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 additional procedures were not investigative in nature, and the additional procedure was compliant with a carrier's post-service claims process. 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 requires that no prior authorization is required for at least one drug prescribed for substance abuse medication-assisted treatment, provided that (i) the drug is a covered benefit, (ii) the prescription does not exceed the FDA labeled dosages, and (iii) the drug is prescribed consistent with the regulations of the Board of Medicine. The measure clarifies that the 24-hour period during which a carrier is required to 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 measure provides that a carrier shall not be required to pay a claim if the carrier has previously authorized health care service and if, during the post-service claims process, it is determined that the claim was submitted fraudulently. Read the Bill »


Bill Has Passed


01/09/2019Prefiled and ordered printed; offered 01/09/19 19103921D
01/09/2019Referred to Committee on Commerce and Labor
01/27/2019Impact statement from SCC (SB1607)
01/31/2019Reported from Commerce and Labor with substitute (15-Y 0-N) (see vote tally)
01/31/2019Committee substitute printed 19105371D-S1
02/01/2019Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/04/2019Read second time
02/04/2019Reading of substitute waived
02/04/2019Committee substitute agreed to 19105371D-S1
02/04/2019Engrossed by Senate - committee substitute SB1607S1
02/04/2019Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/04/2019Passed Senate (40-Y 0-N) (see vote tally)
02/06/2019Placed on Calendar
02/06/2019Read first time
02/06/2019Referred to Committee on Commerce and Labor
02/11/2019Impact statement from SCC (SB1607S1)
02/14/2019Reported from Commerce and Labor (22-Y 0-N) (see vote tally)
02/18/2019Read second time
02/19/2019Read third time
02/19/2019Passed House BLOCK VOTE (98-Y 0-N)
02/19/2019VOTE: BLOCK VOTE PASSAGE (98-Y 0-N) (see vote tally)
02/19/2019Reconsideration of House passage agreed to by House
02/19/2019Passed House BLOCK VOTE (99-Y 0-N)
02/19/2019VOTE: BLOCK VOTE PASSAGE #2 (99-Y 0-N) (see vote tally)
02/22/2019Bill text as passed Senate and House (SB1607ER)
02/22/2019Signed by President
02/22/2019Signed by Speaker
02/25/2019Impact statement from SCC (SB1607ER)
03/04/2019Enrolled Bill Communicated to Governor on March 4, 2019
03/04/2019G Governor's Action Deadline Midnight, March 26, 2019
03/21/2019G Approved by Governor-Chapter 683 (effective 7/1/19)
03/21/2019G Acts of Assembly Chapter text (CHAP0683)