Legislative News

By Lauren Schmitt
Commonwealth Strategy Group

The 2019 Virginia General Assembly session adjourned on Sunday, February 24 – a day later than expected due to some delays with budget negotiations. Luckily, they were able to pass a budget and conclude their work. There are many words that could describe this legislative session – boring is certainly not one of them! While Virginia was in the news more than usual, the General Assembly still went about their business and we continued to advocate strongly for VOS’s priorities. Below is a recap of the major issues we followed.

Surprise Billing and Out-of-Network Coverage
The top issue for the physician community during the 2019 legislative session has been surprise/balance billing and out-of-network coverage. We began working on this in early 2018 with the goal of protecting both patients' and a physicians’ ability to negotiate fairly with health plans. The health plans supported legislation would have prohibited balance billing and forced providers to accept the in-network rate. We were able to defeat these bills, and this was a huge victory for the physician community. It was an uphill battle from the start, and we were going up against negative stories in the media and a lot of misinformation about surprise billing. Luckily, legislators recognized that a flat-out ban on balance billing in the emergency department would severely threaten the emergency safety net. We were able to offer a compromise solution that was strongly supported by physicians, hospitals and patient advocacy groups. Our legislation would have prohibited balance billing in the emergency department, but also would also have required a fair reimbursement for providers. The bills also contained other significant patient protection components. Delegate Lee Ware and Senator Glen Sturtevant carried our legislation, and we were thrilled when they both passed their respective Commerce and Labor committees. Unfortunately, there were questions at the very end about whether this would result in a fiscal impact on the state employee health plan. In the end, the legislature felt it would be prudent to not pass the legislation as this time due to an indeterminate fiscal impact. When the session adjourned on Sunday, no legislation passed addressing this issue. The law will still allow physicians to balance bill and negotiate with health plans. While we are disappointed that our reasonable solution did not make it to the finish line, we are grateful that the General Assembly chose to not act negatively on this issue. A straight ban on balance billing would have been detrimental to physicians’ ability to practice in Virginia and would have harmed the emergency safety net.

There was language in the final budget directing the State Corporation Commission and the Department of Human Resources management to come up with a proposal to address this issue. We have concerns about this language and will be working with the Governor’s office to try and amend it before the reconvened session April 3.

While the emergency services legislation was the most contentious, we were able to successfully pass legislation requiring patient notification for elective services. This will protect patients by notifying them when a service may be out-of-network, but without placing an administrative burden on the referring physician. HB2538, also carried by Delegate Ware, passed both the House and Senate unanimously. There were also multiple bills dealing with out-of-network ancillary services. Despite a lot of work by stakeholders, an agreement could not be reached at this time, and the bills were referred back to the Health Insurance Reform Commission for further study.

Certificate of Public Need
Heading into this session, we were not anticipating any movement on COPN. The Governor and leadership in the House and Senate had indicated that this would be better addressed in 2020 due to the recent implementation of Medicaid expansion. Despite this, there were still several COPN-related bills. We supported three pro-reform bills: HB1680 (Orrock) was a comprehensive reform bill that included the deregulation of imaging, SB1526 (Sturtevant) would have removed psychiatric beds from COPN and SB1614 (McDougle) would have removed ASCs used for urologic, endoscopic and ophthalmologic surgeries from COPN. HB1680 never received a hearing because legislators believed it would eventually be vetoed even if successful in the legislature. SB 1526 and SB1614 passed the Senate Education and Health committee, but unfortunately failed on the Senate floor. SB1614 actually resulted in a tie on the Senate floor, with the Lieutenant Governor breaking the tie to defeat the bill. Governor Northam’s administration has indicated they want to work on significant COPN reform for the 2020 session and will be announcing next steps soon.

Physician’s Assistants
The Medical Society of Virginia worked with the physician’s assistants to introduce legislation that would amend their current practice structure and be modeled after the collaborative practice model previously used for nurse practitioners. Both SB1209 (Peake) and HB1952 (Campbell) passed the legislature unanimously and have already been signed into law by the Governor.

Budget

The final budget adopted by the legislature included a slight increase in Medicaid reimbursement for physicians that are currently reimbursed at a lower rate than 70% of Medicare. Their budget allocates $4,185,199 in General Funds and $11,060,494 in Non-General Funds in FY2020 to physicians who practice emergency medicine and adult primary and preventive care. This would bring them up to a reimbursement equal to 70% of Medicare. While this does not include orthopaedic surgeons, we are pleased the legislature recognizes the need to increase physician reimbursement. We are hopeful they will include a larger increase that applies to more specialties in the near future.