STATE CORPORATION COMMISSION
Bureau of Insurance
July 28, 2020
Administrative Letter 2020-04
To: Pharmacy Benefits Managers; All Carriers Licensed to Write
Accident and Sickness Insurance in Virginia; All Health Services Plans and
Health Maintenance Organizations Licensed in Virginia; and Life and Health Interested
Parties
Re: Licensure Requirements and Certain Prohibited Conduct
During its 2020 Session, the Virginia General Assembly passed
Acts of Assembly Chapters 219 and 1288 (House Bill 1290 and Senate Bill 251,
respectively), related to the licensing of pharmacy benefits managers and
certain prohibited conduct by carriers and pharmacy benefits managers. Please
see §§ 38.2-3465 through 38.2-3470 of the Code
of Virginia (Code). This legislation is effective October 1, 2020.
Under § 38.2-3466 of the
Code, any person providing pharmacy benefits management services or otherwise
acting as a pharmacy benefits manager in the Commonwealth on or after October
1, 2020, shall obtain a license from the Bureau of Insurance (Bureau), unless
otherwise covered by a carrier's license.1 To obtain this initial
license, a person must complete and submit the attached application and pay a
$250 nonrefundable fee. The Bureau will begin accepting applications
immediately. Please allow up to 30 days for processing.
Licenses will be renewable annually for the period October 1
through September 30 in the year following initial issuance. To renew the
license, a licensed pharmacy benefits manager must submit a renewal application
and pay a $100 nonrefundable renewal fee.
The Bureau also encourages carriers and pharmacy benefits
managers to be aware of the conduct prohibited under the new law in § 38.2-3467,
related to advertisements, claims adjudication fees, reimbursements for
services, network restrictions or adequacy determinations, retaliation for
exercising rights and spread pricing.
Questions concerning this
administrative letter should be addressed to Stephen Hogge, Policy Advisor-Insurance, Policy, Compliance, &
Administration Division, Bureau of Insurance, State Corporation Commission,
email stephen.hogge@scc.virginia.gov, or telephone (804) 371-9895.
/s/ Scott A. White
Commissioner of Insurance
_________________________________
1If pharmacy benefits management is performed within and
under the authority of the carrier's license, then no separate pharmacy
benefits manager license is required.
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State
Corporation Commission Bureau of Insurance PHARMACY BENEFIT MANAGER ("PBM") APPLICATION / RENEWAL
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1. This is: ☐ an Application.
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☐ a Renewal.
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2. Name of PBM
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a) FEIN of PBM or, if
an individual, last 4 digits of the SS#
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Business Address (P. O. Box is not an acceptable Business Address)
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b) Street
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c) Suite
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d) City
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e) State
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f) Zip Code or Country
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g) Phone Number
( ) Ext.
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h) Fax Number
( )
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i) Business E-mail
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Mailing Address
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j) Street or P.O. Box
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k) Suite
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l) City
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m) State
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n) Zip Code or Country
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3. Name of person applying
for or renewing the license of the PBM
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a) Title or Position
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Business Address
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b) Street
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c)
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Suite
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d) City
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e) State
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f)
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Zip Code or Country
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g) Phone Number
( ) Ext.
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h) Fax Number
( )
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i) Business E-mail
Address
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4. PBM Structure:
☐ a.) Individual -OR-
☐
b.) Partnership or Other
Unincorporated Association ☐ c.)
Limited Liability Company ☐ d.) Corporation
If
other than an Individual application, provide the total number of
partners, members, or stockholders who each directly or indirectly own,
control, or hold the power to vote, 10% or more of the entity’s ownership
-AND/OR- hold proxies representing 10% or more of the voting securities:
#
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5. Name and
Addresses of each individual or entity with management or control over the
pharmacy benefits manager:
a.
Name
Address
City
State
ZIP
b.
Name
Address
City
State
ZIP
c.
Name Address
City
State
ZIP
d.
Name Address
City
State
ZIP
e.
Name Address
City
State
ZIP
Attach a separate sheet titled “Management or Control
Overflow Sheet” if more than 5 names and addresses
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Form VA PBM (July 2020) Page
1 of 2
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6. Name and
Addresses of each person with a beneficial ownership interest in the pharmacy
benefits manager.
Beneficial ownership interest means, if the PBM is
seeking licensure under:
4.b above, each partner or member;
4.c above, each officer, manager, or member;
4.d above, each of its officers, directors, and
stockholders with greater than 5% ownership
interest:
a.
Name Address
City
State
ZIP
b.
Name Address
City
State
ZIP
c.
Name
Address
City
State
ZIP
d.
Name Address
City
State
ZIP
e.
Name Address
City
State
ZIP
Attach a separate sheet titled “Ownership Interest Overflow
Sheet” if more than 5 names and addresses
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7. Service of
Process Notice:
Except where prohibited by state or federal law, by submitting
an application for a license, the applicant shall be deemed to have appointed
the clerk of the Commission as the agent for service of process on the
applicant in any action or proceeding arising in the Commonwealth out of or
in connection with the exercise of the license. Such appointment of the clerk
of the Commission as agent for service of process shall be irrevocable during
the period within which a cause of action against the applicant may arise out
of transactions with respect to subjects of pharmacy benefits management in
the Commonwealth.
Service of process on the clerk of the
Commission shall conform to the provisions of Chapter 8 of title 38.2-800 .
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8. Felony
Conviction and/or Violations of State Law Requirements Applicable to PBM
By checking one of the boxes below and signing this
application, the applicant states that, to the best of the signer’s knowledge:
☐
No officer
with management or control of the pharmacy benefits manager listed
in #5 above has been convicted of a felony
or has violated any of the
requirements of state law applicable to pharmacy benefits managers.
-OR-
☐
The following officer(s) with management or control of the pharmacy benefits manager listed
in #5 above has been convicted of a felony
or has violated requirements of state law
applicable to pharmacy benefits manager (the applicant must provide on a
separate sheet titled “Officer Conviction/Law Requirement Violation Detail
Sheet” that lists the name, date, jurisdiction, and description of the
relevant conviction or violation).
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9. Signature of
person applying for or renewing the license of the PBM
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10. Date
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11. Print Name of
Signer
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The fee
for initial licensure is $250. The fee for license renewal is $100. All fees
are non-refundable. Make check payable to Treasurer of Virginia. Submit
applicable fees with your completed registration form to:
Street Address: Mailing
Address:
PBM Licensing PBM
Licensing
Policy, Compliance, &
Administration Division Policy, Compliance, &
Administration Division
Bureau of Insurance Bureau
of Insurance
1300
E. Main Street P.O.
Box 1157
Richmond, VA 23219 Richmond,
VA 23218
If you
have questions regarding this form, please e-mail bureauofinsurance@scc.virginia.gov or call
(804) 371-9741.
For
additional information, please see Administrative Letter 2020-04 at https://scc.virginia.gov/typedfiles/Administrative-Letters.
Form VA PBM (July 2020) Page
2 of 2
July 28, 2020
Administrative Letter 2020-05
TO: All Carriers Licensed to
Write Accident and Sickness Insurance in Virginia, All Health Services Plans
and Health Maintenance Organizations Licensed in Virginia, and All Interested
Parties
RE: Implementation and
Enforcement of Chapters 1080 and 1081 of the 2020 Acts of Assembly (House Bill
1251 and Senate Bill 172, respectively) (Balance Billing Legislation)
The purpose of this Administrative Letter is to provide
guidance to health carriers regarding the reporting requirements described in
Enactment Clauses 4 and 5 of the Balance Billing Legislation. These reports will
inform the report the Bureau of Insurance will provide to the Chairmen of the
House Committee on Labor and Commerce and the Senate Committee on Commerce and
Labor annually beginning no later than December 1, 2021. Although statutory
revisions from the Balance Billing Legislation become effective January 1,
2021, reporting and other requirements of the Balance Billing Legislation
became effective July 1, 2020.
Enactment Clauses 4 and 5
require reporting by "health carriers" providing "individual or
group health insurance coverage." Refer to the definition of these terms
in § 38.2-3438 of the Code of Virginia to determine the applicability of these
reporting requirements to coverage offered. Coverage provided under a
fully-insured managed care plan for the years in question is subject to the
reporting requirements. Coverage subject to the reporting requirements does not
include short-term limited duration or excepted benefit plans but does include
fully-insured student health plan coverage provided by a managed care plan.
The Bureau will provide carriers
with an Excel template detailing the data needed for completion of the
reporting requirements. The template includes information the Bureau considers
necessary to produce the report the Bureau must provide as required by
Enactment Clause 6.
Carriers must submit the first
reports by September 1, 2020. All information required to be reported will be
required by September 1 of each year in order for the Bureau to produce its
report by each December 1 beginning with December 1, 2021.
Any questions concerning this
Administrative Letter may be addressed to Eric Lowe, Policy Analyst, Policy,
Compliance and Administrative Division, Bureau of Insurance, State Corporation
Commission, email eric.lowe@scc.virginia.gov, or telephone (804) 371-9628.
/s/ Scott A. White
Commissioner of Insurance
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Draft Hospital Provider Manual
Public comment: August 11, 2020, to September 10, 2020.
The draft Hospital Provider Manual
Chapter V is now available on the Department of Medical Assistance Services
website at http://dmas.virginia.gov/#/manualdraft.
Contact Information: Emily
McClellan, Regulatory Manager, Division of Policy and Research, Department of
Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA
23219, telephone (804) 371-4300, FAX (804) 786-1680, TDD (800) 343-0634, or
email emily.mcclellan@dmas.virginia.gov.
Draft Physician Provider Manual
Public comment August 11, 2020, to September 10, 2020.
The draft Physician Provider Manual
Chapters IV and V are now available on the Department of Medical Assistance
Services website at http://dmas.virginia.gov/#/manualdraft.
Contact Information: Emily
McClellan, Regulatory Manager, Division of Policy and Research, Department of
Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA
23219, telephone (804) 371-4300, FAX (804) 786-1680, TDD (800) 343-0634, or
email emily.mcclellan@dmas.virginia.gov.
VIRGINIA DEPARTMENT OF PLANNING AND BUDGET
Commercial Activities List - Public
Comments and Recommendations
Pursuant to § 2.2-1501.1. of the Code of Virginia, the
Virginia Department of Planning and Budget (DPB) published the Commercial Activities
List (CAL) on September 9, 2019. The CAL is posted on the DPB website under
Documents, Instructions and Publications as "Commercial Activities List -
2019" and is also included as an attachment to this notice.
DPB is seeking written comments on the CAL and invites
recommendations from the public regarding activities being performed by state
agencies that might better be performed by the private sector. The public
comment period will begin August 31, 2020, and end September 14, 2020. Please
include "CAL" in the subject of the email.
Contact Information: Cari Corr, Virginia Department of
Planning and Budget, 1111 East Broad Street, Richmond, VA 23219, telephone
(804) 225-4549, or email cari.corr@dpb.virginia.gov.
Virginia Commercial Activities List for
FY 2018 and FY 2019
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NIGP
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NIGP title
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90608
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Automation; Controls;
Instrumentation - Architectural Services
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90648
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Historical Preservation
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91013
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Elevator Installation,
Maintenance and Repair
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91223
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Construction, General
(Backfill Services, Digging, Ditching, Road Grading, Rock Stabilization,
etc.)
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91265
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Maintenance and Repair,
Tennis/Sport Court
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91316
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Construction,
Communication Equipment (Includes Antenna Towers)
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91359
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Construction and Upgrades,
Wastewater Treatment Plant
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91360
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Construction, Water
System/Plants, Main and Service Line
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91427
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Carpentry
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91464
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Plastering
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91500
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Communications and Media
Related Services
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91522
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Communications Marketing
Services
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91806
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Administrative Consulting
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91815
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Architectural Consulting
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91819
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Buildings, Structures and
Components Consulting
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91831
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Construction Consulting
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91875
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Management Consulting
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91878
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Medical Consulting
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91885
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Personnel/Employment
Consulting (Human Resources)
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91887
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Purchasing Consulting
(Incl. Specification Development)
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92000
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Data Processing, Computer,
Programming, and Software Services
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92022
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Data Preparation and
Processing Services (Including Bates Coding)
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92032
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Intelligent
Transportation System Software (Including Design, Development, and
Maintenance Services)
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92037
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Networking Services
(Including Installation, Security, and Maintenance)
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92039
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Processing System
Services, Data (Not Otherwise Classified)
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92040
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Programming Services,
Computer
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92416
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Course Development
Services, Instructional/Training
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92418
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Educational Services,
Alternative
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92474
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Special Education
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92480
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Tutoring
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92500
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Engineering Services,
Professional
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93881
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Scientific Equipment
Maintenance and Repair
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93921
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Computers, Data Processing
Equipment and Accessories (Not Word Processing Equipment), Maintenance and
Repair
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94155
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HVAC Systems Maintenance
and Repair, Power Plant
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94620
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Auditing
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94649
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Financial Services (Not
Otherwise Classified)
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94650
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Fund Raising Services
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94807
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Administration Services,
Health
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94828
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Dental Services
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94876
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Psychologists/Psychological
and Psychiatric Services (Including Behavioral Management Services)
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95226
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Day Care (Adult)
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95277
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Research and Evaluation,
Human Services (Including Productivity Audits)
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95285
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Support Services
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95605
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Business Research Services
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95826
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Construction Management
Services
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95839
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Financial Management
Services
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95859
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Industrial Management
Services
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95874
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Personnel Management
Services
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95939
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Dam and Levee
Construction, Maintenance, Management and Repair
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95973
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Ship Maintenance and
Repair
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95984
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Towing Services, Marine
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96114
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Commissioning of
Facilities Services (Functional and Prefunctional)
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96116
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Claims Processing Services
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96129
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Economic Impact Studies
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96130
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Employment Agency and
Search Firm Services (Including Background Investigations and Drug Testing
for Employment)
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96191
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Water and Petroleum
Pipeline Services
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96196
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Non-Professional Services
(Not Otherwise Classified)
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96269
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Personnel Services,
Temporary
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96343
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Intergovernmental/Inter-Agency
Contracts
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96847
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Inspection Services,
Construction Type
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96881
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Traffic Sign Maintenance
and Repair
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98854
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Lighting Services for
Parks, Athletic Fields, Parking Lots, etc.
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98863
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Park Area
Construction/Renovation
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99029
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Disaster
Preparedness/Emergency Planning Services
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99067
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Patrol Services
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STATE WATER CONTROL BOARD
Proposed Enforcement Action for
Blackstone Energy Ltd.
An enforcement action has been
proposed for Blackstone Energy Ltd. for violations of the State Water Control
Law at eight mine sites located in Lee, Wise, and Tazewell Counties (A&G
Mine Permit Nos. 1602074 and 11020280; Sigmon Mine Permit No. 1702073; and
Black River Coal Mine Permit No. 1402094). A description of the proposed action
is available at the Department of Environmental Quality office listed or online
at www.deq.virginia.gov. Ralph T. Hilt
will accept comments by email at ralph.hilt@deq.virginia.gov, FAX at (276) 676-4899, or
postal mail at Department of Environmental Quality, Southwest Regional Office,
355-A Deadmore Street, Abingdon, VA 24210, from September 1, 2020, through
September 30, 2020.
Proposed Enforcement Action for
Criss Cross Properties LLC
The State Water Control Board
has proposed an enforcement action for Criss Cross Properties LLC, located in
New Kent County Property at New Kent Highway (TM# 22-65), to address
noncompliance with State Water Control Law and regulations. A description of
the proposed action is available at the Department of
Environmental Quality office listed or online at www.deq.virginia.gov.
Frank Lupini will accept comments by email at frank.lupini@deq.virginia.gov
or postal mail at Department of Environmental
Quality, Piedmont Regional Office, 4949A Cox Road, Glen Allen, VA 23060,
from August 31, 2020, to October 1, 2020.
Proposed Consent Order for Cutalong Virginia LLC
An enforcement action has been proposed for Cutalong Virginia
LLC for violations of the State Water Control Law and regulations associated
with the Cutalong project located in Louisa County, Virginia. The State Water
Control Board proposes to issue a consent order to resolve violations
associated with the Cutalong project. A description of the proposed action is
available at the Department of Environmental Quality
office listed or online at www.deq.virginia.gov. Stephanie
Bellotti will accept comments by email at stephanie.bellotti@deq.virginia.gov or postal mail at Department of Environmental Quality, Northern
Regional Office, 13901 Crown Court, Woodbridge, VA 22193, from September 1,
2020, through October 1, 2020.
Proposed Enforcement Action for
Homestead Oil Corporation
An enforcement action has been
proposed for Homestead Oil Corporation for violations of the State Water
Control Law at E and R Oil in Independence, Virginia. A description of the
proposed action is available at the Department of Environmental Quality office
listed or online at www.deq.virginia.gov. Ralph T. Hilt will accept comments by email at ralph.hilt@deq.virginia.gov, FAX at (276) 676-4899, or
postal mail at Department of Environmental Quality, Southwest Regional Office,
355-A Deadmore Street, Abingdon, VA 24210, from September 1, 2020, through
September 30, 2020.
Proposed Enforcement Action for Le
Suraj Inc.
An enforcement action has been proposed for Le Suraj Inc. for
violations of the State Water Control Law in Belle Haven, Virginia. A
description of the proposed action is available at the Department
of Environmental Quality office listed or online at www.deq.virginia.gov.
Russell Deppe will accept comments by email at russell.deppe@deq.virginia.gov,
FAX at (757) 518-2009, or postal mail at Department
of Environmental Quality, Tidewater Regional Office, 5636 Southern
Boulevard, Virginia Beach, VA 23462, from September 2, 2020, to October 2,
2020.
Proposed Consent Special Order for
The Oaks Development LC
The State Water Control Board
proposes to issue a consent special order to The Oaks Development LC for
alleged violation of the State Water Control Law at Oak Rise Road in New Kent
County, Virginia. A description of the proposed action is available at the Department of Environmental Quality office listed or
online at www.deq.virginia.gov. Cara Witte will accept comments by email
at cara.witte@deq.virginia.gov, FAX at (804) 527-5106, or postal
mail at Department of Environmental Quality,
Piedmont Regional Office (Enforcement), 4949-A Cox Road, Glen Allen, VA 23060,
from August 31, 2020, to October 1, 2020.
Proposed Consent Order for Rock Wood
Products of Dillwyn Inc.
The State Water Control Board has proposed an enforcement
action for Rock Wood Products of Dillwyn Inc. for violations at the Pierce and
Johnson Lumber Company, 19135 North James Madison Highway, Dillwyn, Virginia.
The board proposes to issue a consent order to address noncompliance with State
Water Control Law and regulations. A description of the proposed action is
available at the Department of Environmental Quality
office listed or online at www.deq.virginia.gov. Frank Lupini will
accept comments by email at frank.lupini@deq.virginia.gov or postal
mail at Department of Environmental Quality, Piedmont
Regional Office, 4949A Cox Road, Glen Allen, VA 23060, from August 31, 2020, to
October 1, 2020.
VIRGINIA CODE COMMISSION
Notice to State Agencies
Contact Information: Mailing Address: Virginia
Code Commission, Pocahontas Building, 900 East Main Street, 8th Floor,
Richmond, VA 23219; Telephone: (804) 698-1810; Email: varegs@dls.virginia.gov.
Meeting Notices: Section 2.2-3707 C of the Code of
Virginia requires state agencies to post meeting notices on their websites and
on the Commonwealth Calendar at https://commonwealthcalendar.virginia.gov.
Cumulative Table of Virginia Administrative Code Sections
Adopted, Amended, or Repealed: A table listing regulation sections that
have been amended, added, or repealed in the Virginia Register of
Regulations since the regulations were originally published or last
supplemented in the print version of the Virginia Administrative Code is
available at http://register.dls.virginia.gov/documents/cumultab.pdf.
Filing Material for Publication in the Virginia Register
of Regulations: Agencies use the Regulation Information System (RIS) to
file regulations and related items for publication in the Virginia Register
of Regulations. The Registrar's office works closely with the Department of
Planning and Budget (DPB) to coordinate the system with the Virginia Regulatory
Town Hall. RIS and Town Hall complement and enhance one another by sharing
pertinent regulatory information.
ERRATA
MARINE RESOURCES COMMISSION
Title of Regulation: 4VAC20-540.
Pertaining to Spanish and King Mackerel.
Publication: 36:26 VA.R. 2758-2759 August 17, 2020.
Correction to Effective Dates:
Page 2758, after "Statutory Authority: §§ 28.2-201
and 28.2-210 of the Code of Virginia" add
"Effective dates: August 3, 2020, through September
1, 2020."
VA.R. Doc. No. R20-6467; Filed August 10, 2020, 11:31 a.m.