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HOUSE BILL NO. 1276
AMENDMENT IN THE NATURE OF A SUBSTITUTE
(Proposed by the House Committee on Labor and Commerce
on February 12, 2026)
(Patron Prior to Substitute--Delegate Watts)
A BILL to amend and reenact §
32.1-137.05
of the Code of Virginia, relating to health care providers; required estimate for nonemergency health care services.
Be it enacted by the General Assembly of Virginia:
1. That §
32.1-137.05
of the Code of Virginia is amended and reenacted as follows:
§
32.1-137.05
. Information regarding standard charges; good faith estimate of patient payment amount for nonemergency health care services.
A.
As used in this section:
"Health benefit plan"
has the same meaning as provided in §
38.2-3438
.
"Health carrier"
has the same meaning as provided in §
38.2-3438
.
"Nonemergenc
y health care services" means
any
service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease except for any emergency service, as defined in §
38.2-3438
.
"Patient" includes the patient's legally authorized representative.
"Provider"
means a hospital, physician, or any type of provider licensed, certified, or authorized by statute to provide a covered service under the health benefit plan.
B.
Every hospital shall make available to the public on its website a machine-readable file containing a list of all standard charges for all items and services provided by the hospital in accordance with 45 C.F.R. § 180.50, as amended. As used in this subsection, "hospital," "items and services," "machine-readable," and "standard charge" have the same meaning as set forth in 45 C.F.R. § 180.20.
B.
C.
Every
hospital
provider
shall, upon request of a patient scheduled to receive
an elective procedure, test, o
r
any nonemergency health care
service to be performed by the
hospital
provider
,
or upon request of such patient's legally authorized representative,
provided such request is
made no less than three days in advance of the date on which such
elective procedure, test, or
nonemergency health care
service is scheduled to be performed, furnish the patient with
an
a
written
g
ood faith
estimate of the payment amount for which the
participant
patient
will be responsible for such
elective procedure, test, or
nonemergency health care
service
, including
any
fees or other charges
for an item or service the patient may
be reasonably expected to
receive
in connection with the nonemergency health care service
.
Such good faith estimate shall
:
1. Be based on:
a. Information supplied by the covered person regarding his health benefit plan
;
b. Information reasonably available to the provider at the time the estimate is prepared; and
c. The provider's standard charges;
2
. Include
:
a.
A
description of the scheduled nonemergency health care service
;
b.
T
he provider's standard charge for the service
and any related item or service
;
and
c.
A statement that the estimate
is only an estimate for an item or service the patient may be reasonably expected to receive and that the actual items, services, or payment amounts billed may differ from the good faith estimate depe
nding on changes in the scope of services or the health carrier's processing of the claim and that
the estimate
is not a contract or binding agreement to require the patient
to obtain the items or services or guarantee a certain payment amount.
3. N
ot constitute a warranty or guarantee of the actual amount the patient will owe.
A provider shall not be in violation of this subsection when the patient or health carrier fails to provide accurate or complete information regarding the patient's health benefit plan or the health carrier later makes a determination or adjudicates a claim contrary to the information provided.
Nothing in this subsection shall be construed to require a provider to determine with certainty whether it or any affiliated provider is in
-
network for a particular health benefit plan.
D.
Every
hospital
provider
shall provide written information about the patient's ability to request an estimate of the payment amount pursuant to
this
section
subsection C
. Such written information shall be posted conspicuously in public areas of the
hospital
provider's
facility or
office
, including admissions or registration areas, and included on any website maintained by the
hospital
provider
.