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Bill

HB 2099

Health insurance; required provisions regarding prior authorization for health care services.

2025 Regular Session Introduced by Michelle Maldonado and 1 co-sponsor

Virginia requires health insurers to establish timely prior authorization procedures with expedited review options, effective January 2027, to reduce treatment delays.

Acts of Assembly Chapter text (CHAP0058)
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Bill Summary · HB 2099

Legislative bill overview

HB 2099 requires Virginia health insurers to establish and follow specific procedures for prior authorization of health care services, including timelines for approval decisions and mechanisms for expedited reviews. The bill aims to reduce administrative delays that can prevent patients from accessing necessary medical treatments while maintaining insurers' ability to review medical necessity.

Why is this important

Prior authorization delays can significantly impact patient health outcomes, particularly in urgent or time-sensitive situations. This legislation addresses a widespread complaint from patients and providers that insurance approval processes create unnecessary barriers to care and add administrative burden to medical practices, ultimately affecting healthcare delivery efficiency across the state.

Potential points of contention

  • Implementation burden: Insurers may argue compliance costs will increase premiums or reduce coverage options, while patient advocates contend these costs are justified by preventing harmful delays
  • Definition of "urgent": Disagreement over which conditions qualify for expedited review timelines could lead to disputes between insurers and providers about appropriate approval speeds
  • Enforcement mechanisms: The bill's effectiveness depends on regulatory oversight; unclear penalties for non-compliance could limit practical impact on insurer behavior

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

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