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2026 Session

Budget Amendments - SB30 (Committee Approved)

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JLARC: Access to Medicaid Information (language only)

Item 25 #2s

Item 25 #2s

Legislative Department
Joint Legislative Audit and Review Commission

Language

Page 28, after line 42, insert:

"J.1. For the purposes of conducting its study of the Department of Medical Assistance Service's (DMAS) oversight of managed care, consistent with its statutory authority to obtain information necessary for the performance of its duties from state agencies and any private entity that has entered a contractual relationship to accomplish an agency program, JLARC shall have the legal authority to access all information and records pertaining to Virginia's Medicaid program in the possession of: (i) DMAS pertaining to managed care and MCOs' performance, the setting of capitation rates, and the annual forecast of Medicaid expenditures; (ii) private entities under contract with DMAS for the provision of managed care, including, but not limited to, surveys of members or providers, case management notes, health risk assessments, prior authorization files, and internal appeals files; and (iii) private entities under contract with either DMAS or its contracted MCOs for services related to the delivery of or payment for care through Medicaid or the children's health insurance program.

2. Records provided by DMAS and its contractors to JLARC in connection with this study, where the records would not be subject to disclosure by DMAS, shall be excluded from the provisions of the Virginia Freedom of Information Act (§ 2.2-3700 et seq.). DMAS and its contractors shall identify the specific portion of the records to be protected and the applicable provision of the Freedom of Information Act or other provision of law that excludes the record or portions thereof from mandatory disclosure."



Explanation

(This amendment clarifies authority for JLARC to access relevant Medicaid data and information for its study of the Department of Medical Assistance Service's (DMAS) oversight of managed care.)