Virginia HB 1462: Medicaid and health insurance plans; supervised billing.

Bill Text

2026 SESSION

INTRODUCED

26104450D

HOUSE BILL NO. 1462

Offered January 23, 2026

A BILL to amend and reenact § 38.2-3407.15 of the Code of Virginia and to amend the Code of Virginia by adding sections numbered 32.1-325.002 and 38.2-3408.1, relating to supervised billing under Medicaid and health insurance plans; time limit for retroactive denial by health insurance carriers.

—————

Patron—Maldonado

—————

Referred to Committee on Labor and Commerce

—————

Be it enacted by the General Assembly of Virginia:

1. That § 38.2-3407.15 of the Code of Virginia is amended and reenacted and that the Code of Virginia is amended by adding sections numbered 32.1-325.002 and 38.2-3408.1 as follows:

§ 32.1-325.002. Medicaid payments for supervised billing.

A. For the purposes of this section:

"Qualified licensed provider" means a health care provider who is licensed, enrolled in the Commonwealth's Medicaid program through the Department, and acting within his scope of practice. A qualified licensed provider shall be licensed as a:

1. Physician of medicine or osteopathy who is certified in psychiatry by the American Board of Medical Specialties;

2. Advanced practice registered nurse who is certified as a psychiatric mental health nurse practitioner;

3. Psychologist;

4. Marriage and family therapist;

5. Professional counselor;

6. Clinical social worker;

7. Behavior analyst; or

8. Licensed substance abuse treatment practitioner.

"Qualified non-licensed provider" means a provider that is actively working toward licensure pursuant to the requirements of the health regulatory board of his profession and is otherwise permitted to provide services pursuant to a licensure exception if such provision constitutes a part of his course of study and is adequately supervised.

"Supervised billing" means billing by a qualified licensed provider for covered mental health and substance abuse services within his scope of practice provided by a qualified non-licensed provider when such qualified non-licensed provider is under the direct supervision of the qualified licensed provider.

B. The Department shall, conditional on the receipt of all necessary approvals and the securing of federal financial participation pursuant to subsection D, permit a qualified licensed provider to bill for covered mental health and substance abuse services provided by a qualified non-licensed provider as supervised billing.

C. A qualified licensed provider engaging in supervised billing pursuant to subsection B shall adhere to the supervision requirements provided by his scope of practice and the relevant health regulatory board.

D. The Department shall submit any state plan amendments or waiver applications as may be necessary to implement the provisions of this section and to secure federal financial participation for state Medicaid expenditures under the federal Medicaid program. Supervised billing pursuant to this section shall be contingent on securing all necessary federal approvals and federal financial participation as may be necessary to implement the provisions of this section.

§ 38.2-3407.15. Ethics and fairness in carrier business practices.

A. As used in this section:

"Carrier," "enrollee," and "provider" shall have the meanings set forth in § 38.2-3407.10; however, a "carrier" shall also include any person required to be licensed under this title which offers or operates a managed care health insurance plan subject to Chapter 58 (§ 38.2-5800 et seq.) or which provides or arranges for the provision of health care services, health plans, networks or provider panels which are subject to regulation as the business of insurance under this title.

"Claim" means any bill, claim, or proof of loss made by or on behalf of an enrollee or a provider to a carrier (or its intermediary, administrator or representative) with which the provider has a provider contract for payment for health care services under any health plan; however, a "claim" shall not include a request for payment of a capitation or a withhold.

"Clean claim" means a claim that does all of the following:

1. Identifies the provider that provided the service with industry-standard identification criteria, including billing and rendering provider names, identification numbers, and address;

2. Identifies the patient with a carrier-assigned identification number so the carrier can verify the patient was an enrollee at the time of service;

3. Identifies the service rendered using an industry-standard system of procedure or service coding, or, if applicable, a methodology required under the provider contract. The claim shall include a complete listing of all relevant diagnoses, procedures, and service codes, as well as any applicable modifiers;

4. Specifies the date and place of service;

5. If prior authorization is required for the services listed in the claim, contains verification that prior authorization was obtained in accordance with the provider contract for those s