AN IN‐DEPTH LOOK AT ISSUES AFFECTING HEALTH CARE FOCUS
Health Care Policy in the 2016 Virginia General Assembly Session
By Sara Hendon Heisler
As is o en the case with winter legisla ve sessions in the Com- budget. In another ac on, the budget fully restores the 2.6 monwealth, Virginia’s recently concluded 2016 General As- percent infla on adjustment for Children’s Hospital of The sembly session was ac on-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 s pulates mond to consider new laws, changes to exis ng code, and that “as a condi on on all appropria ons in this act and not- adop on of a two-year budget. Overall, more than 3,200 bills withstanding any other provision of this act, or any other law, and resolu ons were submi ed 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 impac ul legisla on 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 Pa ent Protec on and Affordable Care Act, two-year period beginning July 1, 2016. In the lead up to the unless included in an appropria on bill adopted by the General session, Governor Terry McAuliffe in December offered his Assembly on or a er 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 coun ng on contribu ons 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 Informa on Exchange and to pro- coverage under the Affordable Care Act. It also withheld infla- vide support for providers to join. A budget explana on of that on adjustments for inpa ent and outpa ent hospitals, total- ac on 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 legisla on, the House and Senate developed their compromise on workers compensa on legisla on. The culmi- own budget proposals. Those bills tend to embody some ideas na on 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 legisla on nego ated by the House and the Senate County) directs the Workers’ Compensa on Commission to does not include a provider assessment mechanism either for establish fee schedules by provider types and geographic loca- the exis ng 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 compensa on 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 infla on 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 effec ve Jan. um, and a matching amount in federal funds, to par ally re- 1, 2018. The legisla on also includes stop-loss provisions for store hospital infla on 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, contrac ng 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 substan al language that has been adopted during a five-year Assembly now head to Governor McAuliffe’s desk for consider- period of nego a ons and studies of this topic by the Virginia a on. Among the op ons available to the Governor: sign legis- General Assembly. The budget includes a $1 million general la on into law, allow legisla on to become law without his fund appropria on in fiscal year 2017 for the Workers’ Com- signature, amend legisla on, or veto legisla on. The Virginia pensa on 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 modifica ons Governor McAuliffe might make. VHHA staff will con nue to Cer ficate of Public Need (COPN) was another focal point of monitor legisla ve developments from 2016 and work in the health care policy discussion during the session. Mul ple bills off-season to prepare for 2017. In the mean me, here is a re- proposing a range of op ons from process reforms to piece- cap of some of the many health care policy bills from this ses- meal and wholesale deregula on were submi ed this session. sion that VHHA tracked and engaged on in members’ best in- Last year, the General Assembly called for the forma on 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 mee ngs, 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 legisla on on the from Senator John Miller (D-Newport News) to designate subject took several approaches. Some legisla ve 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 similari es to the Work Group recommenda ons. Those Both measures have passed the House of Delegates and measures did not find much trac on in the legislature. Some the Virginia Senate. other bills drawn to effectuate par al or broad deregula on of HB 293 from Delegate Charniele Herring (D-Alexandria) COPN found more favorable foo ng early in the 2016 legisla- and SB 513 from Senator Siobhan Dunnavant (R-Henrico ve session. Legisla on to largely deregulate Virginia’s system County) to require those prescribing opioids to pa ents narrowly cleared the House of Delegates in February, as did a for a period longer than 14 days to check the Prescrip on 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- prescrip ons las ng more than 90 days. The bills include man (R-Lynchburg), a special subcommi ee of the Senate Edu- several excep ons to this requirement including opioid ca on and Health Commi ee was formed to address COPN prescribing for hospice or pallia ve care pa ents, as part legisla on. A er mee ngs 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 inpa ent admission or at discharge, or for nursing tained language to establish a new health care charity fund home or assisted living facili es using a sole source phar- and provider assessment program, deregulate medical imaging macy. The bills also grant access to the Prescrip on 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 communi es subject to COPN under the direct supervision of the prescriber or dispenser regula on. The bill also would have implemented several rec- and meet other qualifying criteria. Both bills have passed ommenda ons of the state COPN Work Group supported by the House of Delegates and the Virginia Senate. Governor VHHA, including recommenda ons to update the State Medi- McAuliffe has signed SB 513. cal Facili es 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 deregula on sovereign immunity and con nuing educa on 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 legisla ve 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 en ty. The bill has the legisla on did not meet a deadline specifying the path rev- passed the House of Delegates and the Virginia Senate enue-related legisla on must travel through the process. So and been signed by Governor McAuliffe (effec ve Jan. 1, the legisla on 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 prac oner to con nue The budget bills and other legisla on approved by the General to treat pa ents without a pa ent care team physician for
VHHA’S FOCUS — MARCH 2016 2 60 days in the event of the death, disability, re rement, the House of Delegates and the Virginia Senate. loss of license, or reloca on of the pa ent 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 awai ng ac on by Governor McAuliffe. ons (MCO) to access informa on in the Prescrip on 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 Pa ent U liza on to update terminology related to declara ons 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) pa erns of prescribing or dispensing of covered substanc- provide that a magistrate conduc ng 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 informa on to the enforcement divi- ons of a person’s personal representa ve and rela ve. sion of DHP. HB 657 has passed the House of Delegates The legisla on 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 deten on, or involuntary commitment to make a reasonable a empt to no fy the person’s family or rep- HB 685 from Delegate Steve Landes (R-Augusta County) to resenta ve. 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 awai ng ac on 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 func on as pa ent care team physicians for nurse SB 437 from Senator George Barker (D-Fairfax County) to prac oners 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 prac ce and perform certain acts of medical prac ce SB 595 from Senator Kenny Alexander (D-Norfolk) to re- under the supervision of a licensed physician or podiatrist. quire hospitals and other ins tu ons to maintain dead HB 825 has passed the House of Delegates and Virginia human bodies in refrigera on 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 qualifica ons such as successful comple on of a board- approved course of study, successful comple on of Step 1 About the Author and Step 2 of the United States Medical Licensing Exami- na on, 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 prac ce in accordance with a prac ce agree- joining VHHA, Sara worked in private prac ce 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 ma ers including reimbursement and coding and was carried over un l 2017 by the Virginia Senate. issues, fraud and abuse, Medicare and Medicaid issues, and Cer ficate 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 pa ents, upon request, an es mate of the payment amount for scheduled elec ve procedures. An amended version of this bill has passed
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