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Bill

HB 87

State plan for med. assistance; patient-initiated consultation, provider-to-provider consultation.

2026 Regular Session Introduced by Amy Laufer

Virginia Medicaid must allow patients to directly request specialist consultations and permit provider-to-provider referrals without prior authorization requirements.

Incorporated by Health and Human Services (HB1284-Downey) (Voice Vote)
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Bill Summary · HB 87

Legislative bill overview

HB 87 requires Virginia's medical assistance program (Medicaid) to establish policies enabling patients to initiate direct consultations with specialists and allowing providers to request specialist consultations without requiring prior authorization. The bill was incorporated into HB 1284, a broader healthcare policy measure, during the legislative process.

Why is this important

This bill addresses care coordination and access barriers in Virginia's Medicaid system. Streamlining consultation processes could reduce delays in specialist care, improve health outcomes for vulnerable populations, and potentially decrease unnecessary emergency department visits—though it may also increase healthcare utilization and costs.

Potential points of contention

  • Cost implications: Removing barriers to specialist consultations could increase Medicaid spending on referrals and specialist services without clear cost containment mechanisms
  • Prior authorization rationale: Prior authorization exists partly to prevent unnecessary specialist visits; eliminating it may conflict with utilization management goals and fiscal sustainability
  • Implementation complexity: Creating patient-initiated consultation pathways requires significant changes to Medicaid administrative systems, provider networks, and care coordination infrastructure
  • Network adequacy: The bill's success depends on adequate specialist availability; rural or underserved areas may struggle to accommodate increased consultation requests

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

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