Fabio
114 lines
6.9 KiB
Markdown
114 lines
6.9 KiB
Markdown
---
|
||
type: "Bill"
|
||
title: "Health insurance; ethics and fairness in carrier business practices, downcoded claims."
|
||
description: "Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person."
|
||
jurisdiction: "us/states/va"
|
||
legislature: "Virginia General Assembly"
|
||
session: "2026"
|
||
identifier: "SB 164"
|
||
citation: "Virginia SB 164 (2026)"
|
||
classification: ["bill"]
|
||
subjects: []
|
||
status: "enacted"
|
||
primary_sponsors: ["Jeremy S. McPike"]
|
||
version_count: 7
|
||
action_count: 44
|
||
vote_count: 7
|
||
first_action: "2026-01-07"
|
||
last_action: "2026-04-13"
|
||
source: "openstates"
|
||
source_identifier: "ocd-bill/43461926-7d19-4b55-b40a-9d459f9a0f8f"
|
||
source_url: "https://lis.virginia.gov/bill-details/20261/SB164"
|
||
source_hash: "ba5acaa47553cb5b3fd2a7c587acd033b9223f2c9e822412bcd5a7df90fd585f"
|
||
vintage: "2026-07-01"
|
||
source_snapshot: "https://data.openstates.org/daily/2026-07-01/public.pgdump"
|
||
retrieved_at: "2026-07-06"
|
||
confidence: "reported"
|
||
tags: ["legislation", "bill", "us-va"]
|
||
---
|
||
|
||
# Virginia SB 164 (2026) — Health insurance; ethics and fairness in carrier business practices, downcoded claims.
|
||
|
||
Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.
|
||
|
||
## Version chain
|
||
|
||
The bill's text revisions, in order — the diff chain from filing to enrollment.
|
||
|
||
1. **Introduced** (filed) — [source](https://lis.blob.core.windows.net/files/1083620.PDF)
|
||
2. **Commerce and Labor Substitute** (committee substitute) — [source](https://lis.blob.core.windows.net/files/1097327.PDF)
|
||
3. **Delegate Shin Amendments** (committee substitute) — [source](https://lis.blob.core.windows.net/files/1193528.HTML)
|
||
4. **House Amendments** (committee substitute) — [source](https://lis.blob.core.windows.net/files/1194141.HTML)
|
||
5. **Labor and Commerce Substitute** (committee substitute) — [source](https://lis.blob.core.windows.net/files/1185521.PDF)
|
||
6. **Subcommittee #1 Subcommittee Substitute** (committee substitute) — [source](https://lis.blob.core.windows.net/files/1179341.PDF)
|
||
7. **Enrolled** (enrolled) — [source](https://lis.blob.core.windows.net/files/1202608.PDF)
|
||
|
||
## Votes
|
||
|
||
- Constitutional reading dispensed R — **40–0** (pass) · upper
|
||
- H VOTE: — **97–1** (pass) · lower
|
||
- Concur House Amendments R — **40–0** (pass) · upper
|
||
- Reported from Labor and Commerce with substitute — **21–0** (pass) · lower
|
||
- Subcommittee recommends reporting with substitute — **9–0** (pass) · lower
|
||
- Reported from Commerce and Labor with substitute — **15–0** (pass) · upper
|
||
- Passage R — **38–0** (pass) · upper
|
||
|
||
## Sponsors
|
||
|
||
- Jeremy S. McPike — primary (person)
|
||
- Bill DeSteph — cosponsor (person)
|
||
|
||
## Timeline
|
||
|
||
The legislative action history — every referral, reading, and vote.
|
||
|
||
- **2026-01-07** Prefiled and ordered printed; Offered 01-14-2026 26103299D `filing, introduction`
|
||
- **2026-01-07** Referred to Committee on Commerce and Labor `referral-committee`
|
||
- **2026-01-26** Senate committee offered
|
||
- **2026-01-26** Senate committee offered
|
||
- **2026-01-26** Reported from Commerce and Labor with substitute (15-Y 0-N) `committee-passage`
|
||
- **2026-01-27** Committee substitute printed 26106195D-S1 `substitution`
|
||
- **2026-01-28** Rules suspended
|
||
- **2026-01-28** Constitutional reading dispensed Block Vote (on 1st reading) (40-Y 0-N 0-A)
|
||
- **2026-01-28** Passed by for the day Block Vote (Voice Vote)
|
||
- **2026-01-28** Passed by for the day
|
||
- **2026-01-29** Read second time `reading-2`
|
||
- **2026-01-29** Commerce and Labor Substitute agreed to
|
||
- **2026-01-29** Engrossed by Senate (Voice Vote)
|
||
- **2026-01-29** Engrossed by Senate - committee substitute `substitution`
|
||
- **2026-01-30** Read third time and passed Senate `passage, reading-3`
|
||
- **2026-02-04** Placed on Calendar
|
||
- **2026-02-04** Read first time `reading-1`
|
||
- **2026-02-04** Referred to Committee on Labor and Commerce `referral-committee`
|
||
- **2026-02-19** Assigned HCL sub: Subcommittee #1 `referral-committee`
|
||
- **2026-02-24** Subcommittee recommends reporting with substitute (9-Y 0-N) `substitution`
|
||
- **2026-02-26** Reported from Labor and Commerce with substitute (21-Y 0-N) `committee-passage`
|
||
- **2026-02-27** Committee substitute printed 26108190D-H1 `substitution`
|
||
- **2026-03-02** Read second time `reading-2`
|
||
- **2026-03-03** Moved from Uncontested Calendar to Regular Calendar
|
||
- **2026-03-03** Passed by for the day
|
||
- **2026-03-03** Fiscal Impact Statement from State Corporation Commission (SB164)
|
||
- **2026-03-04** Read third time `reading-3`
|
||
- **2026-03-04** committee substitute rejected
|
||
- **2026-03-04** Passed by temporarily
|
||
- **2026-03-04** Floor offered Delegate Shin Amendments
|
||
- **2026-03-04** Reconsideration of
|
||
- **2026-03-04** Labor and Commerce Substituteagreed to by House
|
||
- **2026-03-04** Delegate Shin Floor amendments agreed to `amendment-passage`
|
||
- **2026-03-04** Engrossed by House - committee substitute as amended `substitution`
|
||
- **2026-03-04** Passed House with substitute with amendments (97-Y 1-N 0-A) `passage`
|
||
- **2026-03-06** House substitute with amendments agreed to by Senate (40-Y 0-N 0-A) `amendment-passage, substitution`
|
||
- **2026-03-12** Enrolled `enrolled`
|
||
- **2026-03-12** Bill text as passed Senate and House (SB164ER) `passage`
|
||
- **2026-03-12** Signed by Speaker `passage`
|
||
- **2026-03-12** Signed by President `passage`
|
||
- **2026-03-14** Enrolled Bill communicated to Governor on March 14, 2026 `enrolled, executive-receipt`
|
||
- **2026-03-14** Governor's Action Deadline 11:59 p.m., April 13, 2026 `executive-receipt`
|
||
- **2026-03-24** Fiscal Impact Statement from State Corporation Commission (SB164)
|
||
- **2026-04-13** Approved by Governor-Chapter 881 (effective 7/1/2026) `executive-signature`
|
||
|
||
## Source
|
||
|
||
OpenStates / OpenCivicData bulk snapshot [2026-07-01](https://data.openstates.org/daily/2026-07-01/public.pgdump); origin `ocd-bill/43461926-7d19-4b55-b40a-9d459f9a0f8f`. Confidence: reported (aggregated from official Virginia legislature records).
|
||
|