Health insurance; carrier business practices, authorization of health care services. (SB1607)

Introduced By

Sen. Siobhan Dunnavant (R-Henrico)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Health insurance; carrier business practices; authorization of health care services. Provides that if a carrier has previously authorized an invasive or surgical health care service as medically necessary and during the procedure the health care provider discovers clinical evidence prompting the provider to perform a less or more extensive or complicated procedure than was previously authorized, then the carrier shall pay the claim, provided that it is appropriately coded consistent with the procedure actually performed. The measure requires any provider contract between a carrier and a participating health care provider to contain certain specific provisions addressing how carriers interact with prior authorization requests. The measure clarifies that the 24-hour period during which a carrier must communicate to a prescriber if an urgent prior authorization request submitted telephonically or in an alternate method directed by the carrier has been approved, denied, or requires supplementation includes weekend hours. The bill provides that no prior authorization shall be required for substance abuse medication-assisted treatment or if the prescriber is using a clinical decision support system, defined as applications that analyze data to help providers make decisions and improve patient care. Amends § 38.2-3407.15, of the Code of Virginia. Read the Bill »


01/09/2019: Awaiting a Vote in the Commerce and Labor Committee


01/09/2019Prefiled and ordered printed; offered 01/09/19 19103921D
01/09/2019Referred to Committee on Commerce and Labor

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