The General Assembly Session began on January 13, 2016. Because it is an evennumbered year, this was a long (60-day) Session. The legislature considered just over 3,000 bills and resolutions during this time, continuing Virginia’s tradition of having one of the fastestpaced Sessions in the nation. In addition, the Legislature approved a new biennium budget, as it does during every long Session.
This Session marked the first and only time Governor McAuliffe was able to propose his own biennial budget, since an incoming Governor can only amend the outgoing Governor’s budget, and does not have an opportunity to craft a new budget until mid-way through his term. The Governor’s budget focused on Virginia schools, public safety and other core priorities. It also called for the Commonwealth to expand Medicaid, an effort that has been rebuffed by the Republican-controlled legislature for the last three years. This year, McAuliffe took a new approach to expansion that did not require the use of state dollars but instead charged some hospitals a fee, known as a “provider assessment,” equal to 3 percent of their revenue. McAuliffe stated that that plan would provide $156 million in projected Medicaid savings. In a controversial move, McAuliffe tied many Republican legislators’ budget requests to these savings. This set the stage for a difficult Session filled with partisan bickering.
Besides the budget, the legislature handled bills on the following controversial topics:
- Charter schools
- Clean Power Plan
- Coal tax credit
- COPN reform
- Credit unions
- Economic development and research incentive grants
- Electric chair
- Ethics reform
- Fantasy sports regulation
- Gun background check/reciprocity
- Local proffer reform
- Pipeline safety
- Planned Parenthood
- Prescription drug monitoring program
- Public procurement
- Right to work constitutional amendment
- Smoking in cars with children
- Virtual schools
Overall, the legislature passed about half of the bills and resolutions that were introduced. These bills now head to the Governor for his signature, amendment or veto. The legislature will reconvene for a one-day “Veto Session” on April 20th to consider the Governor’s recommendations, as well as his amendments to their budget proposal.
Issues of Importance to the Health Care Community
Of the 3,000 or so bills introduced this Session, your lobbyists tracked 86 bills of potential interest to the Virginia Society of Anesthesiologists. Most of these bills were of general interest to the health care community, although several were of particular import to the VSA. Below, please find a list of all the bills tracked for the VSA this year, with a brief summary of each bill, as well as its final outcome. We have highlighted the most important bills in yellow, and will discuss those in greater detail below. If you would like any more information on a particular bill on this list, please click here.
Issues of Importance to the Virginia Society of Anesthesiologists
Of all the bills tracked for the VSA this Session, the following were the most important:
- APRN Bill (HB580) – As you may recall, the CRNAs have been pushing for bill to change their title to “Advance Practice Registered Nurse” for several years. We have always successfully defeated these bills. This year, the CRNAs approached us about introducing the bill again. Their concern was that current language in the Code defined them as “nurse practitioners,” which did not distinguish them from other types of NPs. We negotiated for several months, and finally agreed not to oppose their bill if they would:
- Define CRNAs as APRNs and include the supervision requirement in the definition (making this bill the second place in the Code where the supervision requirement is specifically spelled out); and
- Prohibit CRNAs from working under collaborative practice agreements, like other types of NPs.
- Agree not to join the independent practice fight that was being waged by other NPs.
Although the CRNAs were initially reluctant to accept these changes, they did eventually agree to do so. We worked jointly on the bill during Session, and were pleased when the Governor signed it into law last month. The bill will go into effect July 1, 2016. You can view the full text of the bill here: http://lis.virginia.gov/cgibin/ legp604.exe?161+ful+HB580ER
- Independent Practice Bills (SB264, SB369, SB620 were the main bills that survived) – There was a groundswell of legislation this year introduced to allow NPs to practice outside of the patient care team model. Disappointingly, several of our physician legislators were supportive of these efforts. It was the main objective of the Medical Society, and all of its specialty societies like the VSA, to fight these bills. In the end, all of these bills were successfully defeated or watered down. Of those that were amended, some were revised to only allow NPs whose supervising physician has died or retired to contract with the Director of the Department of Health to serve as his/her supervising physician for a 60 day temporary period. Others were amended to simply create a pilot program for physicians to serve via telemedicine as patient care team physicians to NPs practicing in medically underserved areas of Virginia. The Department of Health has been required to consult all stakeholders outside of Session to create this pilot program. These bills will not impact CRNAs in any way, since CRNAs are no longer considered NPs under the Code (see #1 above).
- Prescription Monitoring Program Bills (HB657 and SB 513 were the main bills that survived) – These bills placed stricter requirements on physicians to obtain information from the Prescription Monitoring Program at the time of initiating a new treatment of opioids to last more than 14 days (previously 90 days). The bills also allow a prescriber to delegate the duty to request information from the Prescription Monitoring Program to another licensed, registered, or certified health care provider who is employed at the same facility under the direct supervision of the prescriber or dispenser who has routine access to confidential patient data and has signed a patient data confidentiality agreement. There are several exemptions from the new requirement, including in cases where opioids are prescribed as part of treatment for a surgical procedure, provided the prescription is not refillable.
- COPN Bills (HB 350 was the main bill that survived) – There was a year-long study in 2015 examining whether to repeal or partially repeal Virginia’s COPN process. Ultimately, the COPN Workgroup recommended specific partial repeals. At the beginning of Session, legislators introduced dozens of bills going farther – many of which fully repealed COPN. Not surprisingly, the Virginia Hospital and Healthcare Association opposed any repeal, while many physician groups advocated for it. After hearing testimony from all sides, legislators worked on developing amended language to tackle some, but not all, of the proposed reforms. Ultimately, however, the legislature voted to “continue” the bills to 2017, to allow more time for study.
- Associate Physician Bill (HB900) – This bill, which was introduced by physician legislator Chris Stolle, would have authorized the Board of Medicine to issue a two-year license to practice as an associate physician to an applicant who is 18 years of age or older, is of good moral character, has successfully graduated from an accredited medical school, has successfully completed Step 1 and Step 2 of the United States Medical Licensing Examination, and has not been engaged in a postgraduate medical internship or residency training program. The bill would have required all associate physicians to practice in accordance with a practice agreement entered into between the associate physician and a physician licensed by the Board and provides for prescriptive authority of associate physicians in accordance with regulations of the Board. The bill was opposed by the Medical Society, which argued that the only other state to take such a step – Missouri – has already started to repeal it because of negative unintended consequences. Ultimately, the Medical Society prevailed by having the bill continued to 2017.
- Budget Language: As you may recall, the VSA advocated for budget language that would tie future increases in primary care reimbursement rates to increases in anesthesia reimbursement rates. Currently, Medicaid reimburses anesthesia services at 58% of Medicare rates. For other specialties, the average is 86.8%. If the anesthesia rate were similar, this would increase the anesthesia conversion rate from $12.84 to $18.60 per unit, which equals a $3.4 million increase per year. Despite the fact that physician legislator John O’Bannon was our chief co-patron, and that we had every other member of the Health and Human Resources subcommittee agree to serve as copatrons, our language did not make it into the proposed Legislative budget. We were told that this was because legislators are considering across-the-board physician increases in the next year or two, and do not want to do piecemeal increases before that time.
Aside from our disappointment over the budget result, this was a very good year for the VSA. We were able add the requirement for direct supervision over CRNAs into the Code for a second time, we were able to prohibit CRNAs from practicing under collaborative practice agreements, and were able to keep CRNAs out of the NP scope of practice fight. To be sure, many of these issues will be brought back with a vengeance next year. In particular, there seems to be a sea change in legislators’ attitudes towards NP independent practice, and that effort looks like it is going to get harder and harder to fight. As always, however, we will keep the VSA posted about any threats to your specialty during the off-Session months.