republic-os/legislation/us/states/va/2020/sb-172.md

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type	title	description	jurisdiction	legislature	session	identifier	citation	classification	subjects	status	primary_sponsors	version_count	action_count	vote_count	first_action	last_action	source	source_identifier	source_url	source_hash	vintage	source_snapshot	retrieved_at	confidence	tags
Bill	Health insurance; definitions, payment to out-of-network providers, emergency services.	Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes which includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject to such provisions. The measure authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021. This bill incorporates SB 522 and is identical to HB 1251.	us/states/va	Virginia General Assembly	2020	SB 172	Virginia SB 172 (2020)	bill		enacted	Barbara A. Favola	6	51	10	2019-12-20	2020-04-10	openstates	ocd-bill/84acad82-1cb0-4b04-a419-2ff20762cc44	https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+SB172	03972dc179bd8bfb4a8aa1ce9e84409b1136372484684cb1756182f32db29214	2026-07-01	https://data.openstates.org/daily/2026-07-01/public.pgdump	2026-07-06	reported	legislation bill us-va

Virginia SB 172 (2020) — Health insurance; definitions, payment to out-of-network providers, emergency services.

Health insurance; payment to out-of-network providers. Provides that when an enrollee receives emergency services from an out-of-network health care provider or receives out-of-network surgical or ancillary services at an in-network facility, the enrollee is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement and such cost-sharing requirement cannot exceed the cost-sharing requirement that would apply if the services were provided in-network. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is a commercially reasonable amount based on payments for the same or similar services provided in a similar geographic area. If such provider disputes the amount to be paid by the health carrier, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the amount of the reimbursement. If the health carrier and the provider do not agree to a commercially reasonable payment and either party wants to take further action to resolve the dispute, then the measure requires the dispute will be resolved by arbitration. The measure establishes a framework for arbitration of such disputes which includes (i) a timeline for the proceedings, (ii) a method for choosing an arbitrator, (iii) required and optional factors for the arbitrator to consider, (iv) non-disclosure agreements, (v) reporting requirements, and (vi) an appeals process for appeals on certain procedural grounds. The measure requires the State Corporation Commission to contract with Virginia Health Information (VHI) to establish a data set and business protocols to provide health carriers, providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving disputes. The measure requires the Commission, in consultation health carriers, providers, and consumers, to develop standard language for a notice of consumer rights regarding balance billing. The measure authorizes the Commission, the Board of Medicine, and the Commissioner of Health to levy fines and take action against a health carrier, health care practitioner, or medical care facility, respectively, for a pattern of violations of the prohibition against balance billing. Additionally, the measure prohibits a carrier or provider from initiating arbitration with such frequency as to indicate a general business practice. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject to such provisions. The measure authorizes the Commission to adopt rules and regulations governing the arbitration process. The measure has a delayed effective date of January 1, 2021. This bill incorporates SB 522 and is identical to HB 1251.

Version chain

The bill's text revisions, in order — the diff chain from filing to enrollment.

1. Acts of Assembly Chapter text (CHAP1081) (committee substitute) — source
2. Bill text as passed Senate and House (SB172ER) (committee substitute) — source
3. Engrossed by House - floor substitute SB172H2 (committee substitute) — source
4. Engrossed by Senate - committee substitute with amendments SB172ES1 (committee substitute) — source
5. Impact statement from DPB (SB172H1) (committee substitute) — source
6. SB172S1 (committee substitute) — source

Votes

• Reported from Commerce and Labor with substitute (8-Y 7-N) — 8–7 (pass) · upper
• Constitutional reading dispensed (40-Y 0-N) — 40–0 (pass) · upper
• Referred from Labor and Commerce — 0–0 (fail) · lower
• Constitutional reading dispensed (40-Y 0-N) — 40–0 (pass) · upper
• House substitute agreed to by Senate (39-Y 0-N) — 39–0 (pass) · upper
• Reported from Appropriations with substitute (22-Y 0-N) — 22–0 (pass) · lower
• Reported from Finance and Appropriations with amendments (11-Y 5-N) — 11–5 (pass) · upper
• Passed Senate (36-Y 4-N) — 36–4 (pass) · upper
• VOTE: Passage (99-Y 0-N) — 98–0 (pass) · lower
• Subcommittee recommends reporting with substitute (8-Y 0-N) — 8–0 (pass) · lower

Sponsors

• Barbara A. Favola — primary (person)
• Amanda F. Chase — cosponsor (person)
• Bryce E. Reeves — cosponsor (person)
• Jennifer A. Kiggans — cosponsor (person)
• Jennifer B. Boysko — cosponsor (person)
• Jennifer L. McClellan — cosponsor (person)
• Jill Holtzman Vogel — cosponsor (person)
• John S. Edwards — cosponsor (person)
• Ryan T. McDougle — cosponsor (person)
• Siobhan S. Dunnavant — cosponsor (person)

Timeline

The legislative action history — every referral, reading, and vote.

• 2019-12-20 Prefiled and ordered printed; offered 01/08/20 20101733D introduction
• 2019-12-20 Referred to Committee on Commerce and Labor referral-committee
• 2020-01-15 Assigned C&L sub: Health Insurance referral-committee
• 2020-01-31 Impact statement from DPB (SB172)
• 2020-02-09 Reported from Commerce and Labor with substitute (8-Y 7-N) committee-passage
• 2020-02-09 Committee substitute printed 20107408D-S1 substitution
• 2020-02-09 Rereferred to Finance and Appropriations referral-committee
• 2020-02-10 Reported from Finance and Appropriations with amendments (11-Y 5-N) committee-passage
• 2020-02-11 Constitutional reading dispensed (40-Y 0-N)
• 2020-02-11 Read second time reading-2
• 2020-02-11 Reading of substitute waived
• 2020-02-11 Committee substitute agreed to 20107408D-S1
• 2020-02-11 Reading of amendments waived
• 2020-02-11 Committee amendments agreed to
• 2020-02-11 Engrossed by Senate - committee substitute with amendments SB172ES1
• 2020-02-11 Printed as engrossed 20107408D-ES1
• 2020-02-11 Constitutional reading dispensed (40-Y 0-N)
• 2020-02-11 Passed Senate (36-Y 4-N) passage
• 2020-02-14 Placed on Calendar
• 2020-02-14 Read first time reading-1
• 2020-02-14 Referred to Committee on Labor and Commerce referral-committee
• 2020-02-18 Referred from Labor and Commerce
• 2020-02-18 Referred to Committee on Appropriations referral-committee
• 2020-02-23 Assigned App. sub: Health & Human Resources referral-committee
• 2020-02-25 Impact statement from DPB (SB172ES1)
• 2020-02-26 House subcommittee amendments and substitutes offered
• 2020-02-26 Subcommittee recommends reporting with substitute (8-Y 0-N)
• 2020-02-28 House committee, floor amendments and substitutes offered
• 2020-02-28 Committee substitute printed 20109092D-H1 substitution
• 2020-02-28 Reported from Appropriations with substitute (22-Y 0-N) committee-passage
• 2020-02-28 Incorporates SB522
• 2020-03-02 Impact statement from DPB (SB172H1)
• 2020-03-03 Read second time reading-2
• 2020-03-04 Floor substitute printed 20109578D-H2 (Torian)
• 2020-03-04 Passed by for the day
• 2020-03-05 Read third time reading-3
• 2020-03-05 Committee substitute rejected 20109092D-H1
• 2020-03-05 Substitute by Delegate Torian agreed to 20109578D-H2
• 2020-03-05 Engrossed by House - floor substitute SB172H2
• 2020-03-05 Passed House with substitute (99-Y 0-N) passage
• 2020-03-05 VOTE: Passage (99-Y 0-N)
• 2020-03-05 House substitute agreed to by Senate (39-Y 0-N)
• 2020-03-05 Title replaced 20109578D-H2
• 2020-03-12 Enrolled
• 2020-03-12 Signed by President
• 2020-03-12 Signed by Speaker
• 2020-03-16 Impact statement from DPB (SB172H2)
• 2020-03-16 Impact statement from DPB (SB172ER)
• 2020-03-17 Enrolled Bill Communicated to Governor on March 17, 2020
• 2020-03-17 Governor's Action Deadline 11:59 p.m., April 11, 2020
• 2020-04-10 Approved by Governor-Chapter 1081 (effective - see bill) executive-signature

Source

OpenStates / OpenCivicData bulk snapshot 2026-07-01; origin ocd-bill/84acad82-1cb0-4b04-a419-2ff20762cc44. Confidence: reported (aggregated from official Virginia legislature records).