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Bill

HB 1284

State plan for medical assistance; provider-to-provider consultation.

2026 Regular Session Introduced by Amy Laufer and 1 co-sponsor

Establishes Medicaid requirements for patient-initiated specialist consultations and provider-to-provider coordination to improve care access and coordination in Virginia's medical assistance program.

Approved by Governor-Chapter 767 (effective 7/1/2026)
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Bill Summary · HB 1284

Legislative bill overview

HB 1284 modifies Virginia's Medicaid state plan to establish requirements for patient-initiated consultations with specialists and provider-to-provider consultations between primary care physicians and specialists. The bill incorporates provisions from HB 87 and has advanced through the Health and Human Services Committee with a substitute version.

Why is this important

These consultation requirements directly affect how Medicaid patients access specialist care and how physicians coordinate treatment, potentially reducing unnecessary referrals, improving care coordination, and impacting wait times for specialist appointments. The fiscal impact assessment indicates there are budgetary implications for the state's Medicaid program.

Potential points of contention

  • Patient access vs. gatekeeping concerns: Requirements for provider-to-provider consultations before specialist visits could either improve coordination or create barriers that delay patient access to needed specialist care
  • Implementation costs and timeline: The fiscal impact statement suggests state expenditure implications; debate may center on whether benefits justify costs and feasibility of implementation
  • Specialist availability and workflow: Physicians may resist additional consultation requirements that increase administrative burden without clear reimbursement mechanisms or timeline standards

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

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