It was such a successful session for the Medical Society of Virginia! We could not have done it without our dedicated members. Thank you for all you do and for constantly advocating for the House of Medicine.
Marc Alembik, Trisha Anest, Michael Armstrong, Terri Babineau, Peter Bell, Barbara Boardman, Owen Brodie, Carolyn Burns, John Butterworth, Renee Carter, Sam Caughron, Trevar Chapmon, Sandy Chung, Alice Coombs, Clifford Deal, Craig Derkay, Kelley Dodson, Tom Eppes, Helen Foster, Michael Fowler, William Fox, Thomas Gallagher, Harry Gewanter, Andrea Giacometti, Patrick Gibbons, Randy Gould, Jeffrey Green, John Harbour, Stuart Henochowicz, Mark Hylton, Tony Kay, Wendy Klein, Hazle Konerding, Ritsu Kuno, Josh Lesko, Atul Marathe, Larry Mitchell, Ken Olshansky, Lee Ouyang, Lisa Pinelli, Trisha Pascall-Lopez, Rajanya Petersson, Craig Pinsker, Pradeep Pradhan, Kenneth Qiu, Ghulam Qureshi, Tim Raines, Sterling Ransone, Bill Reha, Karen Rheuban, Rose Rutherford, Kathy Scarbalis, Bruce Silverman, Carol Shapiro, Tovia Smith, Wilson Sprenkle, Richard Szucs, Mark Townsend, Heather Tyree, Jennifer Vanderbeck, Art Vayer, John Paul Vederese, Patrick Woodward, Alan Wynn, Leigh Anne Young, and Peter Zedler.
We were also joined by over 60 medical students representing EVMS, UVA, VCU, LUCOM, VTC, and VCOM!
Madihah Alam, Pranav Baderdinni, Shyam Bhatt, Sarah Birk, Harrison Brookeman, Katie Brow, Alonna Brumbaugh, Anneke Bulthuis, Dominic Campion, Elim Cho, Joowon Choi, Mark Clark, Natalania Contoreggi, Anna Cronin, Kaivalya Dandamudi, Cody Daniel, Rocco Disanto, Kim Doerr, Stefan Edemobi, Pooja Gajulapalli, Salimah Gangji, Gillian Gardiner, Jamie Geraghty, Dan Griffin, Kat Hall, Abby Hankins, Kathryn Hardin, Jake Hartman-Kenzler, Stephen Hayes, Joseph Hirst, Jake Hughes, Sarah Ibanez, Michaela Kingsbury, Saadhana Kukkala, Mina Lee, Elizabeth Li, Bradley Mason, Steven Meas, Dylan Miks, Alex Miner, Juliana Moss, Zoe Moyer, Harshita Nangunuri, Alina Nguyen, Sekar Novika, Kevin Parham, Jineet Patel, Fallon Peplinski, Huzaifah Qureshi, Anusha Sadda, Tamanna Sahni, Shalini Sakhamuri, Claire Seo, Hollie Soave, Shashank Somasundaram, Parth Vaidya, Matt Van de Graaf, Satya Vedula, Tharangini Vummadi, Hannah Wallen, Tayab Waseem, John Wieser, Caitlin Womack, Caroline Woods, Justin Zaremba, and Alexander Zhang.
Creating alternative education qualifications for the State Health Commissioner
SB 993 (Locke), a bill that proposed allowing non-clinicians to serve as either the State Health Commissioner and/or director of the local health department, was carried over for the year. The State Health Commissioner and local health directors are responsible for investigation, quarantine, immunization, and treatment of any communicable disease or public health epidemics. They’re also responsible for standing orders, prescriptions, and treatments for a myriad of conditions and diseases. These responsibilities require clinical expertise and decision making to ensure the appropriate protocols are developed.
In the last few weeks of session, two separate versions of the pharmacist bill remained - HB 1506 (Sickles) and SB 1026 (Dunnavant) - resulting in the bills being sent to a committee of conference. MSV sent letters to the conferees asking the legislators working on a compromise between these two pieces of legislation preserve the patient safety protections and public health considerations in Del. Sickles’ HB 1506.
The legislation that came out of conference establishes a multi-stakeholder workgroup comprised of the Board of Pharmacy, Board of Medicine, Department of Health, and others, to clinically review and, if appropriate, develop recommendations for pharmacists to initiate treatment for a variety of diseases. MSV will continue to work with stakeholders to advocate for physician-lead team-based care in order to protect patient safety and expand access to care.
HB 1040 (Rasoul) and SB 858 (Petersen) attempted to license naturopathic “doctors,” allowing them to prescribe medications, perform minor surgical procedures, and order and perform physical exams and lab tests. SB 858 was referred to the Department of Health Professions (DHP) for a workforce review study. The study will evaluate whether naturopaths meet criteria for potential licensure. If all criteria are met, the bill will likely be brought back next year. The House, the Health, Welfare, and Institutions committee voted to carry the House version of this legislation, HB 1040, over until 2021 after the conclusion of the DHP study requested by the Senate.
Thank you to all those who sent emails, made phone calls, and talked to legislators on these issues. These were all major victories for the House of Medicine!
Surprise Balance Billing
Thanks to the advocacy of MSV members who joined us for lobby days and reached out to their legislators, on April 10, 2020, Governor Ralph Northam signed Senate Bill 172 (Favola) and House Bill 1251 (Torian) into law.
The law is modeled after Washington State’s Balance Billing Protection Act which was supported by Washington State‘s Medical Society. The law prohibits a patient from being balance billed for both emergency services and for nonemergency services involving surgical or ancillary services provided at an in-network facility by an out-of-network (OOO) provider.
Health plans will be required to reimburse providers a “commercially reasonable rate.” The state insurance commissioner and APCD will establish a data set to assist health plans, providers, and arbitrators in determining commercially reasonable payments resolving disputes.
If a provider or facility wishes to dispute the carrier’s payment, they must notify the carrier within 30 calendar days after the receipt of payment. Both parties will have a 30-day period in which they can try to reach an informal negotiation. If no agreement is reached at the end of this period, either party may initiate arbitration to determine a commercially reasonable payment amount. Notably, providers will be allowed to bundle multiple claims in arbitration.
MSV is now working with the Bureau of Insurance, the health plans, Virginia Hospital and Healthcare Association (VHHA), and other stakeholders to provide feedback on the drafted protocols and regulations. For more information on negotiation, arbitration, and the calculation of the commercial reasonable amount, please see the release from MSV’s General Counsel Hancock, Daniel, and Johnson P.C.
Maintenance of Certification (MOC)
All legislation-- HB 1449 (Rasoul) and SB 982 (Hashmi)--introduced on Maintenance of Certification was struck, or otherwise failed to pass either the House or Senate.
The MSV opposes continuing board certification as a requirement for licensure, credentialing, recredentialing, privileging, reimbursement, network participation, employment, or insurance panel participation. As introduced, however, the bills codified many instances in which MOC could be used to regulate a physician’s ability to practice. Moreover, the bills could have potentially jeopardized the accreditation status of Virginia’s trauma centers.
The Medical Society of Virginia plans to convene a taskforce on MOC to review policy and determine steps to address concerns before the 2021 session.
HB 115 (Hope) and SB120 (Barker) successfully passed both chambers and have been signed by the Governor. The bill creates a “safe haven” for physicians, outside of their employer, where they can seek the support they need for burnout and depression. The bill allows for a program to be established that offers a level of confidentiality for physicians who seek such services.
The General Assembly passed a version of HB 1090 (Hope) which sought to codify the Board of Health's Regulations for the Immunization of School Children to be consistent with the immunization schedule developed and published by the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The legislation was amended to replace the CDC’s Advisory Committee on Immunization Practices with the Virginia Department of Health (VDH) as the adjudicator of future required vaccines. The Department of Health will add the four missing vaccines to the list of required vaccines, those being, Hepatitis A, Meningitis, Rotavirus and HPV for males. The VDH will be charged with maintaining regulations for required vaccines which conform to evidence-based routinely recommended vaccine for children. This legislation does not remove any non-medical exemptions.
Thanks to messages from our members and the physician community of Virginia as a whole, this legislation successfully passed out of both houses and is currently awaiting the Governor’s signature!
Multiple bills were introduced this session which attempted to curtail tobacco use by minors and the population of Virginia as a whole. Delegate Hope introduced HB 1119, HB 1120, and HB 1283, all three of which were continued to 2021 by the House of Delegates Finance committee.
MSV and other public health stakeholders are hopeful for the 2021 session and the potential for progress.
Governor Northam included a $4.22 million increase for the Virginia Mental Health Access Program (VMAP) in his budget at the start of the legislative session. VMAP works to expand access to mental health care for children and adolescents by training primary health care providers in mental health treatment, connecting families with care navigation resources, and establishing telehealth services with child psychiatrists. This funding for VMAP would help establish 5 regional hubs of psychiatrists, psychologists, and care navigators that could support approximately 400,000 children.
The VMAP funding was approved by the General Assembly in March; however, most new spending in Virginia’s budget has been halted in the wake of COVID-19. The Commonwealth is awaiting a new revenue forecast before freeing any new spending in the budget. MSV is monitoring this issue and hopes to advocate for VMAP funding once the General Assembly develops a plan to address the budget situation.
While the budget amendment that would increase Medicaid reimbursements failed to make it into either budget, there was an investment to bring Medicaid rates for anesthesia up to the 70% rate that was achieved last session.
Physician Loan Repayment
After being unfunded for ten years, this was the first year that the Physician Loan Repayment program was positively received by the members of the General Assembly. While the budget amendment for the Physician Loan Repayment program failed to make either budget, there was money allocated in the final budget to support a Behavioral Health Loan Repayment Program, which will provide loan repayment to eligible practitioners, including psychiatrists and child and adolescent psychiatrists, who practice a minimum of two years in an underserved community. MSV will continue working with the General Assembly in 2021 to ensure that more Virginians have access to high quality care with the reinstatement of the Physician Loan Repayment Program.
All patient and physician supported COPN legislation was stricken or otherwise failed to pass the House or Senate. These bills included SB 330 (Deeds), HB 1094 (Miyares), SB 503 (Petersen), and SB 523 (McDougle).
There were additional COPN bills, including HB 879 (Sickles), SB 279 (Barker), and SB 1081 (Sutterlein), which MSV monitored throughout the crossover period of the General Assembly.