An Act to amend and reenact §§ 32.1-137.13 and 38.2-3559 of the Code of Virginia, relating to health and health insurance; notice of adverse determination.
HB701 amends Virginia’s health and health insurance laws to strengthen notice requirements when a health plan or other entity issues an adverse determination, meaning a denial or negative coverage decision. The bill requires treating providers to be notified in writing within two working days of an adverse determination, and in the case of prescriptions known to be for the alleviation of cancer pain, the provider must be notified orally by telephone within 24 hours. The notice must also tell the provider how to seek reconsideration and appeal, including contact information for the person responsible for the decision.
The bill also requires a health carrier to notify the covered person in writing of an adverse determination or final adverse determination and the right to request external review within five business days. The notice must include prominent language explaining the right to review by independent health care professionals and must provide contact information for the relevant decision-maker or internal appeals contact. It further expands and clarifies the information that must be included about expedited external review rights, especially for cancer-related cases, urgent medical conditions, and experimental or investigational treatment denials.
HB701 amends §§ 32.1-137.13 and 38.2-3559 of the Code of Virginia, affecting the procedures health carriers, HMOs, and other entities must follow when denying coverage or treatment requests. It imposes tighter timelines for provider and patient notice, adds specific notice content requirements, and reinforces access to reconsideration, internal appeal, and external review processes. The practical effect is to increase transparency and speed in the appeals process for covered persons and treating providers, particularly in urgent and cancer-related cases.
The available record shows no committee transcript or recorded votes, so there is no direct evidence of debate or opposition in the provided materials. Based on the enacted text, the bill appears to reflect a consumer- and provider-protective approach focused on clearer notice and faster access to review mechanisms. Its enactment as Chapter 411 suggests it ultimately received sufficient support to pass and be signed into law.
No specific points of contention are documented in the provided materials. Potential areas of concern inherent in the bill’s subject matter would likely involve the administrative burden on health carriers, the shortened notice deadlines, and the expanded obligations to provide detailed appeal and external review information. On the other hand, patients, treating providers, and advocates for cancer care and timely access to treatment would likely support the added protections and expedited notice requirements.