AN IN‐DEPTH LOOK AT ISSUES AFFECTING HEALTH CARE FOCUS

Health Care Policy in the 2016 General Assembly Session

By Sara Hendon Heisler

As is oen the case with winter legislave sessions in the Com- budget. In another acon, the budget fully restores the 2.6 monwealth, Virginia’s recently concluded 2016 General As- percent inflaon adjustment for Children’s Hospital of The sembly session was acon-packed. And health care policy was King’s Daughters in fiscal year 2017. in the spotlight. VHHA monitored 159 bills throughout the two The compromise budget also eliminated Medicaid Expansion, a months Virginia’s 140-member legislature gathered in Rich- priority for Governor McAuliffe. The spending bill spulates mond to consider new laws, changes to exisng code, and that “as a condion on all appropriaons in this act and not- adopon of a two-year budget. Overall, more than 3,200 bills withstanding any other provision of this act, or any other law, and resoluons were submied in the Virginia Senate and the no general or non-general funds shall be appropriated or ex- House of Delegates, though many did not win final approval. pended for such costs as may be incurred to implement cover- Arguably, the most impacul legislaon of the session is Vir- age for newly eligible individuals pursuant to 42 U.S.C. § 1396d ginia’s biennial budget that sets a state spending plan for a (y)(1)[2010] of the Paent Protecon and Affordable Care Act, two-year period beginning July 1, 2016. In the lead up to the unless included in an appropriaon bill adopted by the General session, Governor Terry McAuliffe in December offered his Assembly on or aer July 1, 2016.” Also removed is $500,000 budget proposal. It included a 3 percent provider assessment, in general funds and $2 million in non-general funds (federal counng on contribuons from hospitals to cover the state’s match) originally appropriated to support Medicaid’s share of costs for making more Virginians eligible for health insurance the Commonwealth Health Informaon Exchange and to pro- coverage under the Affordable Care Act. It also withheld infla- vide support for providers to join. A budget explanaon of that on adjustments for inpaent and outpaent hospitals, total- acon notes “the state has not received federal approval to ing some $94 million in general funds and non-general funds make these payments and the funding is not currently need- denied to Virginia’s local hospitals that have not had an infla- ed.” on adjustment since 2013. Virginia hospitals and other health care stakeholders found Through legislaon, the House and Senate developed their compromise on workers compensaon legislaon. The culmi- own budget proposals. Those bills tend to embody some ideas naon of many months’ work by diverse stakeholders, the final offered by the Governor, but not others. The compromise version of House Bill 378 by Delegate Peter Farrell (R-Henrico budget legislaon negoated by the House and the Senate County) directs the Workers’ Compensaon Commission to does not include a provider assessment mechanism either for establish fee schedules by provider types and geographic loca- the exisng Medicaid program or to support availing more ons. Those fee schedules are to be based on the average Virginians of health insurance coverage under the Affordable workers compensaon reimbursement for each provider type Care Act. The two-year compromise budget includes a 1.3 per- in each defined community. An actuarial firm is to be selected cent inflaon adjustment for hospitals in fiscal year 2017. That by the Commission to analyze 2014 and 2015 payment data as amounts to nearly $16 million in general funds over the bienni- a basis for establishing fee schedules that will be effecve Jan. um, and a matching amount in federal funds, to parally re- 1, 2018. The legislaon also includes stop-loss provisions for store hospital inflaon adjustments with more than $31 mil- high-cost cases, and adds language to reduce silent PPOs. The lion in funding. VHHA and its members appreciate the Virginia bill language allows, and encourages, contracng between General Assembly for including that financial support in the providers, employers, and insurance carriers. This is the first

VHHA’S FOCUS — MARCH 2016 1 substanal language that has been adopted during a five-year Assembly now head to Governor McAuliffe’s desk for consider- period of negoaons and studies of this topic by the Virginia aon. Among the opons available to the Governor: sign legis- General Assembly. The budget includes a $1 million general laon into law, allow legislaon to become law without his fund appropriaon in fiscal year 2017 for the Workers’ Com- signature, amend legislaon, or veto legislaon. The Virginia pensaon Commission to support actuarial costs associated General Assembly will return to Richmond April 20 for a recon- with HB 378. vene session when members will consider any modificaons Governor McAuliffe might make. VHHA staff will connue to Cerficate of Public Need (COPN) was another focal point of monitor legislave developments from 2016 and work in the health care policy discussion during the session. Mulple bills off-season to prepare for 2017. In the meanme, here is a re- proposing a range of opons from process reforms to piece- cap of some of the many health care policy bills from this ses- meal and wholesale deregulaon were submied this session. sion that VHHA tracked and engaged on in members’ best in- Last year, the General Assembly called for the formaon of a terests. Here are some highlights (all bill status updates cur- state Work Group to evaluate COPN. Following months of rent as of early March): study and public meengs, the Work Group in November rec- ommended meaningful changes to streamline, enhance, and  HJ 87 from Delegate Keith Hodges (R-Urbanna) and SJ 35 modernize the COPN process. Subsequent legislaon on the from Senator John Miller (D-Newport News) to designate subject took several approaches. Some legislave measures April as “Advance Care Planning Month” and raise public preferred by VHHA and hospitals took a reform approach that awareness about the importance of end-of-life planning. bore similaries to the Work Group recommendaons. Those Both measures have passed the House of Delegates and measures did not find much tracon in the legislature. Some the Virginia Senate. other bills drawn to effectuate paral or broad deregulaon of  HB 293 from Delegate Charniele Herring (D-Alexandria) COPN found more favorable foong early in the 2016 legisla- and SB 513 from Senator (R-Henrico ve session. Legislaon to largely deregulate Virginia’s system County) to require those prescribing opioids to paents narrowly cleared the House of Delegates in February, as did a for a period longer than 14 days to check the Prescripon separate bill that was less far-reaching. Similar bills introduced Monitoring Program before prescribing the medica- in the Virginia Senate were combined into one measure and on. Under current law, that standard applies to opioid tabled for the year. Under the guidance of Senator Steve New- prescripons lasng more than 90 days. The bills include man (R-Lynchburg), a special subcommiee of the Senate Edu- several excepons to this requirement including opioid caon and Health Commiee was formed to address COPN prescribing for hospice or palliave care paents, as part legislaon. Aer meengs and discussion, an amended version of a surgical or invasive procedure that is not refillable, as of HB 350 proceeded to the full Senate. As amended it con- part of inpaent admission or at discharge, or for nursing tained language to establish a new health care charity fund home or assisted living facilies using a sole source phar- and provider assessment program, deregulate medical imaging macy. The bills also grant access to the Prescripon Moni- services such as MRI and CT services, and create regional and toring Program to individuals at the same facility who are rural carve outs, leaving certain communies subject to COPN under the direct supervision of the prescriber or dispenser regulaon. The bill also would have implemented several rec- and meet other qualifying criteria. Both bills have passed ommendaons of the state COPN Work Group supported by the House of Delegates and the Virginia Senate. Governor VHHA, including recommendaons to update the State Medi- McAuliffe has signed SB 513. cal Facilies Plan. The approach Senator Newman took acknowledged the appro-  HB 319 from Delegate Sam Rasoul (D-Roanoke) to offer priate policy linkage between responsible COPN deregulaon sovereign immunity and connuing educaon credit for and health care funding necessary to stabilize an imbalanced volunteer health care providers who enter into an agree- system in which hospitals provide significant charity care and ment with the Virginia Department of Health (VDH) for must comply with government mandates to deliver free and the provision of uncompensated health care services to discounted care. Senator Newman and his colleagues worked low-income individuals receiving health services through a diligently to strike the right legislave balance but ran out of local health department or a health care facility licensed me in the closing days of the two-month session. Specifically, by VDH and operated by a nonprofit enty. The bill has the legislaon did not meet a deadline specifying the path rev- passed the House of Delegates and the Virginia Senate enue-related legislaon must travel through the process. So and been signed by Governor McAuliffe (effecve Jan. 1, the legislaon was bypassed for the session. However, Senator 2017). Newman and other elected officials have expressed their in- tent to keep studying this issue and other health care reforms  HB 581 from Delegate Roxann Robinson (R-Chesterfield ahead of the 2017 General Assembly session. VHHA plans to County) and SB 264 from Senator Rosalyn Dance (D- monitor and engage in that process. Petersburg) to authorize a nurse praconer to connue The budget bills and other legislaon approved by the General to treat paents without a paent care team physician for

VHHA’S FOCUS — MARCH 2016 2 60 days in the event of the death, disability, rerement, the House of Delegates and the Virginia Senate. loss of license, or relocaon of the paent care team phy- sician. SB 264 has passed the House of Delegates and the  HB 1044 from Delegate Steve Landes (R-Augusta County) Virginia Senate and been signed by Governor McAuliffe. and SB 491 from Senator Emme Hanger (R-Augusta HB 581 has passed the House of Delegates and the Virginia County), would allow Medicaid managed care organiza- Senate and is awaing acon by Governor McAuliffe. ons (MCO) to access informaon in the Prescripon Monitoring Program as necessary to manage the care of  HB 652 from Delegate John O’Bannon (R-Henrico County) MCO enrollees who are included in a Paent Ulizaon to update terminology related to declaraons of neurolog- Management Safety or similar management program de- ical death has passed the House of Delegates and the Vir- signed to protect enrollees and detect possible substance ginia Senate and been signed by Governor McAuliffe. abuse. HB 1044 and SB 491 have each passed the House of Delegates and the Virginia Senate.  HB 657 from Delegate John O’Bannon (R-Henrico County) to require the director of the Department of Health Pro-  HB 1110 from Delegate Rob Bell (R-Albemarle County) and fessions (DHP) to develop criteria for indicators of unusual SB 567 from Senator George Barker (D-Fairfax County) paerns of prescribing or dispensing of covered substanc- provide that a magistrate conducng a temporary deten- es by prescribers or dispensers, and to authorize the direc- on hearing shall consider, if available, the recommenda- tor to disclose such informaon to the enforcement divi- ons of a person’s personal representave and relave. sion of DHP. HB 657 has passed the House of Delegates The legislaon also imposes a duty on health care provid- and the Virginia Senate and has been signed by Governor ers serving an individual subject to emergency custody, McAuliffe. temporary detenon, or involuntary commitment to make a reasonable aempt to nofy the person’s family or rep-  HB 685 from Delegate Steve Landes (R-Augusta County) to resentave. HB 1110 and SB 567 have passed the House of provide that the Commonwealth’s insurance laws do not Delegates and the Virginia Senate and are awaing acon apply to direct primary care agreements. HB 685 has by Governor McAuliffe. passed the House of Delegates, and a modified version passed the Virginia Senate.  SB 369 from Senator Bill Stanley (R-Franklin County) to establish a pilot program for physicians to use telemedi-  HB 825 from Delegate Chris Stolle (R-Virginia Beach) and cine to funcon as paent care team physicians for nurse SB 437 from Senator George Barker (D-Fairfax County) to praconers at sites in medically underserved areas of the direct the Department of Veterans Services, in concert state as designed by the Department of Health. SB 369 has with the Department of Health Professions, to establish a passed the House of Delegates and the Virginia Senate. pilot program through which military medical personnel may pracce and perform certain acts of medical pracce  SB 595 from Senator Kenny Alexander (D-Norfolk) to re- under the supervision of a licensed physician or podiatrist. quire hospitals and other instuons to maintain dead HB 825 has passed the House of Delegates and Virginia human bodies in refrigeraon at temperatures of no more Senate. SB 437 has passed the House of Delegates and the than approximately 40 degrees Fahrenheit, or to enter Virginia Senate and been signed by Governor McAuliffe. into an agreement with a local funeral service establish- ment for storage, has passed the House of Delegates and  HB 900 from Delegate Chris Stolle (R-Virginia Beach) to the Virginia Senate. authorize the Board of Medicine to issue a two-year prac- ce license to applying associate physicians who meet qualificaons such as successful compleon of a board- approved course of study, successful compleon of Step 1 About the Author and Step 2 of the United States Medical Licensing Exami- naon, and who have not completed a medical internship Sara Hendon Heisler joined VHHA in 2015 as Associate or residency program. The bill would require all associate General Counsel. She assists VHHA and its members with legal, governmental, and regulatory affairs. Prior to physicians to pracce in accordance with a pracce agree- joining VHHA, Sara worked in private pracce for six ment between the associate physician and a board- years focusing on health care regulatory and transac- licensed physician. HB 900 passed the House of Delegates onal maers including reimbursement and coding and was carried over unl 2017 by the Virginia Senate. issues, fraud and abuse, Medicare and Medicaid issues, and Cerficate of Public Need. She has a law degree from the University of Richmond.  HB 905 from Delegate David Yancey (R-Newport News) to require hospitals to provide paents, upon request, an esmate of the payment amount for scheduled elecve procedures. An amended version of this bill has passed

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HosPAC is VHHA’s polical acon commiee. The mission of HosPAC is to provide or- ganized and effecve polical acon, and to support state candidates who will work to improve quality health care through policies supported by Virginia’s hospital and health systems. As elected officials in Virginia and Washington make crical decisions affecng Virginia’s hospitals and health systems, HosPAC supports candidates for office whose acons show consideraon for Virginia health care providers and the communies they serve. To learn more about HosPAC or to contribute, visit www.vhha.com/advocacy.

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