Regulatory Update and New Virginia Laws in Effect July 1
Legislation on Fair Business Practices Act
Effective July 1, 2024. HB 123 and SB 425 make changes to the Fair Business Practices Act in Virginia. The genesis of the legislation was a workgroup in the summer of 2023 by the Virginia Hospital and Health Care Association, the Medical Society of Virginia, and the Virginia Association of Health Plans.
The FBPA establishes “rules of the road” for how claims are submitted, paid, or denied and how any retroactive denials are permitted. It applies to health carriers who write individual or group coverage in fully insured markets or as health maintenance organizations.
FBPA does NOT apply to Medicare, Medicare supplements, Medicaid, CHIP, TRICARE, TRICARE supplements, self-insured and self-funded (ERISA) plans.
Under this legislation, a carrier shall pay within 40 days of receipt of a claim. A carrier shall, within 30 days after receipt of a claim, notify the person submitting the claim of any defect or impropriety that prevents the carrier from deeming the claim a clean claim and request the information that will be required to process and pay the claim.
Beginning no later than January 1, 2026, all notifications to providers and information from and to providers to carriers shall be delivered by electronic means. No carrier may impose a retroactive denial of a previously paid claim, or any other way seek recovery, unless the carrier specifies in writing the specific claim or claims for which the retroactive denial is sought, and the carrier provides a written explanation of why the retroactive adjustment is being sought.
VDA Dental Insurance Grievance Tracker
Legislation introduced at the request of the VDA and passed in the 2024 General Assembly session required a work group including the VDA and dental insurance carriers to meet to evaluate the need for further changes to the Fair Business Practices Act. To bring forward the relevant issues, the VDA launched a Dental Insurance Grievance Tracker to allow dentists and their team members to submit their issues. The VDA Council on Government Affairs and VDA counsel have gone through the submissions up to this point to identify trends as well as issues that may be specific to certain carriers.
In analyzing the data to sort out the concerns or grievances that fall within the scope of the FBPA, three trends that are very common that VDA counsel brought forward in the initial work group pertained to:
- Down coding, bundling and up coding together with timing
- Radiographs
- Crowns (build ups and documentation)
In the coming weeks, the VDA will be continuing to run down specific issues and continuing to gather responses from members. The Dental Insurance Grievance Tracker will remain active and we strongly encourage members to bookmark the tracker and share it with the appropriate members of their teams who deal with insurance issues to document issues in your practice that can be addressed through this work group.
DENTAL INSURANCE GRIEVANCE TRACKER
Safe Haven Fatigue and Wellness Legislation
The Virginia General Assembly passed two identical bills in the 2024 session, effective July 1, to:
- expand access to the Safe Haven program to dentists and dental hygienists;
- authorize the Safe Haven program to provide outpatient health care to health care professionals; and
- encourage health care professionals to voluntarily seek behavioral health services without fear of mandatory reports to health regulatory boards in every circumstance.
Safe Haven is voluntary, and enrollment may be by individual, by group or by employer. Sen. Todd Pillion, R-Abingdon and Del. Patrick Hope, D-Arlington, introduced Senate Bill 629 and House Bill 42, respectively.
Dental Medicaid Reimbursement Increase
Effective July 1, a new fee schedule from DMAS reflects a 3 percent across the board increase in reimbursement rates. This follows the VDA successfully championing a 30 percent increase in dental Medicaid reimbursement rates in 2022 – the largest new legislative investment in dentistry in Virginia’s history and the first increase in reimbursement rates in over a decade. Virginia dentists treated an all-time-high of more than 200,000 adults in state fiscal year 2023 who had benefits from the Medicaid program.
Virginia Dentists Now Allowed to Administer Cosmetic Botox
Legislation passed in 2023 with support from the VDA required the Virginia Board of Dentistry to develop training requirements to allow dentists to administer Botox for cosmetic purposes. Language included in the 2023 budget required the board to develop regulations on an emergency basis.
The Virginia Board of Dentistry established training requirements this year to allow Virginia dentists to incorporate Botox for cosmetic purposes into their practice. The Virginia Dental Association is pleased to offer members two in-person, four-hour training courses that fulfill these requirements Friday, August 9, 2024 in Richmond.
The courses will be taught by instructors with the American Academy of Facial Esthetics (AAFE), and course registration will give members access to the online didactic instruction also required by Virginia regulations.
