The rising cost of health care and the lack of comparative information on health care services was a concern of the legislature in 1971. A joint resolution was passed calling for special studies of the costs and Administration of Health Care Services, led by Senator Edward E. Willey. The commission recommended establishing a rate review board to "examine hospital costs and charges." In 1975, the Virginia Rate Review Program was set up as a separate not-for-profit corporation; this was formalized into a board the following year.

The Virginia Health Services Cost Review Council was created by an act of the General Assembly approved April 9, 1978. Initially, the Council was a Commission made up of nine members, eight of whom were appointed by the governor for a three year term: three consumers of health care services, three administrators of nongovernmental health care institutions, one employee of a prepaid hospital service plan, and one employee of a commercial insurer which underwrites accident and sickness insurance. The ninth member was the Commissioner of Health or his designee. The chairman was elected from the consumer members.

On April 4, 1980, the General Assembly approved enlarging the Commission to eleven members, increasing the consumer representatives to five, two with experience in financial management or accounting. The Commission became a Council effective July 1, 1982. The Director of the agency was hired by the Council members, reporting to the Secretary of Health and Human Services. The stated mission is to "promote the economic delivery of high quality and effective institutional health care services to the citizens of the Commonwealth." In 1989, the General Assembly expanded the Council's review of costs and charges to the long-term care industry, absorbing the Long-Term Care Council which was established in 1982.

The size of the council was increased to fifteen, in order to include three nursing home providers and the Director of the Department of Medical Assistant Services, and the executive director position became a gubernatorial appointment. The Council established a uniform system of financial reporting of health care costs. Each health care institution is required to file an annual financial report with details on health care costs, charges, assets, liabilities, and net worth. Through monthly meetings, the Council engages in continuing financial analysis and studies relating to health care institutions. The information gathered is disseminated to the public through its publications.

The Council may initiate reviews or investigations as necessary to assure all users of health care services that aggregate charges are reasonably aggregate costs, and that charges are equitable.

The major publications issued by the Virginia Health Services Cost Review Council include: Annual Report of Health Care Costs, "Charge Survey," and Commercial Diversification Report.