Virginia enacts state law on lab steering

Virginia has set a national precedent on health plan lab referrals that will protect patients from the abusive health plan business practice of in-network pathology/laboratory steering. The CAP has asserted that such business practices by health plans harm patient care by undermining optimal, timely provision of pathology/laboratory services. 

On April 6, Virginia Governor Abigail Spanberger signed SB 745, supported by the CAP and the Virginia Society for Pathology (VSP).

The impact: The law prohibits health plans from steering referrals of pathology and lab services to an exclusive set of designated in-network laboratories, which is done by denying referrals to other in-network providers. 

• Under the Practitioner Self-Referral Act, health plans can’t restrict in-network referrals to only a few (or one) in-network laboratory or pathology providers, thereby excluding other in-network providers, with limited exceptions.
• The law, which does not apply to state-regulated HMOs, takes effect July 1. 

The backstory: The law targets insurer practices that directed patients and specimens to one or two designated commercial labs, sometimes out of state. 

• Physicians raised concerns about delayed diagnoses, fragmented care, and reduced access to in-network specialized pathology services.
• The CAP and VSP raised concerns with Virginia oversight agencies in 2025, including worries regarding impacts on Medicaid patients.
• In 2025, the CAP helped secure new AMA policies (H180.941) and (D180.975) reflecting the broad consensus in medicine that these practices are antithetical to optimal patient care.

What we're saying: In a March 2 letter urging enactment, CAP President Qihui "Jim" Zhai, MD, FCAP, wrote: 

"…This business practice of funneling pathology/laboratory referrals undermines the optimal practice of medicine and can harm Virginia patients without their knowledge."

Go deeper: Read support letters to Gov. Spanberger from the Medical Society of Virginia, the Virginia Hospital and Healthcare Association, and VSP.