                                 CODE OF VIRGINIA

STANDING COMMITTEES TO REQUEST COMMISSION ASSESSMENT (§ 30-343)

A. Whenever a legislative measure containing a mandated health insurance benefit
or provider is proposed that is not identical or substantially similar to a
legislative measure previously reviewed by the Commission within the three-year
period immediately preceding the then-current session of the General Assembly,
the Chair of the House Committee on Labor and Commerce or Senate Committee on
Commerce and Labor having jurisdiction over the proposal shall (i) request that
the Commission assess the proposal and (ii) send a copy of such request to the
Bureau of Insurance of the State Corporation Commission (the Bureau). The
Commission shall be given a period of 24 months to complete and submit its
assessment on each such request. A report summarizing the Commission&#8217;s
assessment shall be forwarded to the chairman of the standing committee that
requested the assessment. For the purposes of this section, &#8220;mandated
health insurance benefit or provider&#8221; has the same meaning as
&#8220;state-mandated health benefit&#8221; provided in &#xA7; 38.2-3406.1.

B. Upon receipt of a copy of such a request, the Bureau shall prepare an
analysis of the extent to which the proposed mandate is currently available
under qualified health plans in the Commonwealth and advise the Commission as to
whether the applicable agency has determined or would likely determine, in
accordance with applicable federal rules, that the proposed mandate exceeds the
scope of the essential health benefits. The Bureau&#8217;s analysis shall be
advisory only and not binding upon the Commission, the Bureau, the State
Corporation Commission, or any other parties. As used in this section,
&#8220;applicable agency&#8221; means the governmental agency that in accordance
with applicable federal rules is responsible for identifying state-mandated
benefits that are in addition to the essential health benefits. If the
applicable federal rules require an agency of the Commonwealth to identify the
state-mandated benefits that are in addition to the essential health benefits
but do not identify a specific agency that is responsible for making such
identification, the Bureau shall be the applicable agency. Following the
Bureau&#8217;s analysis, the Commission shall determine if the proposed mandate
shall be (i) considered as part of an essential health benefits benchmark plan
review in accordance with the provisions of &#xA7; 30-343.1, (ii) assessed
jointly by the Bureau and the Joint Commission on Health Care in accordance with
subsection C, or (iii) considered in another manner by the Commission.

C. Upon request of the Commission, the Bureau and the Joint Commission on Health
Care shall jointly assess the social and financial impact and the medical
efficacy of the proposed mandate, which assessment shall include an estimate of
the effects of enactment of the proposed mandate on the costs of health coverage
in the Commonwealth, including any estimated additional costs that the
Commonwealth may be responsible for pursuant to &#xA7; 1311(d)(3)(B) of the
federal Patient Protection and Affordable Care Act should the proposed mandate
ultimately be determined by the applicable agency to be a benefit that exceeds
the scope of the essential health benefits. Upon completion of the assessment by
the Bureau and the Joint Commission on Health Care, the Commission may make a
recommendation regarding its support of or opposition to the enactment of the
proposed mandate. The Commission&#8217;s recommendation may address whether the
proposed mandate should be provided under health care plans offered through a
health benefit exchange or outside a health benefit exchange.
			The Commission shall be given a period of 24 months to complete and submit
its assessment on each such request. A report summarizing the Commission&#8217;s
study shall be forwarded to the Governor and the General Assembly.

D. Whenever a legislative measure containing a mandated health insurance benefit
or provider is identical or substantially similar to a legislative measure
previously reviewed by the Commission within the three-year period immediately
preceding the then-current session of the General Assembly, the standing
committee may request the Commission to study the measure as provided in
subsection A.

HISTORY: 2013, c. 709; 2015, c. 698; 2016, c. 570; 2017, c. 485; 2021, Sp. Sess.
I, c. 259; 2023, cc. 698, 699; 2024, cc. 36, 219; 2025, c. 268.