A BILL to amend and reenact § 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3418.23, relating to health insurance; coverage for the treatment of acquired brain injury required.
HB1338 would require most health insurers, health care subscription contracts, and health maintenance organizations in Virginia to cover treatment for acquired brain injury. The bill defines acquired brain injury broadly to include injuries or conditions affecting the brain after birth, including traumatic brain injury, stroke, tumors, infections, metabolic and endocrine disorders, diminished oxygen, toxins, and diseases affecting blood supply to the brain.
The required coverage would include a wide range of services and therapies, such as cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy, neuropsychological testing, neurofeedback therapy, functional rehabilitation therapy, community reintegration services, post-acute residential treatment, inpatient and outpatient services, day treatment, and home- and community-based treatment. The bill also states that this coverage cannot be more restrictive than coverage for other illnesses in terms of deductibles, benefit limits, copayments, coinsurance, or similar cost-sharing and utilization limits.
If enacted, the bill would add a new insurance mandate in Title 38.2 of the Code of Virginia and amend the HMO-related statutory construction section to incorporate the new coverage requirement. It would apply to individual and group accident and sickness policies, subscription contracts, and HMO plans delivered, issued, reissued, or extended in Virginia on or after January 1, 2027, or later when a policy term changes or a premium adjustment is made. The mandate would not apply to short-term travel, accident-only, limited or specified disease policies, or Medicare and similar federal coverage.
The available record shows no committee transcript or vote history, so there is no documented floor or committee debate to gauge support or opposition. Based on the bill’s subject matter and structure, it appears to be a consumer- and patient-protection measure aimed at expanding access to medically necessary brain injury treatment. The bill was referred to the House Committee on Labor and Commerce and was left in that committee, indicating it did not advance in the available legislative history.
The main policy issue likely to draw scrutiny is the breadth and cost of the required benefit, especially because the bill mandates coverage for multiple specialized therapies and residential/community-based services that may be expensive or subject to utilization management by insurers. Another possible point of contention is the broad definition of acquired brain injury, which extends beyond traumatic injuries to include a range of medical conditions affecting the brain. Insurers and health plans would likely be the parties most affected by the mandate, while patients with brain injuries and their advocates would likely support it.