Chief Patron: Sickles
SCC: Market Conduct Examination (language only)
Item 475 #1h
Item 475 #1h | | | |
| Independent Agencies |
| State Corporation Commission |
Language
Page 594, line 21, before "Out", insert, "A."
Page 594, after line 25, insert:
"B.1. The State Corporation Commission's Bureau of Insurance (the Bureau) shall establish, in coordination with the Secretary of Health and Human Resources, a workgroup to: (i) evaluate the effectiveness of the frequency and scope of examinations of carriers licensed by the Bureau, whether on a routine periodic basis, or in response to complaints filed by health plan enrollees or providers pursuant to § 38.2-1317 et seq., Code of Virginia, (ii) evaluate the Bureau's process for developing corrective action plans for carrier violations of law identified in such examinations and ensuring satisfactory completion and ongoing compliance with such corrective action plans, (iii) evaluate the Bureau's process for determining monetary penalties on carriers for actual or alleged violations of law identified in any examination or for purposes of settlement of same pursuant to § 38.2-218, (iv) evaluate the Bureau's process for requiring carriers to make restitution payments to providers for actual or alleged violations of law identified in any examination for purposes of settlement of same and for communicating with providers information necessary to ensure proper payment and reconciliation of such restitution payments, (v) develop recommendations for increasing public transparency of the results of such examinations and any resulting corrective action plans, penalties, and restitution payment demands imposed upon carriers, (vii) evaluate actions that should be undertaken by the Bureau in response to “knowing,” or repeat, violations through such examinations, including whether and under what circumstances these would be identified as general business practices under § 38.2-510, and (vii) evaluate options for establishing error tolerance thresholds to assist in streamlining examinations and effectively highlighting significant areas of non-compliance. Based upon the findings of this working group, the workgroup shall make recommendations for regulating carriers and the performance of such examinations that the Commissioner should consider as recommendations to the General Assembly for legislation pursuant to its authority under § 38.2-201.
2. The workgroup shall include relevant stakeholders, including representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the Virginia Hospital & Healthcare Association, and other parties with an interest in examinations of carrier business practices and enforcement and compliance activity related to same.
3.The workgroup shall report its findings and recommendations to the Chairs of the Senate Committees on Commerce and Labor and Education and Health, and the House Committees on Labor and Commerce and Health and Human Services, by November 1, 2025."
Explanation
(This amendment directs the State Corporation Commission, in collaboration with the Secretary of Health and Human Resources, to convene a workgroup to evaluate Bureau of Insurance market conduct examinations of carriers licensed by the Bureau, with a report on findings and recommendations to Chairs of the Senate Committees on Commerce and Labor and Education and Health, and the House Committees on Labor and Commerce and Health and Human Services no later than November 1, 2025.)