The Virginia Hospital & Healthcare Association’s hospitals and health systems worked to shape many important health proposals on the General Assembly’s agenda during the 2017 “short session.” This summary describes final action on those measures with the most significant impact on hospitals and health systems.
Access to Care
Finding a common-sense approach to address access to care for low-income uninsured Virginians remains a top priority for the VHHA. The outcome of the presidential election and congressional republican vows to repeal and replace the Patient Protection and Affordable Care Act (“ACA”) under the new administration effectively squelched any meaningful discussion of Medicaid expansion in Virginia and other non-expansion states.
The Governor’s introduced budget included a provision that would have authorized the Governor, on or after October 1, 2017, to expand Medicaid to the newly eligible population in the event that the continued, amended, or replaced ACA included an enhanced federal match for Medicaid coverage of newly eligible individuals. Also, two House resolutions sought to address Medicaid expansion, HJ 707 (Plum) and HJ 710 (Plum), both of which encouraged the Governor to extend to the Commonwealth the full range of services, benefits, and programs available under federal law through the Medicaid program. As expected, both resolutions were laid on the table in the House Appropriations Health and Human Resources Subcommittee.
The final House and Senate budget removed the Governor’s proposed language to authorize Medicaid expansion and restored what is referred to as the “Stanley Amendment;” expressly prohibiting any general or nongeneral funds from being appropriated or expended for costs as may be incurred to implement Medicaid expansion.
In response to potential changes coming out of repeal and replacement of the ACA, the chairs of House Appropriations and Senate Finance established a joint subcommittee, with four members from each group yet to be nominated, to address related federal and state health policy challenges. The specific charge of the subcommittee is to evaluate and respond to changes to the ACA in the year ahead and provide oversight of Medicaid reforms and Health and Human Resources operations.
Also, in the absence of broader efforts to address the access needs of low-income uninsured Virginians, the Governor’s and House and Senate budget bills included additional funding to increase the income eligibility criteria for the so called “Governor’s Access Plan” or “GAP” for adults with serious mental illness from 80 to 100 percent of the federal poverty level, effective July 1, 2017.
Certificate of Public Need (COPN)
Maintaining a strong COPN law in Virginia became the top priority for VHHA during the 2017 General Assembly session. The potential repeal and replacement of the ACA could bring increases in the number of uninsured, disruptions in insurance markets, fundamental changes to federal funding for the state Medicaid program, and continuation of significant provider payment cuts under the Medicare program. In this environment, repeal or deregulation of COPN poses a threat to access to essential health care services in the Commonwealth and would place our health care safety net at risk. Accordingly, VHHA urged legislators to take a cautious approach to considering any significant changes to state health policy.
Last year, eighteen different bills were introduced seeking to make various changes to COPN. Only two of those bills passed out of the House and none passed out of the Senate. Efforts in the Senate ultimately failed on procedural grounds related to a revenue measure that would have generated state and federal matching funds for purposes of compensating hospitals for losses incurred in the provision of charity care and improving reimbursement rates for Medicaid providers.
This year, seven different bills (four House bills and three Senate bills) were introduced seeking to make various changes to COPN. Only one bill passed out of the House and ultimately all Senate and House bills were passed by indefinitely by the Senate Education & Health Committee. Senate Education & Health Committee action on COPN bills was premised on (i) a commitment to couple repeal or deregulation of COPN with funds to compensate hospitals for losses incurred in the provision of charity care and improve reimbursement rates for Medicaid providers and (ii) concerns about the impact of potential ACA repeal and replacement plans on health policy challenges in Virginia. The disparate approaches taken in the House and Senate indicate that there continues to be no clear consensus between these two bodies on how to move forward on COPN reform. A summary of each of the House and Senate bills is provided below.
HB 2337 (O’Bannon) would have created a two-phase process to sunset COPN requirements for many categories of medical care facilities and projects located in, or contiguous with, more highly populated areas of the state. The requirement for a certificate of public need (i) for all medical care facilities other than nursing homes, rehabilitation hospitals and beds, imaging centers (CT, MRI, PET), organ or tissue transplant services, certain open heart surgery services, and certain neonatal services located in a locality with a population density of at least 200 people per square mile or a population of at least 75,000 people or a locality contiguous to one of these areas that adopts an ordinance to participate in the “health innovation district,” would be repealed effective July 1, 2017, and (ii) imaging centers would be repealed in those localities effective January 1, 2018. Left in House Appropriations.
SB1375 (Cosgrove) (which replicated HB1238 (Stolle)/SB641 (Stanley) from the 2016 General Assembly session) would have implemented all of the recommendations coming out of the COPN Work Group created by the 2015 General Assembly, including eliminating COPN review for lithotripsy, obstetrical services, magnetic source imaging, and nuclear medicine imaging, and initiating a number of process reforms. Passed by indefinitely by Senate Education & Health Committee.
HB2458 (Stolle) as introduced, like SB1375 (Cosgrove) above and SB1566 (Dunnavant) below, would have implemented all of the recommendations coming out of the COPN Work Group created by the 2015 General Assembly. The bill was subsequently amended in the House Health, Welfare & Institutions Committee to also deregulate psychiatric hospitals and operating rooms and ambulatory surgical centers (ASCs) in planning districts with 80% or more utilization. Left in House Appropriations.
SB1566 (Dunnavant) as introduced, like SB1375 (Cosgrove) and HB2458 (Stolle) above, would have implemented all of the recommendations coming out of the COPN Work Group created by the 2015 General Assembly. The patron expressed an intention to amend the bill to also deregulate psychiatric hospitals and operating rooms and ambulatory surgical centers (ASCs) in planning districts with 80% or more utilization to mirror the amended HB2458; however, the amendment was not formally acted upon. SB1566 was coupled with a separate piece of legislation, SB1562 (Dunnavant) that sought to create a Medicaid Supplemental Rate Fund with proceeds to be used to increase base Medicaid reimbursement rates using revenues raised from repealing the nonprofit sales tax exemption for nonprofit hospitals with a revenue of $300 million or more as a means of providing additional funding to offset hospital losses from deregulation. SB1562 was passed by indefinitely in Senate Finance by letter with referral to the Joint Subcommittee to Evaluate Tax Preferences. With the failure of SB1562, the Senate Education & Health Committee declined to take action on passage of SB1566. Passed by indefinitely by Senate Education & Health Committee.
HB1420 (Farrell)/SB1141 (Sturtevant) would have eliminated COPN review for certain projects involving mental hospitals or psychiatric hospitals and intermediate care facilities established primarily for the medical, psychiatric, or psychological treatment and rehabilitation of individuals with substance abuse. Passed by indefinitely by Senate Education & Health Committee; HB1420 by letter referred to Deeds Commission for study.
HB2227 (Head) would have prohibited the Commissioner of Health from denying an application for a COPN for the addition of a new neonatal special care service at a medical care facility located in a planning district with a population of 275,000 or more in which there is only a single existing provider of such service or a new open heart surgery service at a medical care facility located in a planning district with a population of 2,000,000 or more in which there are two or more existing providers of such service solely because of the expected economic impact of the proposed project on an existing service in the planning district or the expected impact of the proposed project on the utilization of or volume of services delivered by an existing service in the planning district. Pulled by patron; left in House Health, Welfare & Institutions Committee.
Two separate bills related to COPN, HB2101 (Byron) and HB2225 (Head), sought to improve uniformity in reporting of charity care services for compliance with COPN charity care conditions and included related measures to improve transparency of information on charity care services furnished by health care providers. The bills included conflicting provisions, but both HB2101 and HB2225 passed out of the House nonetheless. The Senate Education & Health Committee identified that there were conflicting provisions included in the two bills and incorporated HB2225 into HB2101. The Senate Education & Health Committee adopted several amendments to HB2101 and the bill was ultimately sent into conference between the two chambers resulting in further amendments. A summary of each of these bills is provided below.
HB2101 establishes standard definitions for “charity care” and “bad debt” for purposes of compliance with COPN conditions and a uniform framework for determining the value of charity care provided based upon the Medicare payment methodology. The legislation also requires COPN certificate holders to report service specific data on the total amount of charity care that the facility provides to indigent persons, the portion of the total amount of charity care provided that each service represents, and relevant data and information on any parent or subsidiary company of the COPN certificate holder. In addition, every hosptial that receives a disproportionate share hospital adjustment must report the number of inpatient days attributed to patients eligible for Medicaid, but not Medicare Part A, and the total amount of the disproportionate share hospital adjustment received. Passed.
HB2225 would have established a definition of “charity care” and required all hospitals, physicians, and dentists licensed to practice oral and maxillofacial surgery with a COPN to establish charity care policies and make information on such policies available to the public. The legislation would also have required health care providers to submit data on the amount of charity care provided based upon the Medicare payment methodology along with additional reporting requirements for nonprofit hospitals. Incorporated into HB2101.
One final bill, HB1544 (Collins) clarifies that in cases in which a certificate holder holds more than one COPN with conditions, and the certificate holder is unable to satisfy the conditions of one certificate, the Department of Health may provide for satisfaction of the conditions on that certificate by the provision of charity care in excess of the amount required by another certificate issued to the same holder, at the same facility, in an amount approved by the Department as part of an alternative plan of compliance. Passed.
Behavioral Health
The policy priorities of the Joint Commission to Study Mental Health in the 21st Century (the “Deeds Commission”), as well as, a sense of urgency to address gaps in Virginia’s mental health system greatly influenced legislation introduced in the 2017 General Assembly session and budget priorities for behavioral health and substance abuse. Overall, the state has committed more than $32 million toward mental health treatment and services. Recognizing that there are additional opportunities to improve Virginia’s behavioral health system, the General Assembly also extended authority for the Deeds Commission to continue its work for two additional years through December 1, 2019.
As part of this overall effort, VHHA introduced a behavioral health package consisting of three legislative items developed to improve access to services during a psychiatric crisis and one budgetary item to study the efficacy of the Local Inpatient Purchase of Services program (LIPOS) and how its efficacy, flexibility, and reimbursement rates can be improved to better health care outcomes. A summary of key behavioral health legislation considered by the General Assembly is provided below.
HB1426 (Garrett)/SB1221 (Barker) charges the Commissioner of Behavioral Health and Director of Criminal Justice Services, along with relevant stakeholders, to develop an alternative transportation model for individuals under an emergency custody order, temporary detention order, or involuntarily admitted to a hospital. Currently, such transportation is frequently provided by law enforcement and places a strain upon their limited resources. A report is due by October 1, 2017. Passed.
HB1508 (Hope)/SB894 (Favola) requires the Commissioner of Behavioral Health to provide a report on all critical incidents, serious injuries, or deaths that occur in a program operated or licensed by the Department within 15 days of the event. Currently, a report is only required for critical incidents or deaths that occur at facilities operated by the Department of Behavioral Health, not privately owned facilities. Passed.
HB1549 (Farrell)/SB1005 (Hanger) adds same-day mental health screening services and outpatient primary care screening and access to primary health services to the core services that Community Services Boards (“CSBs”) must provide by July 1, 2019. In addition, by July 1, 2021, CSBs must provide (i) crisis services for individuals with mental health or substance use disorders, (ii) outpatient mental health and substance abuse services, (iii) psychiatric rehabilitation services, (iv) peer support and family support services, (v) mental health services for military members located 50 miles or more from a military treatment facility and veterans located 40 miles from a VA hospital, (vi) care coordination services, and (vii) case management services. Currently, CSBs are mandated to provide emergency services and, if funding is available, case management. Passed.
HB1777 (Stolle) requires hospitals that provide inpatient psychiatric services to establish a protocol to allow physician-to-physician communication, if requested by the referring physician, prior to refusing the admission of a medically stable patient and prohibits staff refusal of such a request. Passed.
HB1918 (Robinson)/SB1222 (Barker) (VHHA proposal) would have authorized the development of a psychiatric patient registry to collect de-identified information about patients in need of inpatient psychiatric care in order to notify participating hospitals and improve timeliness of admissions. Left in House Courts of Justice; to be implemented administratively by Department of Behavioral Health and Developmental Services.
HB1975 (Yost)/SB1419 (Howell) (VHHA proposal) would have allowed for an individual under a temporary detention order to receive stabilizing treatment for up to 24 hours prior to appearing for a commitment hearing if deemed medically necessary by the treating physician. HB1975 left in House Courts of Justice; SB1419 stricken at request of patron.
SB1233 (Chafin) (VHHA proposal) would have allowed emergency physicians, psychiatrists, psychiatric nurse practitioners, psychiatric clinical nurse specialists, licensed clinical psychologists, licensed professional counselors, and licensed clinical social workers to perform emergency psychiatric evaluations to determine if an individual meets the criteria for a temporary detention order when a CSB worker cannot arrive to conduct the evaluation within two hours of a request. Passed by indefinitely by Senate Finance; by letter referred to Deeds Commission for study.
The Governor’s proposed amendments to the 2016-18 budget included a $31.7 million investment in behavioral health and treatment for substance abuse. The final House and Senate budget adopted many of these amendments with modification. A summary of key behavioral health items included in the budget is provided below.
- $9.4 million to increase community services boards’ (CSBs) services
- $9.5 million to expand same-day access to assessment services at 25 CSBs
- $4.9 million to expand permanent supportive housing
- $250,000 to enhance the work of the Deeds Commission (consultant fees and extending work through 2019)
- $250,000 to develop a comprehensive plan to realign Virginia’s behavioral health system to community services
- $2.0 million general funds and $2.0 million matching federal Medicaid funds to expand Medicaid eligibility for GAP program (80% FPL to 100% FPL)
Opioid Abuse/Prescription Monitoring Program
The 2016 General Assembly saw bipartisan efforts to address the opioid epidemic in Virginia. Dozens of bills were introduced and funding needs were addressed in budget proposals by the Governor and both chambers. A summary of each of the House and Senate bills is provided below.
Opioid Prescribing Practices/Prescription Monitoring Program (PMP)
HB1885 (Hugo)/SB1232 (Dunnavant) provides that prescribers of a controlled substance containing opioids shall consult the PMP when prescribing an opioid for more than seven days, or more than fourteen days in the case of surgical or invasive procedures, with exceptions for inpatients, nursing homes, and hospice and palliative care. As introduced, SB1232 and a separate bill, HB 1898 (Bell), which was laid on the table in the House Health, Welfare & Institutions Committee, would have limited opioid prescriptions on discharge from the emergency department to no greater than a three-day supply and HB1885 would have limited all opioid prescriptions to a seven-day supply with limited exceptions. Passed.
HB2167 (Pillion)/SB1180 (Chafin) directs the Board of Medicine and the Board of Dentistry to adopt regulations for the prescribing of opioids and products containing buprenorphine. Passed (note, the Board of Medicine adopted regulations February 16, 2017, which became effective March 15, 2017).
HB2161 (Pillion)/SB1179 (Chafin) requires the Secretary of Health and Human Resources to convene a work group to develop educational standards and curricula for training health care providers in the safe and appropriate use of opioids to treat pain while minimizing the risk of addiction and substance abuse with a report to the Governor and General Assembly by Dec. 1, 2017. Passed.
HB2165 (Pillion)/SB1230 (Dunnavant) requires that, beginning July 1, 2020, a prescription for any controlled substance containing an opiate shall be issued as an electronic prescription and prohibits a pharmacist from dispensing a controlled substance that contains an opiate, unless the prescription is issued as an electronic prescription. Passed.
Overdose Treatment
HB1453 (Larock)/SB848 (Wexton) authorizes the Department of Behavioral Health and Developmental Services to train individuals on administration of Naloxone and creates immunity from simple negligence for the dispensing of Naloxone by a trained person without charge or compensation. Passed.
HB1642 (Hope)/SB1031(Marsden) authorizes employees of the Department of Forensic Science, Office of the Chief Medical Examiner, and Department of General Services of the Consolidated Lab Services to possess and administer Naloxone by standing order. Passed.
HB1750 (O’Bannon) codifies that a pharmacist may dispense Naloxone in the absence of a patient-specific oral or written order or prescription pursuant to a standing order issued by the Commissioner of Health. Passed.
Substance Exposed Infants
HB2162 (Pillion) directs the Secretary of Health and Human Resources to convene a work group to study barriers to treatment of substance-exposed infants in the Commonwealth and for the Secretary to report findings to the Governor and General Assembly by Dec. 1, 2017. Passed.
HB1467 (Greason)/SB1323 (Carrico) requires the Board of Health to adopt regulations to include neonatal abstinence syndrome on the list of diseases that must be reported. Passed.
HB1786 (Stolle)/SB1086 (Wexton) requires mandated reporting of a finding by a health care provider (i) within 6 weeks of birth that a child was born affected by substance abuse or experiencing withdrawal symptoms related from an in utero drug exposure; (ii) diagnosis within 4 years following birth that the child has an illness, disease or condition that, to a reasonable degree of medical certainty, is attributable to maternal abuse of a controlled substance during pregnancy; or (iii) diagnosis within 4 years following birth, that the child has fetal alcohol spectrum disorder attributable to in utero exposure to alcohol. Passed.
Other
HB2317 (O’Bannon) authorizes the Commissioner of Health to establish and operate local or regional comprehensive harm reduction programs during a declared public health emergency and permits the provision of sterile hypodermic needles and syringes, as well as, the disposal of used needles. Passed.
HB2163 (Pillion)/SB1178 (Chafin) requires that prescriptions for products containing buprenorphine without naloxone shall be issued only (i) for patients who are pregnant, (ii) when converting a patient from methadone to buprenorphine containing naloxone for a period not to exceed seven days, or (iii) as permitted by regulations of the Board of Medicine or the Board of Nursing. Passed.
Financial Sustainability of Hospitals
Medicaid payment rates for inpatient and outpatient hospitals fall well below costs and the General Assembly has not provided full inflation updates for hospital payment rates since 2013. In 2016, VHHA supported development of a provider contribution program to draw down additional federal funds for the Medicaid program and enhance provider reimbursements as a means of addressing this shortfall and ensuring the financial sustainability of our hospitals and health systems. In light of federal discussions regarding ACA repeal and replacement and the possibility of sweeping changes to federal financing of state Medicaid programs, VHHA did not pursue this proposal in the 2017 General Assembly session.
The Governor’s introduced budget eliminated Medicaid reimbursement inflation updates for hospitals for 2018 (50% inflation factor was applied for 2017). VHHA sought budget amendments to restore full inflation for 2018 (Item 306 #6s (Hanger) and Item 306 #7h (Ingram)). The final House and Senate budget did not include this amendment and inflation was not restored, except for Children’s Hospital of The Kings’ Daughters, which received the full inflation update for 2018.
Also, while a full-scale provider contribution or assessment program was not part of budget discussions, the final House and Senate budget authorized two targeted and yet to be implemented hospital Medicaid supplemental payment programs that utilize inter-governmental transfer (IGT) mechanisms to finance the state share of enhanced payments. One involving several hospitals relies on hospitals assuming the responsibility to finance a current publicly-funded health service. This program is already approved by the Centers for Medicare and Medicaid Services (CMS) and could apply retroactively when and if implemented. A separate program limited to hospitals affiliated with Eastern Virginia Medical School and the Virginia Tech Carilion School of Medicine authorizes transfers from these medical schools to serve as the state share for a Medicaid supplemental payment. This program is pending CMS approval.
Other Budget Priorities
VHHA and other health care stakeholders including the Medical Society of Virginia, Virginia College of Emergency Physicians, Virginia Academy of Family Physicians, and Virginia Association of Health Plans supported Item 306.WWWW to authorize implementation and funding of an emergency care coordination information technology platform. The proposed system will provide timely feeds of hospital admission, discharge, and transfer (ADT) information and other analytics to support improved care for emergency department patients. The funding is conditioned upon receipt of contributions by program participants and federal Health Information Technology for Economic and Clinical Health (HITECH) Act funds.
The budget retains $2.5 million to fund twenty five additional residency slots in FY2018 (thirteen primary care, twelve high need specialties) in Item 306.FFFF with amendments directing the Department of Medical Assistance Services to include in its forecast annual funding for up to twenty five slots if the initial applications result in less than twenty five additional qualified slots being applied for in the first year due to uncertainty regarding ongoing funding and the brief turnaround period for applications to be filed and place any residual funds aside to be used exclusively for offsetting a portion of the $1.25 million in general fund costs for the continuation of this program.
Workers’ Compensation
VHHA continued to work with other stakeholders over the past year including the Medical Society of Virginia, the Virginia Orthopaedic Society, the Virginia Self-Insurers Association, and workers’ compensation insurance carriers to develop necessary enhancements to the prevailing community rate fee schedule created pursuant to legislation passed in the 2016 General Assembly session.
HB1571 (Farrell) makes clarifying updates to the law to address certain compensation events whose complexity moves them beyond the established fee schedules and it incorporates language addressing reimbursement rates when a fee schedule amount cannot be determined for certain hospital medical services rendered. Passed.
Nurse Practitioner Scope of Practice
A number of bills seeking to modify current laws regarding nurse practitioner practice authority and practice agreement requirements were introduced in the 2016 General Assembly session. Ultimately, only modest changes were made to allow additional flexibility for nurse practitioners to prevent barriers to access to care arising out of physician collaboration arrangements.
In advance of the 2017 General Assembly session, VHHA worked with the Virginia Council of Nurse Practitioners to develop legislation that would allow greater flexibility and elimination of practice agreement requirements for nurse practitioners practicing in a hospital or health system or other health care settings; however, the decision was made not to proceed with legislation this year. Efforts to develop consensus legislation are underway with Del. Roxann Robinson (R-Chesterfield) convening a group of stakeholders including VHHA, Medical Society of Virginia, and Virginia Council of Nurse Practitioners to explore and develop recommendations regarding revision or elimination of current requirements on nurse practitioner practice authority in Virginia.
Bills Affecting Hospital and Health Care Operations
Advance Directives
HB2153 (Rasoul) provides legal reciprocity recognition to Durable Do Not Resuscitate Orders properly executed in other states. Passed.
HB1548 (Farrell) clarifies that if a patient has executed a mental health advance directive, the agent may exercise such authority to consent to the patient’s admission to a mental health facility for treatment after a determination has been made by a behavioral health professional that the patient is incapable of making an informed decision. The agent has the authority to make a health care decision over the objection of the patient if any licensed behavioral health professional familiar with the patient confirms in writing that, at the time of executing the advance directive, the patient was capable of making an informed decision. Current law requires an attestation from the patient’s actual attending physician or licensed clinical psychologist. Passed.
HB1747 (O’Bannon)/SB1242 (Dunnavant) allows an exception to the unlicensed practice of law for a “qualified advance directive facilitator” who has completed requisite training approved by the Department of Health to assist people in the completion and execution of a written advance directive. The bill also allows an exception to the unlicensed practice of law for individuals providing ministerial assistance in the completion of advance directives. Passed.
Telemedicine/Telehealth
HB1767 (Garrett)/SB1009 (Dunnavant) clarifies that a prescriber who establishes a physician-patient relationship through an appropriate physical examination performed using telemedicine may prescribe Scheduled II through VI controlled substances. The legislation also clarifies that prescribing controlled substances II through V must be in compliance with federal laws regarding the practice of telemedicine, including maintenance of a required controlled substance registration, and authorizes the Board of Pharmacy to provide such registration to Community Services Boards. Passed.
Other
HB1514 (Fowler)/SB1024 (Dunnavant) creates a duty for health care providers to report the probable existence of a mental or physical disability or infirmity to operate a motor vehicle and provides immunity under the state health records privacy laws for the report or violations of the practitioner-patient privilege, unless they have acted in bad faith or with malicious intent. Passed.
HB1798 (O’Bannon) permits the donation or acquisition of organs for transplant in situations where a prospective recipient is informed that the organ is infected with HIV, the recipient consents to the receipt of the organ, and the donation complies with requirements of the HIV Organ Policy Equity Act, 42 U.S.C. § 274f-5. Passed.
HB1840 (Stolle) modifies provisions of the state health records privacy laws to specify that the individuals who may receive the results of a confidential HIV test are those persons or entities who are permitted or authorized to obtain protected health information under applicable state or federal law. Passed.
HB1921 (Robinson)/SB973 (Sturtevant) extends current penalties for assault of a health care provider (Class 1 misdemeanor) to health care providers outside of the emergency room to the entire hospital, regardless of whether the health care provider is performing duties as an emergency health care provider. The legislation also directs the Department of Health to establish guidelines for the publication of penalties and for training of providers in violence prevention programs. Passed.
HB2209 (O’Bannon)/SB1561 (Dunnavant) establishes the emergency department care coordination program to provide sharing of real-time patient visit information by hospitals and emergency departments for the purpose of improving the quality of patient care services. The legislation does not become effective unless the Commonwealth receives federal Health Information Technology for Economic and Clinical Health (HITECH) Act funds to implement its provisions. (See related budget item in discussion of “Other Budget Priorities” above). Passed.
HB2301 (O’Bannon) authorizes a licensed practical nurse to administer immunizations without the immediate direct supervision of an registered nurse. Passed.
Direct Primary Care Arrangements
HB2053 (Landes)/SB800 (Stanley) provides that state insurance laws and regulations do not apply to agreements between a primary care physician and a patient authorizing the physician to charge a periodic fee as consideration for providing ongoing primary care to the patient. The legislation also provides that a health care provider who participates in a direct primary care practice may participate in a health insurance carrier network, so long as the provider is willing and able to meet the terms and conditions of network membership set by the health insurance carrier, and establishes requirements for disclosures regarding direct primary care agreements. Passed.
Medical Malpractice and Legal Procedure
HB1689 (Habeeb) modifies the provisions for fees that may be charged by a health care provider responding to an attorney request for copies of medical records or a subpoena. The legislation retains the fees for paper copies, establishes a reduced per page fee for electronic copies up to a cap, increases the search and handling fee, and establishes a fee for reproduction of X-ray and imaging studies. The legislation also permits the requestor to specify the format for production of records, requires the health care provider to specify the most cost-effective means of production, and prohibits withholding of production solely on the grounds of nonpayment. Passed.
HB2318 (Stolle) amends the definition of neurological birth injury for purposes of the Virginia Birth-Related Neurological Injury Compensation Program. The definition is intended to be declarative of exiting law and has a delayed effective date of January 1, 2018. Passed.
2017 Studies/Workgroups
There are a number of legislative workgroups and other agency initiatives of relevance to hospitals and health systems included in 2017 General Assembly session legislation and budget items.
| Work Group |
Description of Charge |
Telemental Health Services
(Item 30 #1c) |
The Joint Commission on Health Care shall study options for increasing the use of telemental health services in the Commonwealth. The Joint Commission shall specifically study the issues and recommendations related to telemental health services set forth in the report of the Service System Structure and Financing Work Group of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century. The Joint Commission shall submit an interim report to the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century by November 1, 2017, and a final report of its findings by November 1, 2018. |
Perinatal Quality Collaborative
(Item 294 #1c) |
The Virginia Department of Health is to establish and administer a Perinatal Quality Collaborative. The Perinatal Quality Collaborative shall work to improve pregnancy outcomes for women and newborns by advancing evidence-based clinical practices and processes through continuous quality improvement with an initial focus on pregnant women with substance abuse disorder and infants impacted by neonatal abstinence syndrome. |
DMAS Retraction Workgroup
(Item 306 #22c) |
DMAS shall convene a workgroup with representatives from the provider community, the legal community, and the Office of Attorney General to develop a plan to avoid or adjust retractions or for non-material breaches of the Provider Participation Agreement when the provider has substantially complied with the Provider Participation Agreement. The plan shall include an assessment of any administrative financial impact that implementation of such plan would have on the department and an analysis of any implications for the Department’s efforts to combat fraud, waste, and abuse. The workgroup shall report on the status of this plan to the Chairmen of the House Appropriations and Senate Finance Committees no later than December 1, 2017. |
DMAS Eligibility Screenings
(Item 310 #6c) |
DMAS shall work with relevant stakeholders to (i) assess whether hospital screening teams are making appropriate recommendations regarding placement in institutional care or home and community-based care; (ii) determine whether hospitals should have a role in the screening process; and (iii) determine what steps must be taken to ensure the Uniform Assessment Instrument is implemented consistently and does not lead to unnecessary institutional placements. DMAS shall report to the General Assembly by December 1, 2017, on steps taken to address the risks associated with hospitals screening, including any statutory or regulatory changes needed to improve such screenings. |
Electronic Death Registry System Report
(Item 291 #1c) |
The state teaching hospitals shall work with the Department of Health and Division of Vital Records to fully implement use of the Electronic Death Registration System (EDRS) for all deaths occurring within any Virginia state teaching hospital’s facilities. Full implementation shall occur and be reported, by the Division of Vital Records, to the Chairmen of the House Appropriations and Senate Finance Committees by April 15, 2018, in alignment with the Division of Vital Records plan to promulgate and market the EDRS. (This is a continuation of VDH October 1, 2016 report on efforts to address changes to the electronic system for filing death certificates that would make it easier to file death certificates, address interoperability concerns and provide technical assistance to system users and other improvements.) |
Emergency Department Care Coordination Work Group
(Item 300 #3c) |
VDH shall establish a separate and distinct Emergency Department Care Coordination Advisory Council to whom responsibility for implementing this program shall be delegated under the department's supervision. The ED Council shall include three representatives from hospitals and health systems nominated by the Virginia Hospital & Healthcare Association; three health plan representatives nominated by Virginia Association of Health Plans; and six physician representatives nominated by the Medical Society of Virginia; and representatives from other physician specialty societies. The ED Council shall: (i) specify the necessary functionalities to meet the needs of all key stakeholders; (ii) develop and oversee a competitive selection process for a vendor or vendors that will provide a single, statewide technology solution to fulfill the required functionalities and advance the goals of the initiative; and (iii) select and oversee the implementation of successful information technologies, with implementation no later than June 30, 2018. VDH, in coordination with DMAS and the ED Council, shall recommend, by December 15, 2017, a funding structure for program operations in FY 2019 that apportions program costs across the Commonwealth, participating hospitals and participating health plans. VDH in coordination with the ED Council shall report annually beginning November 1, 2017 to the Secretary of HHR and the Chairmen of the House Appropriations and Senate Finance Committees on progress, including, but not limited to: (i) the participation rate of hospitals and health systems, physicians and subscribing health plans, (ii) strategies for sustaining the program and methods to continue to improve care coordination, and (III) the impact on health care utilization and quality goals such as reducing the frequency of visits by high-volume ED utilizers and avoiding duplication of prescriptions, imaging, testing or other health care services. (The overall purpose is to improve coordination of care across provider types of Medicaid “super utilizers”, the impact of PCP incentive funding on improved interoperability between hospital and provider systems, and methods for formalizing a statewide ED collaboration to improve care and treatment of Medicaid recipients and increase cost efficiency in the Medicaid program, including recognized best practices for EDs.) |
Plan to Restructure Behavioral Health System
(Item 284 #2c) |
Office of the Secretary of Health and Human Resources (OSHHR) to prepare an implementation plan for the financial realignment of Virginia's public behavioral health system. This plan shall include: (i) a timeline and funding mechanism to eliminate the extraordinary barriers list in state hospitals and to maximize the use of community resources for individuals discharged or diverted from state facility care; (ii) sources for bridge funding, to ensure continuity of care in transitioning patients to the community, and to address one-time, non-recurring expenses associated with the implementation of these reinvestment projects; (iii) state hospital appropriations that can be made available to community services boards to expand community mental health and substance abuse program capacity to serve individuals who are discharged or diverted from admission; (iv) financial incentive for community services boards to serve individuals in the community rather than state hospitals; (v) detailed state hospital employee transition plans that identify all available employment options for each affected position, including transfers to vacant positions in either DBHDS facilities or community services boards; (vi) legislation and Appropriation Act language needed to achieve financial realignment; and (vii) matrices to assess performance outcomes. 3. In developing the plan, the OSHHR shall seek input from and participation by DBHDS, community services boards and behavioral health authorities, individuals receiving services and their family members, other affected state agencies, local governments, private providers and other stakeholders. OSHHR shall present the implementation plan to the Chairmen of the House Appropriations and Senate Finance Committees and the Chairman of the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century by December 1, 2017. |
Health Care Assault
(HB1921/SB973) |
The Department of Health shall work with stakeholders to develop guidelines regarding (i) the publication of penalties for a battery on a health care provider who is engaged in the performance of his duties in a hospital or in an emergency room clinic or other facility that provides emergency medical care and (ii) the training of health care professionals and health care providers in violence prevention programs. |
Electronic Opiate Prescriptions
(HB2165/SB1230) |
That the Secretary of Health and Human Resources shall convene a work group of interested stakeholders, including the Virginia Hospital & Healthcare Association and Medical Society of Virginia to review actions necessary for the implementation of the provisions of this act and shall make an interim progress report to the Chairmen of the House Committee on HWI and the Senate Committee on Education and Health by November 1, 2017 and shall make a final report to such Chairmen by November 1, 2018. In addition, the work group shall evaluate hardships on prescribers, the inability of prescribers to comply with the deadline for electronic prescribing and make recommendations to the General Assembly for any extension or exemption processes relative to compliance or disruptions due to natural or manmade disasters or technology gaps, failures or interruptions of services. |
Substance-Exposed Infants
(HB2162) |
That the Secretary of Health and Human Resources shall convene a work group to study barriers to treatment of substance-exposed infants in the Commonwealth. Such work group shall include representatives of the DBHDS and Health and Social Services and such other stakeholders as the Secretary may deem appropriate and shall (i) review current policies and practices governing the identification and treatment of substance-exposed infants in the Commonwealth; (ii) identify barriers to treatment of substance-exposed infants in the Commonwealth, including barriers related to identification and reporting of such infants, data collection, interagency coordination and collaboration, service planning, service availability, and funding; and (iii) develop legislative, budgetary, and policy recommendations for the elimination of barriers to treatment of substance-exposed infants in the Commonwealth. The Secretary shall report his findings to the Governor and the General Assembly by December 1, 2017. |
Workforce Training Regarding Use of Opioids
(HB2161/SB1179) |
That the Secretary of Health and Human Resources shall convene a workgroup to develop educational standards and curricula for training health care providers, including physicians, dentists, optometrists, pharmacists, physician assistants, and nurses in the safe and appropriate use of opioids to treat pain while minimizing the risk of addiction and substance abuse. Such educational standards and curricula shall include education and training on pain management, addiction, and the proper prescribing of controlled substances. The workgroup shall report its progress and the outcomes of its activities to the Governor and the General Assembly by December 1, 2017. |
Alternative Transportation
(HB1426/SB1221) |
The Commissioner of Behavioral Health and Developmental Services (the Commissioner) and the Director of Criminal Justice Services (the Director) shall, in conjunction with the relevant stakeholders, including the Virginia Association of Community Services Boards, the National Alliance on Mental Illness - Virginia, the Department of Medical Assistance Services, the Office of Emergency Medical Services, Mental Health America of Virginia, VOCAL, Inc., the Virginia Hospital and Healthcare Association, the Virginia Association of Health Plans, the Office of the Executive Secretary of the Supreme Court of Virginia, the Virginia Association of Chiefs of Police, the Virginia Sheriffs' Association, the Virginia Association of Regional Jails, and the University of Virginia Institute of Law, Psychiatry, and Public Policy, develop a model for the use of alternative transportation providers to provide safe and efficient transportation of individuals involved in the emergency custody or involuntary admission process as an alternative to transportation by law enforcement. The model shall include criteria for the certification of alternative transportation providers, including the development of a training curriculum required to achieve such certification, and shall identify the appropriate agency responsible for providing such training and such certification. Further, the Commissioner and the Director shall identify any barriers to the use of alternative transportation in the Commonwealth and detail the costs associated with the implementation of such a model, along with the cost savings and benefits associated with the successful implementation of such a model. The model shall be completed by October 1, 2017. |
Managed Care Organization Report Card
(HB2304) |
The Department of Medical Assistance Services shall work collaboratively with managed care organizations and relevant stakeholders, where appropriate, to annually publish a uniform and agreed-upon managed care organization report card for the Department for the Medallion program and shall make such information available to new enrollees as part of the enrollment process. |
Air Transportation Services
(HB1728) |
That the Department of Health shall convene a work group composed of stakeholders, including representatives of law enforcement, emergency medical services providers, health insurance providers, the Medevac Committee of the Emergency Medical Services Advisory Board, emergency physicians, and other interested stakeholders, to review the rules, regulations, and protocols governing use of air transportation services, also known as air ambulances, in emergency medical situations. The Department shall also review the rules, regulations, and protocols governing dispatch of air transportation services providers in response to emergency medical situations and develop recommendations for changes to such rules, regulations, and protocols that will address differences in procedures governing dispatch of air transportation services providers in emergency medical situations, differences in billing that may affect individuals involved in emergency medical situations during which air transportation services providers are dispatched for the provision of air transportation, and other issues related to the use of air transportation services in emergency medical situations. The Department shall report its findings and recommendations to the Governor and the General Assembly by December 1, 2017. |
Please contact Brent Rawlings or Sara Heisler with any questions regarding this material.
More information on these and other measures considered during the 2017 General Assembly session is available at here.
