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Legislative News

2016 General Assembly Session
Certificate of Public Need Legislation

By Cal Whitehead
VOS Lobbyist

One of the most contentious issues this legislative session was the potential reform of Virginia’s Certificate of Public Need program. Budget language in 2015 had directed Secretary Hazel to form a workgroup to review COPN and make recommendations on reform. The workgroup met several times in the interim. The workgroup’s report was mainly focused on improving the administrative process and did not recommend removing any major services from requiring a COPN. As a result, there were numerous bills this session on this topic- ranging from workgroup recommendations to full-out repeal of the program. The following COPN bills were all introduced this year:

The majority of these bills were combined or tabled early in session. The following bills became the main focus:

This bill removed most services from COPN and created a permit process instead, with several quality standards.

This bill included process reforms, as well as removing mental health services from COPN.

This bill removed imaging, but included utilization standards, charity care requirements, and equipment registration.

This bill was supported by the VHHA and reflected the recommendations of Sec. Hazel’s workgroup.

Delegates O’Bannon, Byron and Peace led the efforts for comprehensive COPN reform in the House of Delegates. Delegate Stolle favored process changes instead; he carried the bill supported by the Virginia Hospital and Healthcare Association (which opposed reform). The Medical Society of Virginia supported reform legislation, as long as it included strict charity care requirements and quality of care standards.

The legislation had an uphill battle in the House of Delegates and barely made it out of the Health, Welfare and Institutions Committee. HB 193 (O’Bannon), HB 350 (Byron) and HB 689 (Peace) were the only bills to make it to the floor. Many thought that the bills would die at this point, because several Republican Delegates from Southwest were opposed to reform. VHHA then chose to air a television commercial in the Roanoke and Southwest regions directly targeting Republicans who supported reform. It was a very sensational, attack-style campaign ad and most were shocked by its content. This tactic backfired and angered the Republican caucus in both the House and Senate. As a result, HB 193 and HB 350 passed the House floor. Many legislators indicated they only voted for the bills because they were so disgusted with VHHA’s actions.

In the Senate, the Education and Health committee decided to carry over and take no action on their members’ bills and wait for the House bills to come over. Senator Newman, the chair of the committee, supports COPN reform and led efforts in the Senate to find common ground between proponents and opponents. The majority of members on the Education and Health committee opposed COPN reform and getting any significant legislation out of there was thought to be close to impossible.

Senator Newman and Sec. Hazel worked together to heavily amend Del. Byron’s bill. Her bill was changed to remove imaging services, implement process changes and provide a method for hospitals to draw down federal funds. This new bill easily passed out of committee. Delegate O’Bannon’s bill was carried over to 2017, with a commitment from Senator Newman that the committee will meet in the interim and address the legislation.

The one bill left, HB 350 was heard on the Senate floor. However, because it involved revenue, Senate rules required it be referred to the Senate Finance committee. At this point, there were only a few days left of session and the deadline for revenue bills had long expired. The bill was referred back to committee, essentially killing it for the year.

While this was the end of the road for COPN reform this session, it is far from over and will definitely be a focus again next year. The Speaker of the House of Delegates has committed to carrying comprehensive reform legislation himself next year. This can be directly attributed to the actions of VHHA and it is likely the Speaker’s bill will be more far-reaching than any of the bills this year. Senator Newman has also indicated that the Education and Health committee will work over the summer and fall on legislation and be ready to go at the start of the 2017 General Assembly Session. It is safe to say that the legislative efforts to reform COPN are just beginning.

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Worker’s Compensation Commission Appoints Advisory Panel for Fee Schedule

By Cal Whitehead
VOS Lobbyist

Virginia Workers’ Compensation Commission (VWCC) Chairman Wesley Marshall has made appointments to the Medical Fee Schedule Regulatory Advisory Panel. The panel is authorized by new law passed by the 2016 General Assembly and signed by Governor McAuliffe. The legislation carried by Delegate Peter Farrell and Senator Frank Wagner orders the VWCC to establish a unique fee schedule for health care services provided to injured workers covered by Virginia’s workers compensation laws.

The first meeting of the panel is Thursday, May 26 at 9:00 AM at the VWCC offices in Richmond. The Virginia Orthopaedic Society (VOS) has a designated slot on the panel, to which VOS government affairs coordinator Cal Whitehead has been appointed. Surgeons and practice administrators will have opportunities to provide feedback and data throughout the process.

The new statute requires the Regulatory Advisory Panel to undertake a variety of actions, including:

  1. Consulting with the Commission regarding the retention of a firm with nationwide experience and actuarial expertise in the development of workers’ compensation fee schedules;

  2. Consulting with the Commission prior to the adoption of any methodology to obtain statistically valid estimates of the statutory reimbursement objective for fee scheduled medical services within defined medical communities;

  3. Assisting with the development of regulations adopting initial medical fee schedules and adjusting those schedules;

  4. Meeting with the Commission to offer recommendations in development of the Virginia medical fee schedules; and

  5. Meeting, reviewing, and making recommendations to the Commission prior to July 1, 2017 on workers’ compensation issues relating to:

    1. Pharmaceutical costs not previously included in the Virginia fee schedules;
    2. Durable medical equipment costs not previously included in the Virginia fee schedules;
    3. Attorney fees awarded under Va. Code section 65.2-714;
    4. How to resolve issues that the peer review committees established under Chapter 13 (sections 65.2-1300 through 65.2-1310) of Title 65.2 of the Code of Virginia as repealed had been authorized to address;
    5. Prior authorization for medical services; and
    6. Any other issues that the Commission assigns to the Regulatory Advisory Panel

The Commission’s staff has begun preliminary investigation on some of the required matters. VWCC has consulted with programs in other jurisdictions regarding staffing for medical fee schedule development and administration. They have also obtained background information regarding the process of retaining firms to process data, develop methodology, and construct fee schedules. The Commission’s staff has considerable experience in drafting RFP’s for contract services and we have started to draft outlines for an eventual RFP.

The fee schedule is to be implemented on January 1, 2018.

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