Virginia 2025 Regular Session

Virginia Senate Bill SB1290 Compare Versions

OldNewDifferences
1-OFFERED FOR CONSIDERATION 2/03/2025
1+2025 SESSION
2+
3+INTRODUCED
4+
5+25100991D
26
37 SENATE BILL NO. 1290
48
5-AMENDMENT IN THE NATURE OF A SUBSTITUTE
9+Offered January 8, 2025
610
7-(Proposed by the Senate Committee on Commerce and Labor
11+Prefiled January 8, 2025
812
9-on ________________)
13+A BILL to amend and reenact 38.2-3408 and 38.2-4221 of the Code of Virginia, relating to health insurance; reimbursement for services rendered by certain practitioners other than physicians.
1014
11-(Patron Prior to SubstituteSenator Deeds)
1215
13-A BILL to amend and reenact 38.2-3408 and 38.2-4221 of the Code of Virginia, relating to health insurance; reimbursement for behavioral health services rendered by certain practitioners other than physicians.
16+
17+PatronDeeds
18+
19+
20+
21+Referred to Committee on Commerce and Labor
1422
1523
1624
1725 Be it enacted by the General Assembly of Virginia:
1826
1927 1. That 38.2-3408 and 38.2-4221 of the Code of Virginia are amended and reenacted as follows:
2028
2129 38.2-3408. Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians.
2230
2331 A. If an accident and sickness insurance policy provides reimbursement for any service that may be legally performed by a person licensed in this Commonwealth as a chiropractor, optometrist, optician, professional counselor, psychologist, clinical social worker, podiatrist, physical therapist, chiropodist, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, physician assistant, marriage and family therapist, athletic trainer, or licensed acupuncturist, reimbursement under the policy shall not be denied because the service is rendered by the licensed practitioner, provided that, for services performed by an athletic trainer, such service is performed in an office setting.
2432
2533 B. If an accident and sickness insurance policy provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the policy shall not be denied because the service is rendered by the licensed pharmacist, provided that (i) the service is performed for an insured for a condition under the terms of a collaborative agreement, as defined in 54.1-3300, (ii) the service is for the administration of vaccines for immunization, or (iii) the service is provided in accordance with 54.1-3303.1.
2634
27-C. The reimbursement for any behavioral health service, as defined in 37.2-100, provided by a licensed practitioner listed in subsection A shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing such service in the area served, provided that the claim is submitted using the diagnoses and procedure codes applicable to the service, such licensed practitioner's name, the national provider identifier for the licensed practitioner providing the service, and, if required by the insurer, the name of the facility in which the service is provided.
35+C. The reimbursement for a service provided by a licensed practitioner listed in subsection A shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing such service in the area served, provided that the claim is submitted using the diagnoses and procedure codes applicable to the service, such licensed practitioner's name, the national provider identifier for the licensed practitioner providing the service, and, if required by the insurer, the name of the facility in which the service is provided.
2836
2937 D. No insurer shall reduce the reimbursement paid to a licensed physician in order to comply with the provisions of this section.
3038
3139 E. This section shall not apply to Medicaid, or any state fund.
3240
3341 38.2-4221. Services of certain practitioners other than physicians to be covered.
3442
3543 A. A nonstock corporation shall not fail or refuse, either directly or indirectly, to allow or to pay to a subscriber for all or any part of the health services rendered by any doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, physician assistant, marriage and family therapist, athletic trainer, or licensed acupuncturist licensed to practice in Virginia, if the services rendered (i) are services provided for by the subscription contract; (ii) are services which the doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, physician assistant, marriage and family therapist, athletic trainer, or licensed acupuncturist is licensed to render in this Commonwealth; and (iii) are, for any services rendered by an athletic trainer, rendered in an office setting.
3644
3745 B. If a subscription contract provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the subscription contract by the nonstock corporation shall not be denied because the service is rendered by the licensed pharmacist provided that (i) the service is performed for a subscriber for a condition under the terms of a collaborative agreement, as defined in 54.1-3300, between a pharmacist and the physician with whom the subscriber is undergoing a course of treatment or (ii) the service is for the administration of vaccines for immunization. Notwithstanding the provisions of 38.2-4209, the nonstock corporation may require the pharmacist, any pharmacy or provider that may employ such pharmacist, or the collaborating physician to enter into a written agreement with the nonstock corporation as a condition for reimbursement for such services. In addition, reimbursement to pharmacists acting under the terms of a collaborative agreement under this subsection shall not be subject to the provisions of 38.2-4209.1.
3846
39-C. The payment for any behavioral health service, as defined in 37.2-100, provided by a licensed practitioner listed in subsection A shall be in the same amount as the payment paid under the subscription contract for a licensed physician performing such service in the area served.
47+C. The payment for a service provided by a licensed practitioner listed in subsection A shall be in the same amount as the payment paid under the subscription contract for a licensed physician performing such service in the area served.
4048
4149 D. No nonstock corporation shall reduce the reimbursement paid to a licensed physician in order to comply with the provisions of this section.