Item 479 | First Year - FY2025 | Second Year - FY2026 |
|---|---|---|
| Plan Management (40800) | $408,828,801 | $604,053,109 |
| Federal Health Benefit Exchange Plan Management (40801) | FY2025 $115,176 | FY2026 $115,176 |
| State Health Benefit Exchange Plan Management (40802) | FY2025 $51,836,501 | FY2026 $54,996,501 |
| Commonwealth Health Reinsurance Program (40803) | FY2025 $356,877,124 | FY2026 $548,941,432 |
| Fund Sources: | ||
| General | FY2025 $25,530,333 | FY2026 $67,530,333 |
| Dedicated Special Revenue | FY2025 $51,421,344 | FY2026 $54,581,344 |
| Federal Trust | FY2025 $331,877,124 | FY2026 $481,941,432 |
Authority: §§ 38.2-316.1 and 38.2-326, Code of Virginia; § 42.18041 c, United States Code.
A. There is hereby appropriated to the State Corporation Commission $115,176 the first year and $115,176 the second year from the general fund to pay for the plan management functions authorized in Chapter 670 of the Acts of Assembly of 2013.
B.1. Notwithstanding the provisions of § 4-3.02 of this act, the Secretary of Finance may authorize either a working capital advance or an interest-free treasury loan in an amount not to exceed $40,000,000 for the State Corporation Commission to fund start-up costs and other costs associated with the implementation of a State Health Benefit Exchange. The Secretary of Finance may extend the repayment plan for any such working capital advance or interest-free treasury loan for a period longer than twelve months.
2. The State Corporation Commission may use a portion of the user fees collected from health insurance carriers participating in the State Health Benefit Exchange to repay the working capital advance or interest-free treasury loan authorized in B.1.
C. Out of this appropriation, $25,000,000 the first year and $67,000,000 the second year from the general fund shall be transferred to the Commonwealth Health Reinsurance Program Special Fund State Corporation Commission, established pursuant to § 38.2-6604, Code of Virginia.
D. Notwithstanding any other provision of law, the state-mandated health benefit required by Chapter 473 of the Acts of Assembly of 2023 shall apply to all qualified health plans offered in the Commonwealth.
E. The State Corporation Commission shall set the payment parameters for the Commonwealth Health Reinsurance Program at levels to achieve the premium reduction target of 15 percent for Plan Year 2025.
F. The Bureau of Insurance shall request guidance from the Centers for Medicare and Medicaid Services on: (i) how nutritional counseling is defined as a preventive care benefit under the Patient Protection and Affordable Care Act and review whether the current definition of nutritional counseling in Virginia's Essential Health Benefit benchmark plan meets federal guidelines; and (ii) whether removing prior authorization for eating disorder services would be considered an expansion of services that would warrant a state-funded cost defrayal under the Patient Protection and Affordable Care Act. The Bureau of Insurance shall report its findings to the Joint Commission on Health Care and the Health Insurance Reform Commission by September 1, 2024.