Chapter 353, Acts of Assembly – 2022 Session(*1) (House Bill 912) required the State Corporation Commission, Bureau of Insurance (Bureau) to convene a work group composed of representatives of the Virginia Association of Health Plans (VAHP), the Virginia Hospital & Healthcare Association (VHHA), and the Medical Society of Virginia (MSV),(*2) for the following purposes:

• To determine options for ensuring continuity of care covered by insurance for a reasonable amount of time under reasonable conditions during the time that providers and insurance carriers are negotiating provider contracts; and,

• To provide recommendations regarding improvements to § 38.2-3407.10 of the Code of Virginia (Code) and any other relevant laws, to ensure proper notice to enrollees and providers, to ensure reasonable opportunities for continuity of care and coverage, and to determine whether special considerations should apply for health care systems that own and operate affiliated hospitals, medical groups, and insurance carriers.

Based on its findings, the Work Group recommends the following:

• Section 38.2-3407.10 of the Code should not be amended to include continuity of care provisions during carrier and provider contract negotiations, as such an amendment is not necessary. Continuity of care protections are only necessary once the contract terminates, not while the contract is still active.

• Specific changes are necessary to improve and clarify the provisions of § 38.2-3407.10 of the Code:

a) Clarify the notice of termination requirement and when the 90-day continuity of care period starts;

b) Drop the requirements that the enrollee be in an “active course of treatment" or request to receive continuity of care services;

c) Make Virginia’s continuity of care law more accommodating to enrollees who have potentially debilitating or life-threatening conditions, as well as to enrollees admitted to inpatient facilities;

d) Expand the initiation point for continuity of care for pregnancy;

e) Expand the scope of continuity of care provisions to group practices; and,

f) Simplify the Code by eliminating the separate requirements for primary care providers.

• Special considerations should not apply for health care systems that own and operate affiliated hospitals, medical groups, and insurance carriers.

In terms of scope, the Work Group notes that § 38.2-3407.10 of the Code applies only to fully insured plans, which corresponds to roughly 35% of Virginia’s commercial health insurance market.
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(*1) A copy is attached as Appendix A.
(*2) Referred to as “the Work Group."