All Roll Calls
Yes: 260 • No: 1
Sponsored By: Jeremy S. McPike (Democratic)
Signed by Governor
Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.
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12 provisions identified: 8 benefits, 1 costs, 3 mixed.
Virginia-regulated health plan contracts must bar providers from discriminating solely because a patient has a possible or pending accident lawsuit. Providers are not required to treat patients who threatened or made professional-liability claims or regulatory complaints against them or related people. The State Corporation Commission can refer suspected repeated violations without corrective action to the Board of Medicine or Commissioner of Health. Those authorities can impose fines, recover costs, and take other authorized action, then report their findings to the Commission.
Insurers must respond within 72 hours, including weekends, when delaying advance approval could seriously threaten health or recovery. Standard requests have a seven-calendar-day response deadline. Responses must approve, deny with reasons, or request specific information; completed follow-up information starts the applicable decision period. Insurers cannot change approvals once care is scheduled or provided as approved. Exceptions cover provider-requested changes, fraud or misrepresentation, and specified federal or manufacturer actions affecting care or safety. The rule does not require approval after a patient leaves the plan.
Insurers must keep services, procedures, codes, and forms requiring advance approval in one public online location. They must update that information when new requirements take effect and notify providers at least 30 calendar days before changes. That notice period does not apply when approval requirements are removed during an emergency. Insurers cannot deny claims for missing approval when the rules applying on the care date were not posted as required.
Insurers must identify a paid claim, explain any recovery in writing, and give at least 30 days' advance notice. Recovery must be permitted by the provider contract and cannot violate the law's other protections. Allowed grounds include fraud, duplicate payment, services not delivered, or payment made no more than 12 months earlier. Providers can agree in writing to extend the 12-month period for recovery through future-payment withholding or offsets. Related insurer messages and provider responses must be electronic no later than January 1, 2026. These rules govern provider repayments, not patients' personal repayment duties.
Insurers must pay claims for care they approved or said was covered and medically needed. Exceptions include unsupported claims, payment already made or another responsible payer's payment, fraud, material reliance on incorrect information, and previously unknown ineligibility despite reasonable care. During an approved invasive procedure or surgery, new clinical evidence can require a less extensive, more extensive, or more complicated procedure. Insurers must pay for that changed procedure when it is covered, medically needed, correctly coded, and submitted through required claim procedures. Investigative procedures are excluded; the law does not set patients' out-of-pocket amounts.
Insurers or claims agents may lower a claim's billing code only through a person or a system using correct coding standards. The decision must consider relevant patient data documented on the claim, and providers must receive notice and adjustment codes. Contracts must allow at least 180 days after notice to dispute the change and provide reasonable decision and appeal timelines. A person must review each dispute decision; patient-specific batch disputes are allowed under the contract and federal health privacy rules. These protections exclude limited-scope benefits, including stand-alone dental plans.
Insurers must let contracted providers check whether services are covered and medically needed, along with approval and payment requirements. Contracts must disclose routine practices for combining billing codes or lowering them to pay less. Applicable policies must be available electronically within 10 business days of a request. If copyright prevents sharing a policy, insurers must clearly explain how it applies. Beginning July 1, 2025, insurers must offer electronic checks of enrollment in plans overseen by Virginia's State Corporation Commission.
Insurers must pay provider claims within 40 days of receipt, with exceptions for documented disputes or suspected fraud. They must report defects and request needed information within 30 days; otherwise, the claim is treated as complete. Required notices and information must be electronic no later than January 1, 2026. Insurers must keep claim-receipt records that claimants can inspect and use as proof of filing. Claims whose denials are overturned become complete claims that day, triggering the applicable payment rules. Any interest owed must be paid without a request, with the claim or within 60 days afterward. Insurers must disclose payment-method fees and offer a fee-free option, then use it when providers choose it and supply enrollment information.
This section's advance-approval rules exclude drugs governed by Virginia's separate drug-approval law. They also exclude qualifying health maintenance organizations using a multispecialty physician group whose doctors are both employees and shareholders. To qualify, the plan must provide or arrange physician care through those group doctors or contracted community providers.
Before complaining to the state about missed 40-day payment deadlines, providers must try to confer and document disputed claims. They must attest to those steps and generally wait 30 calendar days after requesting a conference if the insurer responds. No waiting period applies when the provider judges the insurer unresponsive. Virginia providers harmed by insurer violations or breaches of required contract terms can sue for actual damages, reasonable legal fees, and court costs. A judge or jury can award up to three times actual damages for gross negligence and willful conduct. Each improperly handled claim is a separate violation, and insurers, networks, and intermediaries cannot punish providers for exercising legal or contract rights.
Insurers must include applicable fee schedules or payment explanations, material attachments, and policies when offering provider contracts. A clear written explanation can replace a policy when copyright prevents sharing it. Contract changes require at least 60 calendar days' advance notice. Providers can block the change by giving notice within 30 calendar days that they will end the contract at its earliest allowed date. Insurers must send contracts, amendments, and notices electronically by July 1, 2025; providers must do so by January 1, 2026. Both sides must put an agreed delivery method and location in the contract; electronic fax is not allowed.
Insurers must maintain a federally aligned electronic interface for advance approval of medical items and services. Implementation is due January 1, 2027, or a later date set by the federal Centers for Medicare & Medicaid Services. Providers must make their health record or health technology systems able to access it within one year after that deadline. Providers can request an undue-hardship waiver for a period set by the appropriate regulator. Insurers must publish federal-compliant approval data by March 31 each year for the prior calendar year. A stakeholder work group monitors federal changes and studies approval measures, including possible prescription-drug expansion. Its reports include an interim 2025 assessment and annual legislative reports, ending with a final report due November 1, 2028.
Jeremy S. McPike
Democratic • Senate
There are no cosponsors for this bill.
All Roll Calls
Yes: 260 • No: 1
Senate vote • 3/6/2026
House substitute with amendments agreed to by Senate
Yes: 40 • No: 0
House vote • 3/4/2026
Passed House with substitute with amendments
Yes: 97 • No: 1
House vote • 2/26/2026
Reported from Labor and Commerce with substitute
Yes: 21 • No: 0
House vote • 2/24/2026
Subcommittee recommends reporting with substitute
Yes: 9 • No: 0
Senate vote • 1/30/2026
Read third time and passed Senate Block Vote
Yes: 38 • No: 0
Senate vote • 1/29/2026
Commerce and Labor Substitute agreed to
Yes: 0 • No: 0
Senate vote • 1/29/2026
Engrossed by Senate Block Vote (Voice Vote)
Yes: 0 • No: 0
Senate vote • 1/28/2026
Passed by for the day Block Vote (Voice Vote)
Yes: 0 • No: 0
Senate vote • 1/28/2026
Constitutional reading dispensed Block Vote (on 1st reading)
Yes: 40 • No: 0
Senate vote • 1/26/2026
Reported from Commerce and Labor with substitute
Yes: 15 • No: 0
Acts of Assembly Chapter text (CHAP0881)
Approved by Governor-Chapter 881 (effective 7/1/2026)
Fiscal Impact Statement from State Corporation Commission (SB164)
Governor's Action Deadline 11:59 p.m., April 13, 2026
Enrolled Bill communicated to Governor on March 14, 2026
Bill text as passed Senate and House (SB164ER)
Enrolled
Signed by President
Signed by Speaker
House substitute with amendments agreed to by Senate (40-Y 0-N 0-A)
Passed House with substitute with amendments (97-Y 1-N 0-A)
Engrossed by House - committee substitute as amended
Delegate Shin Floor amendments agreed to
Labor and Commerce Substituteagreed to by House
Reconsideration of
Floor Offered
Passed by temporarily
committee substitute rejected
Read third time
Fiscal Impact Statement from State Corporation Commission (SB164)
Passed by for the day
Moved from Uncontested Calendar to Regular Calendar
Read second time
Committee substitute printed 26108190D-H1
Reported from Labor and Commerce with substitute (21-Y 0-N)
Chaptered
4/13/2026
Enrolled
3/12/2026
Amendment
3/4/2026
Substitute
2/27/2026
Substitute
2/25/2026
Substitute
2/24/2026
Substitute
1/27/2026
Substitute
1/26/2026
Introduced
1/7/2026
HB5, Employment; paid sick leave, civil penalties.
Employment; paid sick leave; civil penalties; civil actions. Requires one hour of paid sick leave for every 30 hours worked for all employees of private employers and state and local governments, with certain exceptions. The bill requires that employees who are employed and compensated on a fee-for-service basis accrue paid sick leave in accordance with regulations adopted by the Commissioner of Labor and Industry. The bill provides that employees transferred to a separate division or location remain entitled to previously accrued paid sick leave and that employees retain their accrued paid sick leave under any successor employer. The bill allows employers to provide a more generous paid sick leave policy than prescribed by its provisions and specifies that employees, in addition to using paid sick leave for their physical or mental illness or to care for a family member, may use paid sick leave to seek or obtain certain services or to relocate or secure an existing home due to domestic abuse, sexual assault, or stalking. The bill requires the Commissioner to promulgate regulations for the implementation and enforcement of the bill's provisions by July 1, 2027.The bill authorizes the Commissioner, in the case of a knowing violation, to subject an employer to a civil penalty not to exceed $150 for the first violation, $300 for the second violation, and $500 for each successive violation. The Commissioner or Attorney General may commence administrative proceedings or bring a civil action to enforce the bill's provisions. Additionally, the bill authorizes an aggrieved employee to bring a civil action against the employer in which he may recover double the amount of any unpaid sick leave and the amount of any actual damages suffered as the result of the employer's violation. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill is identical to SB 199.
SB199, Employment; paid sick leave, civil penalties.
Employment; paid sick leave; civil penalties; civil actions. Requires one hour of paid sick leave for every 30 hours worked for all employees of private employers and state and local governments, with certain exceptions. The bill requires that employees who are employed and compensated on a fee-for-service basis accrue paid sick leave in accordance with regulations adopted by the Commissioner of Labor and Industry. The bill provides that employees transferred to a separate division or location remain entitled to previously accrued paid sick leave and that employees retain their accrued paid sick leave under any successor employer. The bill allows employers to provide a more generous paid sick leave policy than prescribed by its provisions and specifies that employees, in addition to using paid sick leave for their physical or mental illness or to care for a family member, may use paid sick leave to seek or obtain certain services or to relocate or secure an existing home due to domestic abuse, sexual assault, or stalking. The bill requires the Commissioner to promulgate regulations for the implementation and enforcement of the bill's provisions by July 1, 2027. The bill authorizes the Commissioner, in the case of a knowing violation, to subject an employer to a civil penalty not to exceed $150 for the first violation, $300 for the second violation, and $500 for each successive violation. The Commissioner or Attorney General may commence administrative proceedings or bring a civil action to enforce the bill's provisions. Additionally, the bill authorizes an aggrieved employee to bring a civil action against the employer in which he may recover double the amount of any unpaid sick leave and the amount of any actual damages suffered as the result of the employer's violation. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill incorporates SB 372 and is identical to HB 5.
HB95, Va. Residential Landlord and Tenant Act; landlord remedies, noncompliance with rental agreement.
Virginia Residential Landlord and Tenant Act; landlord remedies; noncompliance with rental agreement; payment plan. Requires a landlord who owns more than four rental dwelling units or more than a 10 percent interest in more than four rental dwelling units, before terminating a rental agreement due to nonpayment of rent if the exact amount of rent owed is less than or equal to one month's rent plus any late charges contracted for in the rental agreement and as provided by law, to serve upon such tenant a written notice informing the tenant of the exact amount due and owed and offer the tenant a payment plan under which the tenant must pay the exact amount due and owed in equal monthly installments over a period of the lesser of six months or the time remaining under the rental agreement. The bill prohibits the landlord from charging any additional late fees during the payment plan period in connection with the unpaid rental amount for which the tenant entered into the payment plan so long as the tenant makes timely payments in accordance with the terms of the payment plan. The bill also outlines the remedies a landlord has if a tenant fails to pay the exact amount due and owed or enter into a payment plan within five days of receiving notice or if a tenant enters into a payment plan and after such plan becomes effective fails to pay rent when due or fails to make a payment under the terms of the agreed-upon payment plan. The bill has a delayed effective date of January 1, 2027.
HB1393, Electric utilities; pilot program for energy assistance and weatherization for certain individuals.
Electric utilities; pilot programs for energy assistance and weatherization for certain individuals. Amends annual funding commitments for the purposes of the annual pilot program for energy assistance and weatherization for low-income, elderly, and disabled individuals conducted by Dominion Energy Virginia and Appalachian Power Company. Under the bill, Appalachian Power Company is required to continue its pilot program at no less than $1 million and no greater than $1.5 million annually. Dominion Energy Virginia is required to continue its pilot program at no less than $156 million and no greater than $204 million for the time period beginning July 1, 2026, and ending July 1, 2038. The bill extends the sunset date of such pilot programs from July 1, 2028, to July 1, 2038.The bill also provides that Dominion Energy Virginia may recover costs associated with certain electrical facilities that have been approved by the State Corporation Commission as of December 1, 2033, provided that certain requirements are met and notwithstanding any limitations on such cost recovery in current law. The bill directs Dominion Energy Virginia to propose to the Commission, in any proceeding to determine rates for generation and distribution services commencing after January 1, 2027, and before July 1, 2033, that certain costs related to capacity procurement requirements and distribution infrastructure investments are allocated to the utility's customer class approved to serve customers with a contracted or measured electric demand of 25 megawatts or greater and an anticipated or measured average annual electric load factor of 75 percent or greater. The bill provides that certain customers in manufacturing, industrial, or consumer goods warehousing and distribution activities other than data storage may elect to remain on their existing rate schedule. The bill requires Dominion Energy Virginia, in connection with its first proceeding to determine rates for generation and distribution services commencing after July 1, 2026, to include in its petition to the Commission a proposal to revise its tariff for supplementary, maintenance, or standby service for customers with power plants, effective as of January 1, 2028. The bill provides that the Commission shall only approve such proposal if it determines that such tariff will not adversely affect other retail customers or the utility in a manner contrary to the public interest, and any revised tariff terms shall include protections against stranded cost risks to the utility customer base. Additionally, the bill authorizes Dominion Energy Virginia to file a petition for the securitization of certain deferred fuel costs. The bill requires the Commission, in evaluating certain petitions, to require to the greatest extent it finds in the public interest the use of wages, salaries, benefits, and other remuneration to any mechanic, laborer, or worker employed, retained, or otherwise hired to perform services in connection with a contract contemplated pursuant to such petition at the prevailing wage rate and to the greatest extent practicable, the use of a skilled workforce through registered apprenticeship programs for any authorized demand flexibility programs, utility-related procurement through utility-owned or third-party providers, and an evaluation of other potential opportunities to develop Virginia's skilled workforce by requiring minimum apprenticeship program requirements for such electric generation or energy storage facility work. This bill incorporates HB 634.
HB834, Virginia Residential Landlord and Tenant Act; fire or casualty damage, termination by landlord.
Virginia Residential Landlord and Tenant Act; fire or casualty damage; termination by landlord. Requires a landlord, prior to giving a tenant 21 days' notice of his intention to terminate the rental agreement for a dwelling unit that has been damaged or destroyed by fire or casualty, to (i) make a reasonable effort to meet with the tenant to discuss reasonable alternatives and offer the tenant a substantially similar dwelling unit, if one is available, or (ii) determine that the damage was caused by the tenant's failure to maintain the dwelling unit in accordance with relevant law. Current law allows the landlord to terminate such agreement by giving the tenant 14 days' notice of his intention to terminate on the basis of the landlord's determination that such damage requires the removal of the tenant and that the use of the premises is substantially impaired. The bill requires the landlord, upon receiving a request from the tenant after the tenant has received such notice, to reevaluate the extent of damage and habitability of such dwelling unit unless the landlord has determined that the damage was caused by the tenant's failure to maintain the dwelling unit. The bill has a delayed effective date of January 1, 2027.
HB675, Protection of employees; coercion or threat based on immigration status, civil penalty.
Protection of employees; coercion or threat based on immigration status; civil penalty. Prohibits an employer, including the Commonwealth and its agencies and political subdivisions, from using coercion or issuing a threat to an employee based on immigration status in furtherance of committing a violation of the Virginia Minimum Wage Act or provisions related to the payment of wages. An aggrieved employee is permitted to file a complaint with the Commissioner of Labor and Industry within 180 days of the alleged coercive action or threat. The bill authorizes the Commissioner to investigate such complaints and, if the allegation is substantiated, to impose a civil penalty in the following amounts: (i) up to $5,000 for the first violation, (ii) up to $9,000 for the second violation, and (iii) up to $12,000 for any subsequent violation. The bill provides that any such penalty assessed shall be paid to the Commissioner for deposit into the General Fund. The bill also authorizes the Commissioner to seek injunctive relief as may be necessary for enforcement.