2021 General Assembly Session
Retirement & Insurance Related Legislation
2021 General Assembly Summary – Post Session Report
Retirement and Insurance Related Legislation
Fairfax County Public Schools, Office of Government Relations
This report describes the Retirement and Insurance related legislation considered during the 2021 General Assembly Regular Session. Bills are listed as having Passed or Failed.
The Governor has until March 31 to act on any legislation adopted by the General Assembly and he has the option to sign, amend, or veto any bill. Bills with amendments or vetoes will be considered by the General Assembly at its Reconvened Session, scheduled for April 7. Legislation signed by the Governor goes into effect on July 1, 2021 unless otherwise specified in the legislation itself.
Essential Health Benefits; Abortion Coverage HB 1896 (Hudson) and SB 1276 (McClellan) would remove the prohibition on the provision of coverage for abortions in any qualified health insurance plan that is sold or offered for sale through a health benefits exchange established or operating in Virginia.
Health Insurance; Authorization of Drug Prescribed for the Treatment of a Mental Disorder HB 2008 (Heretick) and SB 1269 (McPike) would require that any provider contract between a carrier and a participating health care provider with prescriptive authority, or its contracting agent, contain provisions that require, when a carrier has previously approved prior authorization for any drug prescribed for the treatment of a mental disorder listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, no additional prior authorization can be required if (i) the drug is a covered benefit; (ii) the prescription does not exceed the U.S. Food and Drug Administration-labeled dosages; (iii) the prescription has been continuously issued for no fewer than three months; and (iv) the prescriber performs an annual review of the patient to evaluate the drug's continued efficacy, changes in the patient's health status, and potential contraindications. The bills would provide that this requirement does not prohibit a carrier from requiring prior authorization for any drug that is not listed on its prescription drug formulary at the time the initial prescription is issued. The bills would also require that such provider contracts contain provisions requiring a carrier to honor a prior authorization issued by the carrier for a drug regardless if the drug is removed from the carrier's prescription drug formulary after the initial prescription for that drug is issued. Under the bills, provisions related to provider contracts and prior authorization would apply to the state insurance health plan.
Health Insurance; Provider Contracts SB 1289 (Surovell) would require that each provider contract include a provision prohibiting a provider from discriminating against any enrollee solely due to the enrollee's status as a litigant in pending litigation or a potential litigant due to being involved in a motor vehicle accident. The bill would provide that the State Corporation Commission, if it has cause to believe that a provider has engaged in a pattern of such discrimination, may submit information to the Board of Medicine or the Commissioner of Health for action.
Prescription Drug Price Transparency HB 2007 (Sickles) would direct the Department of Health to enter into a contract or an agreement with a nonprofit data services organization to collect, compile, and make available on its website information about prescription drug pricing and requires every health carrier, pharmacy benefits manager, and drug manufacturer to report information about prescription drug prices to the nonprofit data services organization with which the Department of Health has entered into a contract for such purpose. The bill would provide that in any case in which the Department determines that the data reported by health carriers, pharmacy benefit managers, and drug manufacturers is insufficient, the Department may require wholesale distributors to report certain data about prescription drug costs. The bill would not become effective until January 1, 2022.
Unemployment Compensation; Failure to Respond; Continuation of Benefits; Repayment of Overpayments HB 2040 (Hudson) would provide that if a claimant has had a determination of initial eligibility for benefits under this chapter, as evidenced by the issuance of compensation or waiting-week credit, payments shall continue, subject to a presumption of continued eligibility and in accordance with the terms of this subsection, until a determination is made that provides the claimant notice and an opportunity to be heard. When a question concerning continued eligibility for benefits arises, a determination would be made as to whether it affects future weeks of benefits or only past weeks. With respect to future weeks, presumptive payment would not be made until but no later than the end of the week following the week in which such issue arises, regardless of the type of issue. With respect to past weeks, presumptive payment would be issued immediately, regardless of the type of issue. Notice would be given to individuals who receive payments under such presumption that pending eligibility may affect their entitlement to the payment and may result in an overpayment that requires repayment.
The Commission would waive the requirement to repay the overpayment, after an individual case review, if (i) the overpayment was made without fault on the part of the individual and (ii) requiring repayment would be contrary to equity and good conscience. An overpayment made "without fault on the part of the individual" would include overpayments that (i) result from administrative error; (ii) are the result of inducement, solicitation, or coercion on the part of the employer; or (iii) result from the employer's failure to respond timely or adequately to the Commission's request for information, as required by § 60.2-528.1. An overpayment would not be considered "without fault on the part of the individual" if such overpayment was the result of (a) a reversal in the appeals process, unless the employer failed to respond timely or adequately to the Commission's request for information regarding the individual's separation from employment: (b) a programming, technological, or automated system error not directly associated with an individual claim that results in erroneous payments to a group of individuals: or (c) fraud. It would be contrary to equity and good conscience if requiring repayment of an overpayment would deprive the individual of the income required to provide for basic necessities, including shelter, food, medicine, childcare, or any other essential living expenses. Overpayments where the obligation to repay has not been waived would be collectible by civil action in the name of the Commission. No determination with respect to benefit overpayments would be issued until after a determination or decision that finds a claimant ineligible or disqualified for benefits previously paid has become final.
The Commission would notify each person with an unpaid overpayment of benefits established for claim weeks paid commencing March 15, 2020, under Chapter 6 (§ 60.2-600 et seq.) of Title 60.2 of the Code of Virginia, or under an unemployment benefit program of the United States or any other state, that such individual may be entitled to a waiver of obligation to repay such overpayment and shall provide 30 days from the date of such notification for the individual to request a waiver of repayment. For good cause shown, the Commission may extend the 30-day period for requesting a waiver. The Commission would conduct an individualized review and adjudicate any request received in accordance with the provisions of § 60.2-619 of the Code of Virginia, as amended by this act, and any individual who is denied a waiver shall have the right to appeal as provided in subsection D of § 60.2-619 of the Code of Virginia, as amended by the bill. In ruling on any waiver request, the Commission would apply the provisions of Title 60.2 or, if applicable, the overpayment waiver provisions of any unemployment compensation program of the United States.
The provisions of the bill that would allow the waiver of any obligation to repay overpayments established for the week commencing March 15, 2020, through the week commencing June 26, 2021, would apply only to overpayment balances that remain outstanding as of July 1, 2021. Amounts already paid or collected against such overpayments shall not be reimbursed to the claimant, except for benefits paid under the Pandemic Unemployment Assistance program.
Notwithstanding any provision to the contrary, the Commission would be able to suspend or forgo referring any overpayment established since March 15, 2020, to the collections process established under § 2.2-4806 of the Code of Virginia. However, the authority to suspend or forgo such referrals would expire on July 1, 2022.
The fifth enactment clause of the bill would provide, “That all costs to the Unemployment Compensation Fund (the Fund) resulting from the provisions of this act for overpayments of benefits under Chapter 6 (§ 60.2-600 et seq.) of Title 142 60.2 of the Code of Virginia would be reimbursed to the Fund from the general fund in the general appropriation act. For an overpayment waived pursuant to this act, no employer would be responsible for (i) reimbursing benefits or (ii) benefits charges, except as provided in § 60.2-528.1 145 of the Code of Virginia.” The provisions of the bill would expire on July 1, 2022.
Virginia Retirement System; Technical Amendments HB 2181 (Mundon-King) and SB 1251 (Newman) would make technical amendments to provisions of the Code of Virginia relating to the Virginia Retirement System to reflect recent changes to federal law and conform terminology to federal law, including changing the required minimum distribution provisions to reflect recent changes in federal law, and conforming terminology related to disability retirement benefits.
Workers' Compensation; Claims Not Barred SB 1351 (Lewis) would provide that an order issued by the Workers' Compensation Commission awarding or denying benefits shall not bar by res judicata any claim by an employee or cause a waiver, abandonment, or dismissal of any claim by an employee if the order does not expressly adjudicate such claim.
Health Insurance; Cost-Sharing Payments for Prescription Asthma Inhalers HB 1822 (Askew) would have prohibited health insurance companies and other carriers from setting an amount exceeding $50 per 30-day supply of a tier one or tier two prescription asthma inhaler that a covered person is required to pay at the point of sale in order to receive a covered prescription asthma inhaler unless the carrier is prohibited from providing the additional benefits under state or federal law. The measure also would have prohibited a provider contract between a carrier or its pharmacy benefits manager and a pharmacy from containing a provision authorizing the carrier's pharmacy benefits manager or the pharmacy to charge, requiring the pharmacy to collect, or requiring a covered person to make a cost-sharing payment for a covered prescription asthma inhaler in an amount that exceeds such limitation. The provisions would have applied with respect to health plans and provider contracts entered into, amended, extended, or renewed on or after January 1, 2022.
Health Insurance; Provider Contracts HB 2021 (Gooditis) would have prohibited a carrier from unilaterally amending any material provision of a provider contract or adding any new material provision to any provider contract within 12 months of execution of the provider contract or the date of last amendment to the provider contract. The measure would have required such an amendment to be agreed to by the provider in a signed written amendment to the provider contract. The measure would have also required that carriers supply fee schedules in writing, make fee schedules available in machine-readable electronic format, and provide the complete fee schedule applicable to the provider for each health plan in which the provider participates or is proposed to participate. The measure would have required that amendments to a provider contract be presented in a manner so as to allow the provider to easily identify the specific terms being proposed for amendment and that proposed amendments be formatted to clearly identify the changes to the language of the agreement. HB 2274 (Webert) would have required that each provider contract include provisions requiring providers to provide health care services to enrollees in a manner similar to and within the same time availability in which the provider provides health care services to any other individual and prohibiting a provider from discriminating against any enrollee as a result of the enrollee's enrollment in a health plan or on the basis of the enrollee's race, color, creed, national origin, ancestry, religion, sex, marital status, age, disability, payment source, state of health, need for health care services, status as a litigant except in cases where the enrollee claims medical malpractice by the provider, status as a Medicare enrollee, status as a medical assistance recipient, sexual orientation, or gender identity, or on any other basis prohibited by law. The bill would have prohibited a provider contract from requiring a provider to provide any type or kind of health care service to enrollees that it does not customarily provide to others. The bill would have provided that a provider that violates the anti-discrimination provisions may be subject to fines and other discipline from the provider's licensing authority and an enrollee injured as result of any discrimination is entitled initiate a civil action against the provider.
Insurance Coverage for Infertility Treatment and Fertility Preservation; Study and Report HJ 545 (Helmer) would have directed the Health Insurance Reform Commission to study mandating insurance coverage for infertility treatment including in vitro fertilization and standard fertility preservation procedures that are medically necessary to preserve the fertility of a covered individual due to the covered individual receiving cancer treatment that may directly or indirectly cause iatrogenic infertility.
Pharmaceutical distribution payment system study HJ 560 (Guzman) would have requested the Secretary of Health and Human Resources to convene a work group to examine the pharmaceutical distribution payment system in the Commonwealth and innovative solutions to address the cost of prescription drugs to Virginians at the point of sale.
Unemployment Compensation; Benefits; Suitable Work; Benefits Charges HB 2037 (Tran) would have provided that, under specific conditions related to the COVID-19 virus, work will not be deemed suitable and benefits will not be denied to any otherwise eligible individual for refusing to accept new work if the individual presents satisfactory evidence that such individual has tested positive for COVID-19, has been otherwise directed by a physician to quarantine due to COVID-19, or is providing care for an immediate family member who has tested positive for COVID-19; or the individual has a reasonable belief, based on satisfactory evidence, that the workplace is unsafe because it does not meet governmental-mandated COVID-19 health and safety standards for the workplace, including standards issued by the U.S. Occupational Safety and Health Administration, the Department of Labor and Industry, or the Department of Health, or through an executive order or directive issued by the Governor. The bill would have provided, that for individuals who refuse to accept an offer of work based on such conditions, no benefits charges will be deemed to be the responsibility of the previous employer, unless the individual has refused an offer to return to work to his previous employer because the individual has a reasonable belief that the workplace is not in compliance with the Department of Labor and Industry's standards for the prevention of COVID-19. The provisions of the bill would have expired 30 days after the expiration or revocation of all states of emergency declared by the Governor related to the COVID-19 pandemic.
Unemployment Compensation; Overpayments Due to Administrative Error HB 1977 (Askew) would have provided that if an individual receives an overpayment of unemployment benefits under the state program that occurred due to an administrative error, the individual would not required to repay the overpayments.
Universal Health Care, Joint Commission on Health Care study of options for financing HB 2271 (Samirah) would have directed the Joint Commission on Health Care to enter into a contract with a qualified entity to study options for financing universal health care in the Commonwealth with a report the findings, conclusions, and recommendations of the qualified entity to the General Assembly due by October 1, 2022.
Virginia Retirement System; Retired Law-Enforcement Officers Employed as School Security Officers (Leftwich) and SB 1137 (Cosgrove) would have provided that if a retired law-enforcement officer was employed by a local school division as a school security officer on January 1, 2020, and had a bona fide break in service of at least one month between retirement and employment as a school security officer, such person would not required to establish a 12-month break in service that would otherwise be required by law.