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.
Summary
HB701 amends Virginia law governing how health carriers and other entities notify patients and providers when a claim or requested service is denied as an adverse determination. The bill requires the treating provider to receive written notice within two working days, and for prescriptions known to be for cancer pain, oral notice by telephone within 24 hours. The notice must also tell the provider how to seek reconsideration and appeal, including contact information for the decision-maker and the person responsible for the appeal process.
The bill also updates the notice that health carriers must give covered persons about their right to external review. It requires carriers to inform patients, in prominent bold language, about when they may request standard or expedited external review, including cases involving cancer, urgent medical conditions, emergency services, and experimental or investigational treatments. The notice must explain when a person may file for expedited review, when internal appeal exhaustion is deemed complete, and must include the standard and expedited review procedures and forms.
Impact
HB701 amends §§ 32.1-137.13 and 38.2-3559 of the Code of Virginia, strengthening notice requirements for adverse coverage decisions and external review rights. It affects health carriers, utilization review entities, treating providers, and covered persons by imposing tighter timelines and more detailed disclosure obligations, especially for cancer-related pain prescriptions and urgent or experimental treatment denials. The bill is intended to improve transparency and access to reconsideration, appeal, and external review processes in Virginia health insurance law.
Sentiment
The bill appears to have been broadly supported and noncontroversial. It advanced through subcommittee, committee, both chambers, and final concurrence with unanimous or near-unanimous votes at each stage, and there is no committee transcript indicating significant opposition or debate. The voting history suggests strong bipartisan agreement on improving notice and appeal rights in health coverage determinations.
Contention
No major points of contention are evident in the available record. The main policy choices reflected in the bill are procedural: how quickly notice must be given, what information must be included, and how expedited review rights are triggered. Any potential concern would likely center on administrative burden for carriers and review entities versus improved patient protections, but the unanimous votes indicate those issues did not generate visible opposition in the legislative process.