Virginia 2020 Regular Session Status: In Committee

HB 901 — Health insurance; payment to out-of-network providers.

Last action — Incorporated by Appropriations (HB1251-Torian)

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House of Delegates
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2020 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Health insurance; payment to out-of-network providers. Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also establishes a standard for calculating the health carrier's required payment to the out-of-network provider of the services, which standard is the lower of the market-based value for the service or 125 percent of the amount that would be paid under Medicare for the service. If such provider determines that the amount to be paid by the health carrier does not comply with the applicable requirements, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request the State Corporation Commission to review the disputed reimbursement amount and determine if the amount complies with applicable requirements. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly. This bill was incorporated into HB 1251.

Bill Text

What changed in the latest version

190 added · 272 removed

Plain-language change summary

The recent amendment to Bill HB 901 clarifies definitions related to emergency medical conditions and cost-sharing requirements, which are important terms in health insurance. It specifies that an "emergency medical condition" includes serious symptoms that would lead a reasonable person to seek immediate medical help. This change matters because it helps ensure that individuals facing potential health crises have a clear understanding of their coverage and protections under insurance plans. Overall, the amendment aims to enhance patient care and access to necessary medical services in emergencies.

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SESSION history | hilite | pdf | print version 20104699D HOUSE BILL NO.
SESSION history | hilite | pdf | print version 20107373D HOUSE BILL NO.
901 Offered January 8, 2020 Prefiled January 7, 2020 A BILL to amend and reenact §§ 38.2-3438 and 38.2-3445 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3445.01, relating to health insurance;
901 AMENDMENT IN THE NATURE OF A SUBSTITUTE (Proposed by the House Committee on Labor and Commerce on February 4, 2020) (Patrons Prior to Substitute--Delegates Sickles and Levine [HB 189]) A BILL to amend and reenact §§ 38.2-3438 and 38.2-3445 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3445.01, relating to health insurance;
---------- Patrons-- Sickles, Ayala, Byron, Carr, Guzman, Heretick, Krizek, Webert and Willett ---------- Referred to Committee on Labor and Commerce ---------- Be it enacted by the General Assembly of Virginia:
Be it enacted by the General Assembly of Virginia:
That the State Corporation Commission's Bureau of Insurance (the Bureau) shall notify the Chairmen of the House and Senate Committees on Commerce and Labor of the information reported to the Bureau pursuant to the second and third enactments of this act no later than December 1 of each year.
That the State Corporation Commission's Bureau of Insurance (the Bureau) shall notify the Chairmen of the House and Senate Committees on Commerce and Labor of the information reported to the Bureau pursuant to the second and third enactments of this act no later than December of each year.
⬇ Download PDF
View plain text versions (2)
  • Impact statement from DPB (HB901H1) View text Current html February 04, 2020
  • Impact statement from SCC (HB901) View text html January 07, 2020

Action History

  1. Incorporated by Appropriations (HB1251-Torian)

  2. Impact statement from DPB (HB901H1)

  3. Incorporates HB189 (Levine)

  4. Committee substitute printed 20107373D-H1

  5. Referred to Committee on Appropriations

  6. Reported from Labor and Commerce with substitute (22-Y 0-N)

  7. Impact statement from DPB (HB901)

  8. Subcommittee recommends referring to Committee on Appropriations

  9. Subcommittee recommends reporting with substitute (8-Y 0-N)

  10. Impact statement from SCC (HB901)

  11. Assigned L & C sub: Subcommittee #2

  12. Referred to Committee on Labor and Commerce

  13. Prefiled and ordered printed; offered 01/08/20 20104699D

Sponsors

Sponsorship breakdown

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1 sponsors · 8 co-sponsors · 139 not signed on

Sponsors (1)

Co-sponsors (8)

Not signed on (139)

139 members have not signed on to this bill.

Show all 139 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Reported from Labor and Commerce with substitute (22-Y 0-N)

Passed 22 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 22000
Total 22000
% of votes cast 100%0%0%0%
How each member voted (22)
Member Party Vote
Lindsey, Joseph C. — Yea
Alfonso H. Lopez — Yea
Ayala, Hala S. — Yea
Bourne, Jeffrey M. — Yea
Byron, Kathy J. — Yea
Christopher T. Head — Yea
Gooditis, Wendy W. — Yea
Guzman, Elizabeth R. — Yea
Heretick, Steve E. — Yea
Israel D. O'Quinn — Yea
Jeion A. Ward — Yea
Keam, Mark L. — Yea
Kory, Kaye — Yea
Lamont Bagby — Yea
Marshall, Daniel W., III — Yea
Michael J. Webert — Yea
Mullin, Michael P. — Yea
R. Lee Ware — Yea
Ransone, Margaret B. — Yea
Richard C. "Rip" Sullivan, Jr. — Yea
Terry G. Kilgore — Yea
Tony O. Wilt — Yea

Official roll call →

Subcommittee recommends reporting with substitute (8-Y 0-N)

Passed 8 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 8001
Total 8001
% of votes cast 89%0%0%11%
How each member voted (9)
Member Party Vote
Lindsey, Joseph C. — Yea
Alfonso H. Lopez — Yea
Byron, Kathy J. — Yea
Christopher T. Head — Yea
Gooditis, Wendy W. — Yea
Heretick, Steve E. — Yea
Jeion A. Ward — Not Voting
Michael J. Webert — Yea
Richard C. "Rip" Sullivan, Jr. — Yea

Official roll call →

Subjects

health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 901 do?
Health insurance; payment to out-of-network providers. Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also establishes a standard for calculating the health carrier's required payment to the out-of-network provider of the services, which standard is the lower of the market-based value for the service or 125 percent of the amount that would be paid under Medicare for the service. If such provider determines that the amount to be paid by the health carrier does not comply with the applicable requirements, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request the State Corporation Commission to review the disputed reimbursement amount and determine if the amount complies with applicable requirements. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly. This bill was incorporated into HB 1251.
Who sponsors HB 901?
HB 901 is sponsored by Heretick, Steve E., Betsy B. Carr, Paul E. Krizek, Michael J. Webert, Rodney T. Willett, Elizabeth R. Guzman, Mark D. Sickles, Ayala, Hala S., and Byron, Kathy J..
What is the current status of HB 901?
This bill died with 2020 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 901?
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