Bill > HB2099

This bill requires health insurance carriers to include specific provisions in their provider contracts regarding prior authorization for health care services, with the goal of increasing transparency and efficiency in the authorization process. The bill mandates that carriers communicate decisions on prior authorization requests within specific timeframes (72 hours for expedited requests and 7 calendar days for standard requests), and provide clear reasons for any denials. Carriers must create and maintain a publicly accessible website listing all health care services requiring prior authorization, with at least 30 days' notice before making changes to these requirements. The bill prohibits carriers from revoking a previously approved prior authorization except under limited circumstances, such as evidence of fraud or a safety issue. Carriers must also publish annual prior authorization data and are prevented from denying claims for failing to obtain prior authorization if the requirements were not clearly posted. The provisions will take effect on January 1, 2027, and the State Corporation Commission's Bureau of Insurance is required to establish a work group to monitor implementation, assess industry readiness, and evaluate policies related to these new prior authorization transparency requirements. The work group will report its findings by November 1, 2025, and will include representatives from various healthcare and insurance organizations.

Business and Industry

https://lis.virginia.gov/bill-details/20251/HB2099