HB1294: Health insurers; efficiency information.
Be it enacted by the General Assembly of Virginia:
1. That ?? 38.2-4214 and 38.2-4319 of the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by adding a section numbered 38.2-3404.1 as follows:
? 38.2-3404.1. Comparative efficiency of health insurers.
A. As used in this section, "health insurer" means any insurance company that issues accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, a corporation that provides accident and sickness subscription contracts, or any health maintenance organization that provides a health care plan that provides, arranges for, pays for, or reimburses any part of the cost of any health care services, that is licensed to engage in such business in the Commonwealth, and that is subject to the laws of the Commonwealth that regulate insurance within the meaning of ? 514(b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. ? 1144(b)(2)).
B. Each health insurer shall provide to the Commissioner of Insurance, by March 1 of each year commencing in 2011, data regarding the efficiency of its operations within the Commonwealth, which data shall include information regarding (i) the health insurer's administrative costs; (ii) the percentage of premiums and other revenues paid in claims; (iii) the extent to which covered persons are able to choose the physicians, hospitals, and other health care providers; (iv) the use of incentives directed at providers, covered persons, or both, that reduce health care costs while improving patient health; (v) preauthorization requirements; and (vi) the restrictions on the use of imaging and other services. Such data shall be provided in such format and detail as the Commission prescribes by regulation.
C. The Commissioner of Insurance shall establish a methodology for compiling and organizing data submitted by health insurers pursuant to subsection B in a manner that permits the public to compare, and to track over time, the relative efficiency of each health insurer operating within the Commonwealth. The data regarding the efficiency of each health insurer, in a format that permits the relative efficiencies of health insurers to be compared and tracked over time, shall be posted by the Commissioner on an Internet site maintained by the Bureau of Insurance.
? 38.2-4214. Application of certain provisions of law.
No provision of this title except this chapter and, insofar as they are not inconsistent with this chapter, ?? 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-218 through 38.2-225, 38.2-230, 38.2-232, 38.2-305, 38.2-316, 38.2-322, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, 38.2-700 through 38.2-705, 38.2-900 through 38.2-904, 38.2-1017, 38.2-1018, 38.2-1038, 38.2-1040 through 38.2-1044, Articles 1 (? 38.2-1300 et seq.) and 2 (? 38.2-1306.2 et seq.) of Chapter 13, ?? 38.2-1312, 38.2-1314, 38.2-1315.1, 38.2-1317 through 38.2-1328, 38.2-1334, 38.2-1340, 38.2-1400 through 38.2-1444, 38.2-1800 through 38.2-1836, 38.2-3400, 38.2-3401, 38.2-3404, 38.2-3404.1, 38.2-3405, 38.2-3405.1, 38.2-3406.1, 38.2-3406.2, 38.2-3407.1 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3409, 38.2-3411 through 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3501, 38.2-3502, subdivision 13 of ? 38.2-3503, subdivision 8 of ? 38.2-3504, ?? 38.2-3514.1, 38.2-3514.2, ?? 38.2-3516 through 38.2-3520 as they apply to Medicare supplement policies, ?? 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3541, 38.2-3541.1, 38.2-3542, 38.2-3543.2, Article 5 (? 38.2-3551 et seq.) of Chapter 35, ?? 38.2-3600 through 38.2-3607, Chapter 52 (? 38.2-5200 et seq.), Chapter 55 (? 38.2-5500 et seq.), Chapter 58 (? 38.2-5800 et seq.) and ? 38.2-5903 of this title shall apply to the operation of a plan.
? 38.2-4319. Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, ?? 38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-305, 38.2-316, 38.2-322, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, Chapter 9 (? 38.2-900 et seq.), ?? 38.2-1016.1 through 38.2-1023, 38.2-1057, Article 2 (? 38.2-1306.2 et seq.), ? 38.2-1306.1, ? 38.2-1315.1, Articles 3.1 (? 38.2-1316.1 et seq.), 4 (? 38.2-1317 et seq.) and 5 (? 38.2-1322 et seq.) of Chapter 13, Articles 1 (? 38.2-1400 et seq.) and 2 (? 38.2-1412 et seq.) of Chapter 14, ?? 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3404.1, 38.2-3405, 38.2-3405.1, 38.2-3407.2 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3411.2, 38.2-3411.3, 38.2-3411.4, 38.2-3412.1:01, 38.2-3414.1, 38.2-3418.1 through 38.2-3418.15, 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500, subdivision 13 of ? 38.2-3503, subdivision 8 of ? 38.2-3504, ?? 38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3541.1, 38.2-3542, 38.2-3543.2, Article 5 (? 38.2-3551 et seq.) of Chapter 35, Chapter 52 (? 38.2-5200 et seq.), Chapter 55 (? 38.2-5500 et seq.), Chapter 58 (? 38.2-5800 et seq.) and ? 38.2-5903 of this title shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (? 38.2-4200 et seq.) of this title except with respect to the activities of its health maintenance organization.
B. For plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended, no provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, ?? 38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-322, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, Chapter 9 (? 38.2-900 et seq.), ?? 38.2-1016.1 through 38.2-1023, 38.2-1057, ? 38.2-1306.1, Article 2 (? 38.2-1306.2 et seq.), ? 38.2-1315.1, Articles 3.1 (? 38.2-1316.1 et seq.), 4 (? 38.2-1317 et seq.) and 5 (? 38.2-1322 et seq.) of Chapter 13, Articles 1 (? 38.2-1400 et seq.) and 2 (? 38.2-1412 et seq.) of Chapter 14, ?? 38.2-3401, 38.2-3405, 38.2-3407.2 through 38.2-3407.5, 38.2-3407.6 and 38.2-3407.6:1, 38.2-3407.9, 38.2-3407.9:01, and 38.2-3407.9:02, subdivisions 1, 2, and 3 of subsection F of ? 38.2-3407.10, 38.2-3407.11, 38.2-3407.11:3, 38.2-3407.13, 38.2-3407.13:1, and 38.2-3407.14, 38.2-3411.2, 38.2-3418.1, 38.2-3418.2, 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500, subdivision 13 of ? 38.2-3503, subdivision 8 of ? 38.2-3504, ?? 38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3542, 38.2-3543.2, Chapter 52 (? 38.2-5200 et seq.), Chapter 55 (? 38.2-5500 et seq.), Chapter 58 (? 38.2-5800 et seq.) and ? 38.2-5903 shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (? 38.2-4200 et seq.) of this title except with respect to the activities of its health maintenance organization.
C. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals.
D. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law.
E. Notwithstanding the definition of an eligible employee as set forth in ? 38.2-3431, a health maintenance organization providing health care plans pursuant to ? 38.2-3431 shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area.
F. For purposes of applying this section, "insurer" when used in a section cited in subsections A and B of this section shall be construed to mean and include "health maintenance organizations" unless the section cited clearly applies to health maintenance organizations without such construction.