Health insurance reform commission makes headway on benefits bills backlog


Nicole Pasia


On Tuesday, the Virginia Health Insurance Reform Commission discussed a number of mandated provider benefit bills referred from the 2020 session. The bi-cameral commission is charged with reviewing legislation, ensuring proper implementation of the Affordable Care Act (ACA), and recommending changes as necessary.


Stay one step ahead. Join our email list for the latest news.



Commission Chair Sen. George Barker previously asked the Bureau of Insurance (BOI) to provide more information about the bills before the commission made further legislative recommendations. Bradley Marsh, BOI health insurance policy advisor, reviewed current federal and state laws on health benefit mandates. 

Under federal law, states may require qualified health plans (QHPs) to offer additional benefits not listed as essential health benefits (EHB). As of January 1, 2012, states must cover the cost of the additional non-EHB benefits QHPs provide.

Current Virginia state law, however, has prohibited QHPs from providing additional non-EHB benefits since January 1, 2012. The state law may be considered discriminatory under federal law, according to the BOI’s recent conversations with the Centers for Medicaid and Medicare Services (CMS).

If state law changes and allows QHPs to provide additional benefits, then the state would subsequently be required to cover them. Marsh said: 

“That will be the case for a lot of the bills that we’ll see here. They’ll fall into that category where they would potentially result in the cost of the state, but because of S 38.2-650, they do not as of right now, based on our understanding.” 

Marsh outlined how these conditions applied to each of the health benefit bills referred to the commission. Here are a few: 


HB 39 – Coverage for pregnant enrollees outside of open enrollment period

State would not pay. Federal law does not allow special enrollment due to pregnancy in QHPs because Virginia uses the federal exchange platform ( Virginia is projected to remain on the federal exchange platform until 2024.

HB 645 – Expands coverage for diabetes services

State would pay if state law prohibiting QHPs from providing coverage is considered discriminatory under federal law.

HB 1036 – Coverage for mental health and substance use disorder services

State would pay if state law prohibiting QHPs from providing coverage is considered discriminatory under federal law.

SB 423 – Provides coverage for hearing aids for minors without copayments or fees

State would pay if state law prohibiting QHPs from providing coverage is considered discriminatory under federal law. However, an analysis by JLARC determined an additional fiscal impact on the state employee health plan, so the bill would not go into effect July 1, 2022.


After the BOI’s report, Sen. Scott Surovell (D-Fairfax), asked for clarification on when the state law will be considered discriminatory, and by whom. 

Julie Blauvelt, BOI deputy commissioner of insurance on life and health, said CMS was the federal agency that first raised concern over the state law’s legitimacy, but has not offered an official verdict.

“We don’t have any official determination about whether it’s definitely discriminatory, but [CMS] always do use terms of being ‘potentially discriminatory.’ Potentially this could be an issue for Virginia and any other state that splits up its market and applies certain benefits to certain parts of its [market] and not the entire [network].”

Members of the public then offered testimony on the bills, including Doug Gray, executive director of the Virginia Association for Health Plans. Gray encouraged members of the commission to “think carefully” about the state possibly allowing more benefits.

“We have a long list of wants here, and we have a challenge of trying to figure out how you could change the essential health benefits to permit this … This discussion about whether individual and small group [markets] can offer additional benefits after [2012] is a big deal. If you can, you’re going to have to pay for it, and it’s clear by the regulations today.”

The commission is expected to meet two more times before the end of the year, and will discuss the referred bills in greater detail upon its next meeting. A recording of the full meeting is available here.