TITLE 12. HEALTH

STATE BOARD OF HEALTH

Notice of Intended Regulatory Action

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the State Board of Health intends to consider amending 12VAC5-371, Regulations for the Licensure of Nursing Facilities. Chapters 166 and 180 of the 2025 Acts of Assembly (i) authorize the State Health Commissioner to impose sanctions on nursing homes licensed in Virginia pursuant to the laws regulating medical care facilities and services and (ii) require the State Board of Health to promulgate regulations implementing the provisions of the act. The purpose of the proposed action is to establish requirements for the licensure of nursing facilities, including provisions regarding design, construction, and maintenance of such facilities; operation, equipping, staffing and staffing qualifications; service standards; infection prevention; disaster preparedness; facility security; and matters of administration. Chapters 166 and 180 specify the forms of sanctions that the commissioner may impose, the nursing home's continued responsibility for persons under its care, the use of funds remunerated in accordance with such sanctions, the process for the imposition of such sanctions, and the commissioner's ability to revoke such nursing home's license. The proposed action establishes the procedures to implement the act. Revisions to the regulation may also include input from public comment.

The agency intends to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: §§ 32.1-12 and 32.1-127 of the Code of Virginia.

Public Comment Deadline: December 31, 2025.

Agency Contact: Val Hornsby, Policy Analyst, Virginia Department of Health, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 875-1089, or email val.hornsby@vdh.virginia.gov.

TITLE 14. INSURANCE

STATE CORPORATION COMMISSION

Notice of Extension of Public Comment Period

Title of Regulation: 14VAC5-405. Rules Governing Balance Billing for Out-of-Network Health Care Services (amending 14VAC5-405-20, 14VAC5-405-30, 14VAC5-405-40).

Notice is hereby given that the State Corporation Commission is extending the public comment period regarding the Proposed regulation published in 42:3 VA.R. 430-435 September 22, 2025. In accordance with § 2.2-4007.01 of the Code of Virginia, the commission amended 14VAC5-405, Rules Governing Balance Billing for Out-of-Network Health Care Services. The proposed amendments (i) add definitions of "general business practice" and "good faith negotiation period"; (ii) require a health carrier to provide instructions regarding the claim payment dispute process and to develop and implement processes to analyze the outcome of arbitration decisions involving the same provider, CPT code, and geographic area in determining a commercially reasonable payment amount; (iii) clarify requirements related to the good faith negotiation period and the ability for the health carrier and the out-of-network provider to continue to negotiate after the good faith negotiation period; (iv) prohibit health carriers or providers from initiating arbitration with such frequency as to indicate a general business practice; and (v) clarify that any payment due from the health carrier to the provider is subject to the applicable interest provisions stipulated in the Code of Virginia. The commission is publishing an amending order seeking comments on the proposed regulation.

Statutory Authority: §§ 12.1-13 and 38.2-223 of the Code of Virginia.

Public Comment Deadline: December 31, 2025.

Agency Contact: Julie Blauvelt, Deputy Commissioner, Bureau of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, VA 23218, telephone (804) 371-9515, or email julie.blauvelt@scc.virginia.gov.

AT RICHMOND, NOVEMBER 6, 2025

COMMONWEALTH OF VIRGINIA, ex rel.

STATE CORPORATION COMMISSION

CASE NO. INS-2025-00072

Ex Parte: In the matter of amending

Rules Governing Balance Billing for

Out-of-Network Health Care Services

AMENDING ORDER

By Order Establishing Proceeding ("Order") entered August 25, 2025, the State Corporation Commission ("Commission") gave notice of the Bureau of Insurance's ("Bureau") proposed amendments to the Rules Governing Balance Billing for Out-of-Network Health Care Services¹ ("Amended Rules"). The Order, together with the proposed Amended Rules, were subsequently forwarded to the Virginia Registrar of Regulations and published in the Virginia Register of Regulations.

In the Order, the Commission directed that "any interested person may comment on, propose modifications or supplements to, or request a hearing on the proposed Amended Rules by following the instructions on the Commission's website: scc.virginia.gov/case-information/submit-public-comments" on or before October 31, 2025 ("Comment Period"). The Commission further directed that "those unable, as a practical matter, to submit such documents electronically may file such comments by U.S. mail to the Clerk of the State Corporation Commission."

Prior to expiration of the Comment Period, the Bureau discovered that the link on the Commission's website for the submission of comments in this case was not active. In order to ensure that the public has the full opportunity to participate in this proceeding, the Bureau has recommended to the Commission that the Comment Period be extended; that the deadline for the Bureau to respond to comments submitted in this proceeding likewise be extended; and that the proposed Amended Rules be considered for adoption with an effective date of March 1, 2026.

NOW THE COMMISSION, upon consideration of this matter, is of the opinion and finds that the Order be modified to give interested persons additional time to comment on, propose modifications or supplements to, or request a hearing on the proposed Amended Rules, and to extend the Bureau's attendant timeframe to submit its response to comments.

Accordingly, IT IS ORDERED THAT:

(1) The Commission's Order Establishing Proceeding dated August 25, 2025, is modified to allow all interested persons to comment on, propose modifications or supplements to, or request a hearing on the proposed Amended Rules to file such comments or hearing request on or before December 31, 2025, and to direct the Bureau to file its response to any comments filed on or before January 30, 2026. Any interested person may comment on, propose modifications or supplements to, or request a hearing on the proposed Amended Rules by following the instructions on the Commission's website: scc.virginia.gov/case-information/submit-public-comments.

Those unable, as a practical matter, to submit such documents electronically may file such comments by U.S. mail to the Clerk of the State Corporation Commission, c/o Document Control Center, P.O. Box 2118, Richmond, Virginia 23218-2118. All documents shall refer to Case No. INS-2025-00072. Any request for hearing shall state why a hearing is necessary and why the issues raised in the request for hearing cannot be adequately addressed in written comments.

(2) The Bureau shall provide notice of this Amending Order to all carriers licensed in Virginia to write accident and sickness insurance and to any other interested persons as the Bureau may designate.

(3) The Commission's Office of General Counsel shall provide a copy of this Amending Order, together with the proposed Amended Rules, to the Virginia Registrar of Regulations for publication in the Virginia Register of Regulations.

(4) Interested persons may download unofficial copies of the Amending Order and the proposed Amended Rules from the Commission's website: scc.virginia.gov/pages/case-information.

(5) This matter is continued.

A COPY hereof shall be sent by the Clerk of the Commission to: C. Meade Browder, Jr., Senior Assistant Attorney General, at MBrowder@oag.state.va.us, Office of Attorney General, Division of Consumer Counsel, 202 North 9th Street, 8th floor, Richmond, Virginia 23219-3424; and to the Commission's Office of General Counsel and the Bureau of Insurance in care of Deputy Commissioner Julie Blauvelt.