant to § 30-343 and, on the basis of such information, assess the implications of the Act's implementation on residents of the CommonwealBh, businesses operating within the Commonwealth, and the general fund of the Commonwealth;

3Consider the development of a comprehensive strategy for implementing health reform in Virginia, including recommendations for innovative health care solutions independent of the approach embo7iedembodied in the Act that meet the needs of Virginia's citizens and government by creating an improved health system that will serve as an economic driver for the Commonwealth while allowing for more effective and efficient delivery of high quality care at lower cost;

Receive periodic reports from the Bureau of Insurance of the State Corporation Commission (the Bureau) pursuant to § 30-343 and recommend, in accordance with the provisions of § 30-343.1, health benefits required to be included within the scope of the essential health benefits provided under health insurance products offered in the Commonwealth, including any benefits that are not required to be pro5.provided by the terms of the Act;

5.

Develop such recommendations as may be appropriate for legislative and administrative consideration in order to increase access to health insurance coverage, ensure that the costs to business and individual purchasers of health insurance coverage are reasonable, and encourage a robust marketinessmarket for health insurance products in the Commonwealth.

Whenever a legislative measure containing a mandated health insurance benefit or provider is proposed that is not identical or substantially similar to a legislative measure previously reviewed by the Commission within the three-year period immediately preceding the then-current session of the General Assembly, the Chair of the House Committee on Labor and Commerce or Senate Committee on Commerce and Labor having jurisdiction over the proposal shall (i) request that the Commission assess the proposal and (ii) send a copy of such request to the Bureau of Insurance of the State Corporation Commission (the Bureau).

The Commission shall be given a period of 24 months to complete andrporationand submit its assessment.

Upon receipt of a copy of such a request, the Bureau shall prepare an analysis of the extent to which the proposed mandate is currently available under qualified health plans in the Commonwealth and advise the Commission as to whether, on the basis of that analysis, the applicable agency has determined or would likely determine, in accordance with applicable federal rules, that the proposed mandate exceeds the scope of the essential health benefits.

The Bureau's analysis shall be advisory only and not binding upon the Commission, the Bureau, the State Corporation Commission, or any other of 3 parties.

As used in this section, "applicable agency" means the governmental agency that in accordance with applicable federal rules is responsible for identifying state-mandated benefits that are in addition to of 3 the essential health benefits.

If the Commission has determined that an application for a new benchmark plan will be of 3 made for a change to the benchmark plan, at least two additional public hearings shall be held prior to advertisedselection andof planneda andnew shallbenchmark includeplan anrequired opportunityby forsubsection theF. public to participate both in-person and remotely.

NSuch relatedhearings toshall anybe benchmarkadequately planadvertised review.maintainand aplanned websiteand toshall conveyinclude relevantan informationopportunity Rofor the public Oto Lparticipate Lboth Ein-person Dand Sremotely. 7 R

H.

The Bureau shall establish and maintain a website to convey relevant information to the public of 3 related to any benchmark plan review.