Legislative News

By Lauren Schmitt
Commonwealth Strategy Group

MSV Annual Retreat
The Medical Society of Virginia held its annual retreat in Roanoke in October. Their House of Delegates reviewed resolutions submitted by members and specialty physician societies. VOS did not submit a resolution this year. Our top priority continues to be COPN reform and MSV has reaffirmed their support of this issue. They did pass a resolution to amend MSV’s policy on balance billing. The policy now provides MSV with flexibility to pursue legislation that would potentially eliminate balance billing in the emergency setting, but also ensuring there is fair reimbursement for physicians and direct payment. Please read below for more information on our efforts regarding surprise and out-of-network billing.

2019 General Assembly Session
Before we know it, the 2019 legislative session will be here. They will begin on Wednesday, January 9 and are scheduled to adjourn Saturday, February 23. Please save the date for Tuesday, February 5, for our Board meeting and a reception in the evening with legislators. Healthcare issues continue to dominate the legislature and it is important the legislators are hearing from orthopaedic surgeons in their districts.

Certificate of Public Need
COPN reform continues to be a top priority for VOS. Governor Northam and his administration have expressed interest in pursuing reforms. However, they have said they are hesitant to do anything before Medicaid expansion has been implemented. We are working to educate the administration on why reform is urgently needed and is also a critical component to the success of Medicaid expansion. We are actively speaking with key leaders in the legislature to discuss strategy for legislation in 2019. We continue to lead a coalition of groups that all support significant reform to COPN laws. Visit our coalition website for more information.

Surprise Billing and Out-of-Network Coverage
VOS continues to work with MSV and other physician specialty groups in response to legislative concerns regarding surprise billing and out-of-network insurance coverage. The Health Insurance Reform Commission (HIRC) met in October to continue discussions regarding the effects of surprise billing and balance billing on patients. The HIRC had previously met in July and gave the physician community a clear directive to work with the health plans and find a solution to the issue. The legislators stressed that their top concern is patients who receive care from out-of-network providers at an in-network hospital. They emphasized finding a solution for these scenarios in which the patient has no control or choice in the matter. As one Senator put it, “come up with a solution or we’ll make one for you that no one will like.” Since then, the stakeholders have been meeting and trying to find a reasonable compromise. We have made progress in regards to non-emergent services and all agree there should be notification to patients and the ability to choose a different option. We are working on draft language that will protect the patient but not place too heavy of an administrative burden on the physician.

The one area where providers and health plans still disagree is the emergency setting. This was the focus of discussion in today’s HIRC meeting. We presented the provider community’s legislative proposal. Our proposed legislation eliminates balance billing in the emergency room, but also does the following:

strengthens the prudent layperson standard
establishes a fair payment standard
requires direct payment from the plans to the provider
allows for dispute resolution at the Bureau of Insurance

The Virginia Association of Health Plans presented their proposed legislation, which is simply to eliminate the language in the Code that allows physicians to balance bill in the emergency setting. They stressed that they believe the current payment standard is fair and that the different components of the provider community’s legislation will only incentivize physicians to go out-of-network.

There were a lot of questions and concerns from the HIRC members. There were several comments that the “easiest solution” would just be to mandate that any physician who provides care in a hospital must accept the same health insurance plans as the hospital. We are educating legislators on why this is not the best solution. We have scheduled several meetings with legislators to start advocating for our legislation.

ORTHO-PAC
Have you contributed to the ORTHO-PAC this year? ORTHO-PAC is our VOS’s political action committee. It is our political marketing machine that allows us to support legislators who are pro-physician and pro-patient. A fully funded PAC provides us opportunities to engage directly with policy leaders in Virginia. Our contributions allow us to compete in a crowded political environment by giving us access to legislators so we can advocate our positions on Certificate of Public Need reform, worker’s compensation, scope of practice, balance billing, reimbursement matters and other critical policies that directly affect orthopaedic surgeons. Make an online contribution today here.