By Cal Whitehead
Commonwealth Strategy Group
2018 General Assembly
The2018 Virginia General Assembly adjourned on March 10, but without adopting a biennial budget. The budget negotiators, called conferees, have been unable to agree on whether or how to include some form of expanded Medicaid coverage. In a role switch, the House of Delegates did include Medicaid expansion in its budget proposal. The Senate did not. Since 2009, it has been the Republican-controlled House that was the primary opponent to expansion but a drastic change in composition from the 2017 elections reduced their nearly 2/3 majority to 51/49. New Governor Ralph Northam, MD has Medicaid expansion as a priority. The General Assembly will be called back into “special session” by Governor Northam on April 11 to continue work on a budget. VOS will keep the membership informed.
VOS focused most of its attention on COPN reform legislation and the efforts of the VOS-led and AAOS-supported Coalition to Reform COPN. A full report on that is available in this newsletter.
A bad precedent was avoided when VOS was able to have HB 621 tabled for the year. The bill would have required orthopaedists to give notice to patients about the risk of cobalt poisoning associated with joint replacement and the symptoms of poisoning. Several VOS leaders, in particular Drs. David Kahler and James Browne, provided input that was helpful in convincing the Patron, Delegate Rob Bell, to have the issue referred to the Board of Health Professions for review. These notice concepts, while well-meaning, could create an unending list of conditions that doctors would need to notice. VOS will work with stakeholders and agency leadership on the study.
Step Therapy and Prior Authorization
Physician groups, patient advocates, and pharmaceutical companies continue to seek policy changes that will reduce burdens of insurance company practices that deny or delay prescriptions for patients. Insurance lobbyists argue that these are necessary to control costs based on clinical practice guidelines. Senator Bill DeSteph and Delegate Glen Davis have introduced bills that have received a lot of attention but have not advanced during the last few sessions. MSV intends to lead this effort as a priority item this year.
Delegate Chris Head introduced HB 139 which would require insurance companies to reimburse physicians during a credentialing application period. Reimbursement will occur retroactively upon completion of credentialing. MSV estimates that, on average, this has the potential to avoid lost revenue of $100,000 - $150,000 per physician over a 90-day period.
Legislation to expand Nurse Practitioner (NP) autonomy has passed General Assembly and awaits Governor Northam’s action by April 9. The legislation will allow an NP who has practiced for five years under a physician-NP collaborative practice agreement to practice independently within the practice area for which the NP is licensed and certified (primary care, psychiatry, emergency, etc.). The collaborating physician must attest to the required experience.
April 20-22, 2018
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