VirginiaHB7012026 Regular SessionHouseWALLET

Health and insurance; notice of adverse determination.

Sponsored By: Michelle Lopes Maldonado (Democratic)

Signed by Governor

Summary

Health insurance; notice of adverse determination. Requires health carriers to send in writing to a covered person the notice of an adverse determination or final adverse determination and the covered person's right to request an external review, as required by current law, within five business days after the adverse determination or final adverse determination has been made. The bill also requires such notice to include certain information related to the person who made the adverse determination or final adverse determination.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Patients get clearer outside review rights

Virginia health carriers must send covered patients written notice within five business days after an adverse or final adverse decision. The notice must explain outside review rights in prominent bold text and include required decision-maker or appeal contacts, steps, and forms. Faster review is available for qualifying cancer cases or when waiting seriously threatens life, health, or recovery of maximum function. For experimental or investigational treatment denials, faster review requires a doctor's written certification that waiting would make treatment significantly less effective. Final denials of these treatments can also receive standard outside review. Final decisions about admission, available care, continued stays, or emergency care can qualify for faster review before facility discharge. Patients filing a fast internal appeal can also request fast outside review; the independent reviewer decides whether internal review must finish first. After a standard internal appeal, patients can request outside review if no written decision arrives within 30 days. This route applies only when the patient did not request or agree to a delay.

Stronger safeguards for patients facing care denials

Virginia law requires entities making adverse care decisions to make a good-faith effort to get information from the treating provider first. Before a final decision, the provider can discuss medical need with the entity's physician adviser or peer. For prescriptions to relieve cancer pain, a physician adviser must review medical need with the provider. The entity must notify the provider in writing within two working days after an adverse decision. For prescriptions known to relieve cancer pain, it must also call the provider within 24 hours. Notices must explain reconsideration and appeal steps, including each responsible contact's name or unique identifier, address, and phone number.

Sponsors & Cosponsors

Sponsor

  • Michelle Lopes Maldonado

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 493 • No: 0

House vote • 3/12/2026

Senate amendment agreed to by House

Yes: 98 • No: 0

Senate vote • 3/11/2026

Reconsideration of Senate passage agreed to by Senate Block Vote

Yes: 40 • No: 0

Senate vote • 3/11/2026

Commerce and Labor Amendment agreed to

Yes: 0 • No: 0

Senate vote • 3/11/2026

Passed Senate with amendment Block Vote

Yes: 39 • No: 0

Senate vote • 3/11/2026

Passed Senate with amendment Block Vote

Yes: 40 • No: 0

Senate vote • 3/10/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 37 • No: 0

Senate vote • 3/10/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 3/9/2026

Reported from Commerce and Labor with amendment

Yes: 14 • No: 0

House vote • 2/11/2026

Passed House Block Vote

Yes: 98 • No: 0

House vote • 2/11/2026

Read third time and passed House Block Vote

Yes: 96 • No: 0

House vote • 2/5/2026

Reported from Labor and Commerce with substitute

Yes: 22 • No: 0

House vote • 2/3/2026

Subcommittee recommends reporting with substitute

Yes: 9 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0411)

    4/8/2026Governor
  2. Approved by Governor-Chapter 411 (effective 7/1/2026)

    4/8/2026Governor
  3. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/31/2026Governor
  4. Enrolled Bill communicated to Governor on March 31, 2026

    3/31/2026House
  5. Signed by Speaker

    3/31/2026House
  6. Bill text as passed House and Senate (HB701ER)

    3/30/2026House
  7. Enrolled

    3/30/2026House
  8. Signed by President

    3/30/2026Senate
  9. Senate amendment agreed to by House (98-Y 0-N 0-A)

    3/12/2026House
  10. Passed Senate with amendment Block Vote (40-Y 0-N 0-A)

    3/11/2026Senate
  11. Reconsideration of Senate passage agreed to by Senate Block Vote (40-Y 0-N 0-A)

    3/11/2026Senate
  12. Passed Senate with amendment Block Vote (39-Y 0-N 0-A)

    3/11/2026Senate
  13. Commerce and Labor Amendment agreed to

    3/11/2026Senate
  14. Engrossed by Senate as amended

    3/11/2026Senate
  15. Read third time

    3/11/2026Senate
  16. Passed by for the day Block Vote (Voice Vote)

    3/10/2026Senate
  17. Constitutional reading dispensed Block Vote (on 2nd reading) (37-Y 0-N 0-A)

    3/10/2026Senate
  18. Rules suspended

    3/10/2026Senate
  19. Senate committee offered

    3/9/2026Senate
  20. Fiscal Impact Statement from State Corporation Commission (HB701)

    3/9/2026House
  21. Reported from Commerce and Labor with amendment (14-Y 0-N)

    3/9/2026Senate
  22. Referred to Committee on Commerce and Labor

    2/12/2026Senate
  23. Constitutional reading dispensed (on 1st reading)

    2/12/2026Senate
  24. Passed House Block Vote (98-Y 0-N 0-A)

    2/11/2026House
  25. Reconsideration of passage agreed to by House

    2/11/2026House

Bill Text

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