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HJ 464

Cardiovascular disease screening coverage; Health Insurance Reform Commission to study.

2025 Regular Session Introduced by Mark Earley

A study to evaluate if Virginia should mandate insurance coverage for CAC and CIMT cardiovascular risk tests in at‑risk adults, analyzing cost, efficacy, and impact.

Left in Rules
0
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Bill Summary · HJ 464

Summary of HJ 464: Cardiovascular Disease Screening Coverage; Health Insurance Reform Commission to Study

Purpose and intent

  • HJ 464 is a House Joint Resolution directing the Health Insurance Reform Commission to study whether insurance carriers should be required to cover certain tests used for the early detection of cardiovascular disease in at‑risk populations.
  • The focus is on evaluating potential coverage for specific imaging tests that can help assess cardiovascular risk and guide preventive care.

Key provisions

  • Tests examined for potential coverage:
    • Computed tomography scans measuring coronary artery calcification (CAC score)
    • Ultrasonography scans measuring carotid intima-media thickness (CIMT) and plaque
  • Target population for coverage consideration:
    • Males aged 45 to 75
    • Females aged 55 to 75
    • Enrollees who are diabetic or who have an intermediate or higher risk of developing coronary heart disease according to the Framingham Heart Study coronary prediction algorithm
  • Study scope required of the Health Insurance Reform Commission:
    • Assess social and financial impact of mandating coverage for these tests
    • Evaluate medical efficacy of such coverage
    • Estimate the potential effect on health‑coverage costs in Virginia, including any additional costs the Commonwealth may bear under § 1311(d)(3)(B) of the federal ACA
    • Determine whether the coverage should be considered in an essential health benefits (EHB) benchmark plan review under Virginia law (§ 30‑343.1)
  • Administrative and technical support:
    • The Office of the Clerk of the House of Delegates provides administrative staff
    • The Division of Legislative Services provides legal, research, policy analysis, and other services
    • The Bureau of Insurance provides technical assistance
    • All state agencies may be called to assist

Affected parties

  • Insurance carriers operating in Virginia and their enrollees who meet the specified criteria
  • Healthcare providers performing CAC scoring and CIMT testing
  • State agencies involved in health policy, insurance regulation, and budgetary planning
  • The Commonwealth may incur direct or indirect costs associated with potential coverage mandates

Timeline and procedural aspects

  • Introduced: January 8, 2025; Prefiled January 8, 2025; Offered January 13, 2025 (HJ 464)
  • Status: Referred to Rules; currently left in Rules as of February 4, 2025
  • Commission timeline: Must complete meetings by November 30, 2025
  • Final deliverable: An executive summary (and recommendations) due no later than the first day of the 2026 Regular Session; summary must indicate whether the Commission intends to submit a final report to the General Assembly and Governor
  • Publication: Executive summary and report to be posted on the General Assembly website

Potential impact and considerations

  • This resolution does not itself mandate coverage; it initiates a formal study to determine feasibility, cost, and clinical value of coverage for CAC and CIMT testing in at‑risk populations.
  • If the Commission recommends coverage, legislative action could follow to mandate coverage or modify EHB benchmarks; such actions could influence premiums, plan design, and state budgeting.
  • The assessment will consider alignment with federal ACA provisions and potential cost implications for Virginia’s health‑care programs and subsidies.

Note on status

  • Patron: Earley
  • Legislative actions indicate the bill remains in Rules and is not yet progressed to committee or floor vote as of the latest available actions.

Compiled from official sources — confirm details with the bill’s official record.

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