Legislative News

By Lauren Schmitt
Commonwealth Strategy Group

The 2020 Virginia legislative session adjourned on Thursday, March 12. They were scheduled to adjourn Saturday, March 7, but had to extend a few more days to finish all of the legislation and the budget.

After the historic election in November, the Democrats now have the majority of both the House of Delegates and Senate. Democratic leadership was clear that they were going to pursue their top policy priorities right away. And they did exactly that- with the legislature passing bills bringing sweeping reform and a change in policy to most issues, including gun control, increasing the minimum wage, allowing collective bargaining for state employees, marijuana decriminalization, passing the Equal Rights Amendment, rolling back restrictions on reproductive health care services, no-excuse absentee voting, and many more.

Even with all of these issues being debated this year, healthcare was still a priority. Read below for an update on health-care related bills.

Surprise Billing
Surprise billing remained at the top of the priority list for legislators. They were determined to resolve this issue this year and we are pleased that we were able to work with the legislature and other stakeholders to pass legislation that protects patients but still allows physicians to receive a fair reimbursement.

The physician community introduced bills sponsored by Delegate Luke Torian and Senator Barbara Favola that were identical to the proposal we had last year and would only apply to emergency services. The health plans had Senator Barker and Delegate Sickles introduce their bill- which would have implemented a fee schedule based on the health plans’ in-network rate or 125% of Medicare (whichever is lower) for both emergency AND non-emergency services. We were able to successfully defeat the health plans’ fee schedule, but legislators and the patient advocates insisted we address both emergencies and non-emergencies.

A proposal was then offered based on the Washington State model, which applies to emergencies and non-emergencies services at an in-network hospital IF the services involve surgical or ancillary services and are provided by an out-of-network provider. After researching this proposal and discussing with our physician colleagues in Washington, we determined that this was a good option for physicians and certainly better than any of the other proposals on the table. VOS supported this new bill, as did the Medical Society of Virginia and other physician specialty groups. We were thrilled when the legislature passed it unanimously. The bill contains the following components:

Pays providers a “commercially reasonable amount” that is undefined so there is no benchmark that can then impact in-network payments.
For the purposes of arbitration and for determining the “best offers” for the baseball style arbitration, a data set will be created based on commercial health insurance claims (excluding Medicaid and Medicare) and will be prepared using the All Payer Claims Database, in collaboration with providers and health insurers, for use by providers, facilities, insurers, and arbitrators. The data set will include

Median in-network allowed amount
Median OON allowed amount
Median billed charges

We are pleased that the bill includes “baseball style” independent dispute resolution and takes patients out of the middle of the billing process. It is also a huge win for us that it doesn’t put a benchmark in the Code and allows the arbiter to consider physician charges when determining a fair payment.

Certificate of Public Need
COPN reform continues to be a priority for VOS, but we have had to reassess our strategy due to a lack of major support in the legislature. Senator Petersen introduced legislation on our behalf this year, SB 503, that was based on a compromise proposal discussed during the Governor’s COPN work group. This would have created an expedited review process for specific projects and amended the charity care conditions to require certificate holders accept some type of mix of Medicaid, Medicare or Tricare patients. Not surprising, the hospitals opposed our bill and it died in the Senate. The hospital association introduced their own bill, that is a lot of process and administrative reforms. This bill is headed to the Governor’s desk where he will have the opportunity to sign, veto or make amendments to the bill. We will re-evaluate how we move forward on this issue after we see the Governor’s actions on this legislation.

Scope of Practice
Legislation was introduced this year that would have expanded the scope of practice for pharmacists and naturopathic providers. HB 1506 (Del. Sickles) and SB 1026 (Sen. Dunnavant), as originally introduced, would have greatly expanded pharmacists’ scope of practice and allowed them to provide vaccinations, test for the flu, strep and UTIs and many other services they are not qualified to do. The physician community strongly opposed the bills in that form because we believe there were significant patient safety concerns. We are pleased we were able to work with the patrons and come up with a compromise that does not threaten patient safety.

HB 1040 (Del. Rasoul) and SB 858 (Sen. Petersen) introduced bills that would have given naturopathic providers licensure and allowed them to call themselves “naturopathic doctors.” We were able to defeat these and instead, the Department of Health Professions will conduct a study on whether licensure is needed for this profession.

Ortho-PAC
Our PAC is a critical tool in our advocacy program. It allows us to support legislators who are friendly to our profession and issues in the General Assembly. As you know, every year the legislature considers bills that could potentially impact our profession and patients. A strong PAC provides us the opportunity for our voice to be heard by elected officials in the legislature and executive branch. Our PAC enables us to support legislators who support our profession. Please support our ORTHO-PAC and make your contribution today!