Virginia would keep some managed care price limits after agreements end

Conditions governing cooperative agreements would expire, while certain managed care pricing restrictions would remain in place. This applies to conditions governing cooperative agreements approved under this chapter and pricing restrictions that are part of those conditions. Only pricing restrictions that are part of the agreement conditions and are in effect on June 30, 2028, would continue. The conditions expire on June 30, 2028. Covered pricing limits remain in effect for five years after that date.

The Commissioner would oversee the remaining pricing restrictions and report each year to the Attorney General. This applies to managed care pricing restrictions in effect when the agreement conditions expire and to the entity subject to those restrictions. The Commissioner and the entity subject to the restrictions would have to make an agreement about them within the 90 days before the conditions expire. The agreement would be based on restrictions in effect June 30, 2028, and could include other terms both sides accept. During the five-year period, changes to the restrictions would require their mutual written agreement. The five-year oversight period starts when the agreement conditions expire. The Commissioner would report to the Attorney General annually on oversight and compliance.

The Commissioner could seek payment for oversight costs from supervised parties, and the Department of Health would repeal regulation 12VAC5-221 when the conditions first expire. The reimbursement provision applies to parties supervised under these provisions. The repeal applies to Virginia regulation 12VAC5-221. Reimbursement could cover reasonable, actual costs directly related to oversight, up to $200,000 per year. Reimbursement money would be held for Department expenses administering the oversight provisions. It could go to another agency only for expenses directly related to that oversight. The Commissioner would send a cost report within 30 days after each quarter ends, and payment would be due within 30 days after a request. The regulation would be repealed at the first expiration of the conditions.