Current Legislation Being Discussed at the General Assembly.
COPN House Subcommittee to Meet Jan. 27
The Chairman of the House Health, Welfare, and Institutions (HWI) Committee, Del. Bobby Orrock (R-Spotsylvania County), has announced that the HWI Subcommittee 3 will conduct its first meeting of the Session on Wednesday, Jan. 27 at 5:00 p.m. in the General Assembly Building’s House Room D. The Subcommittee, chaired by Del. Dickie Bell (R-Staunton) is scheduled to consider all proposed legislation making changes to Virginia’s Certificate of Public Need (COPN) program. A total of 14 different bills on COPN have been introduced in the House. Most of the activity at the General Assembly has been focused on two bills offering competing approaches to addressing the COPN law. One bill introduced by Del. Chris Stolle (R- Virginia Beach), HB 1083, seeks to implement improvements to the COPN review process and establish a framework for future program reforms. A separate bill introduced by Del. John O’Bannon (R-Henrico County), HB 193, seeks to repeal COPN over three years. These and other proposed measures seeking to deregulate COPN by varying degrees will be considered in the coming weeks. Earlier this week, a group of Republican legislators held a press conference calling for the General Assembly to pass legislation to reform the COPN law, a sign this issue is receiving considerable attention in 2016.
Scope of Practice Legislation
HB 581 (Robinson) and SB 264 (Dance): Nurse practitioners; practicing outside of a patient care team. Authorizes a nurse practitioner with at least 2,000 hours of post licensure experience to practice without the requirement for collaboration and consultation with a patient care team physician as part of a patient care team or a written or electronic practice agreement between the licensed nurse practitioner and a licensed physician in certain clinical settings. The bill also grants prescriptive authority to such nurse practitioners.
HB 909 (Minchew): Nurse practitioners; practicing outside of a patient care team. Authorizes a nurse practitioner to practice without the requirement for collaboration and consultation with a patient care team physician as part of a patient care team or a written or electronic practice agreement between the nurse practitioner and a physician in any clinic that is located in a medically underserved area of the state. The bill also grants prescriptive authority to such nurse practitioners.
SB 369 (Stanley): Nurse practitioners; practicing outside of a patient care team. Authorizes a nurse practitioner to practice without the requirement for collaboration and consultation with a patient care team physician as part of a patient care team or a written or electronic practice agreement between the nurse practitioner and a physician in any clinic that is located in a medically underserved area of the state or an area of the state that has an unemployment rate of one and one-half times the statewide average unemployment rate. The bill also grants prescriptive authority to such nurse practitioners.
SB 463 (Carrico): Nurse practitioners; certified nurse midwives; practicing without a patient care team or practice agreement. Authorizes a nurse practitioner licensed by the Boards of Medicine and Nursing in the category of certified nurse midwife to practice without the requirement for collaboration and consultation with a patient care team physician as part of a patient care team or a written or electronic practice agreement between the licensed nurse practitioner and a licensed physician. Under current law, such practice is authorized only under a Department of Health pilot program. The bill grants prescriptive authority to such nurse practitioners and directs the Boards of Medicine and Nursing to jointly promulgate regulations governing such practice. Finally, the bill repeals the pilot program authorizing such practice as obsolete.
SB 620 (Stanley): Nurse practitioners. Eliminates the requirement that a nurse practitioner practice as part of a patient care team with a practice agreement with a patient care physician. The bill also eliminates a Board of Health pilot program authorizing certain nurse practitioners. To practice without a practice agreement as the bill makes such pilot obsolete. The bill requires regulations to be promulgated within 280 days of enactment. The “Enhanced” Nurse Licensure Compact (Registered Nurses and Licensed Practical Nurses)
The purpose of this proposal is continuation of Virginia’s participation in the Nurse Licensure Compact Virginia is one of 25 states that belong to the current Nurse Licensure Compact, and we have been a member since January 1, 2005. Recently, the delegates to the National Council of State Boards of Nursing approved model language for a revised Compact with all states in support. The revised Compact must be adopted by the General Assembly for continued participation by Virginia. The new Compact is the same model as current Nurse Licensure Compact. It is Mutual Recognition: one state based license, issued by state of primary residence, nationally recognized and locally enforced. The enhanced compact will become effective when 26 states pass legislation or December 31, 2018 whichever occurs first.
Key points about the new Compact are: • Promotes increased participation by non-compact states, increases tele health opportunities, addresses threats to state based licensure, and makes necessary improvements for a Compact that has been in existence for 15 years. Virginia Employers are supportive of the NLC and rely on Nurses practicing on a multistate privilege for their staffing needs
• No increase in cost (current fee of $ 6,000 annually) • Calls for uniform initial licensure and a higher threshold for issuing a license with multistate privilege; background checks, no felony convictions, no current discipline, no monitoring program participation. • Does not prohibit states from issuing a single state license if higher threshold not met. • Renames the oversight body (Commission of Compact Administrators) creating a joint public entity and provides for authority to promulgate uniform regulations related to the NLC, following public participation, and enforces Compliance with the NLC. The current process regarding regulation of the Compact creates inconsistency between states and delays in adoption of regulations. Virginia currently belongs to other compacts that contain similar language. • Contains a grandfathering provision Effective when adopted by 26 states (compact or non-compact) or December 21, 2018 whichever comes first?
The Compact is important because expanded mobility of nurses and the use of advanced communication technologies as a part of our nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation. Uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.
We supported this and here is the endorsement that was sent to Jay Douglas at the BON to show our support. Subject: Letter of Endorsement for new Nurse Licensure Compact
Date: 1/15/16
On behalf of the Virginia Organization of Nurse Executives and Leaders (VONEL), as the Legislative Chair, we endorse the Department of Health Professions recommendation that we adapt the new Nurse Licensure Compact (Compact). This proposal expands on the current Nurse Licensure Compact that Virginia in which 25 other states currently participate. Virginia has been an active member in the Compact since January 1, 2005. The new Compact represents a mutual recognition that one state based license, issued by state of primary residence, will be nationally recognized and locally enforced. The enhanced compact will become effective when 26 states pass legislation or December 31, 2018 whichever occurs first.
The Compact will strengthen the current compact that has been in existence for 15 years. The compact expands the mobility of nurses, the use of health care delivery via advanced communication technologies and will require greater coordination and cooperation among states for nurse licensure and regulation. Uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits. The Compact will allow for the following:
Promotes increased participation by non-compact states, increases tele health opportunities, and addresses threats to state based licensure.
Virginia employers are supportive of the NLC and rely on nurses practicing on a multistate privilege for their staffing needs.
No increase in cost to the state of Virginia (current fee of $ 6,000 annually).
Calls for uniform initial licensure and a higher threshold for issuing a license with multistate privilege; background checks, no felony convictions, no current discipline, no monitoring program participation.
Does not prohibit states from issuing a single state license if higher threshold not met. Renames the oversight body (Commission of Compact Administrators) creating a joint public entity and provides for authority to promulgate uniform regulations related to the NLC, following public participation, and enforces Compliance with the NLC. The current process regarding regulation of the Compact creates inconsistency between states and delays in adoption of regulations. Virginia currently belongs to other compacts that contain similar language.
As a state wide organization representing Nurse Executives and Leaders within the profession of nursing we would like to bring this Compact to your attention and request your commitment to supporting its passage during the regular session of the General Assembly. We appreciate your service to the Commonwealth and continued focus on the health of our state.
If we can be of any assistance to you in the future or you have questions about health care in the Commonwealth please do not hesitate to call upon us. If we can provide any more specifics about the new Nurse Licensure Compact we are at your disposal. I can be reached directly by phone (804) 647-2535. To gain more information about our organization, please visit our webpage at http://www.vonenursing.com/
Kevin M. Shimp, MS, RN VONEL Legislative Chair A Bridge to Health Care Careers for Former Military Medics and Corpsmen
Background: Military medics and corpsmen receive extensive and valuable health care training while on active duty. When they transition to civilian life, their military health care experiences may not easily translate into comparable certifications/licenses required for health care jobs. As a result, many veteran medics and corpsmen are unemployed or cannot apply their skills in civilian health care jobs. Efforts are already underway to translate veterans’ military experience into academic credit and shorten the pathway to obtaining various civilian credentials. However, in health care, veterans may still need to spend 2 or more years in school before they can obtain a credential.
Last year, the Joint Commission on Health Care completed a study on scope of practice exemptions in approved hospitals for certain military-trained personnel. As a result, they began exploring the possibility of a pilot project in Virginia with the Virginia Hospital and Healthcare Association.
Program Goals: Work with Virginia health care employers to explore ways they can hire highly skilled military medics and corpsmen before they have received a recognized credential. Help fill workforce gaps for employers and keep veterans’ clinical skills up-to-date. Allow Virginia employers to recruit motivated employees from a pipeline of 11,000 medics and corpsmen who transition out of the military every year; many of whom will go on to become licensed health care professionals.
Positive Impacts: Virginia would be the first state to offer this kind of innovative pathway for this subset of highly skilled veterans. Likely to draw even more veterans to Virginia since it provides immediate employment. Creates a path to employability and helps build the health care workforce of the future and meet current employment challenges.
Model Programs: The VA’s Intermediate Care Technician (ICT) Pilot Program o Program to hire former combat medics and corpsmen as advanced health technicians in emergency departments.
Proposal: Pilot program with hospital systems willing to participate: o Why launch as a pilot program? . Creation of a new position; need to test clinical utility . Familiarize employers with the veterans’ skills/abilities; build buy-in. . Test whether medics/corpsmen would be interested in this role. Provide explicit legislative authority for employers participating in this pilot program to allow veteran medics/corpsmen to perform clinical activities they are competent to do before they have obtained a recognized credential. The medics would work under the supervision of a physician. Health systems may want to develop new position descriptions that utilize the medics’ skills and meet the system’s workforce needs. Pilot program staff would help in developing appropriate positions. Health systems would likely develop their own internal credentialing process to ensure the medics are competent to perform a specified set of duties; Pilot program staff would provide technical assistance and support. Pilot program staff would help with marketing and recruitment of veterans who are good matches for particular positions.
Fiscal Impact: To implement the program effectively will require staff (likely housed at DVS) and resources to manage the program. This small investment would likely result in hundreds of veterans gaining meaningful employment in health care jobs in Virginia. Proposed program staff 1 senior level and 2 mid-level professionals This staffing is needed because of the complexity and broad diversity in military medic training and in civilian health care jobs. These individuals would need to have sufficient knowledge of the medics and corpsmen military training and the civilian health care sector in order to adequately match veterans to the positions and to help support employers in hiring and integrating the veterans into their existing staffing models.
Conclusion: Health care is the fastest growing field for jobs. Medics and corpsmen have extremely relevant, real-world experience from their extensive military education and training. They can help fill many gaps in health care workforce needs. This small investment would likely result in hundreds of veterans gaining meaningful employment in health care jobs in Virginia. These men and women have earned our support through their service to our Nation and the Commonwealth.