Legislative Update – February 22, 2019

2019 General Assembly Session Comes to a Close

Thank you to our members, specialty and local society presidents, members and staff, and partnering groups for your commitment to the work required to make this year’s session successful.

Read an update from this week below. A full 2019 legislative wrap-up will be distributed in the spring issue of MSV’s printed newsletter.

Medicaid Reimbursement Rates

Due to the leadership of Del. Scott Garrett, MD and Sen. Emmett Hanger, the General Assembly approved a budget that includes a provision to raise Medicaid reimbursement rates to 70% of Medicare rates. This amendment would impact anesthesia, primary and preventive care, and emergency care, which are all currently below 70% of Medicare rates.

The budget will now go to the Governor.

Prior Authorization and Step Therapy

MSV’s priority prior authorization legislation, SB 1607 (Dunnavant) is on its way to the Governor’s desk for signature. This is a huge victory for physicians and patients. The bill would streamline medication prior authorizations. It would also ensure payment for pre-approved surgeries and invasive procedures; during an approved procedure, if a physician provided appropriate additional medical care, they would be reimbursed without requiring an additional authorization.

HB 2126 (Davis) would reform step therapy and would improve clinical criteria as well as create expedient exemptions processes for patients already on an effective treatment or with an urgent need. HB 2126 has passed the General Assembly and awaits the Governor’s signature. Thank you for those that sent messages to legislators emphasizing this as a priority issue for Virginia’s patients!

Surprise/Balance Billing

Despite unified support from the physician, hospital, and patient communities, SB 1763 (Sturtevant) was killed due to health plan opposition and lobbying.

SB 1763 (Sturtevant) would have prohibited balance billing for emergency care and required physicians be paid the regional commercial average payment directly. It would have strengthened the prudent layperson standard by requiring the plans to cover the emergency care, regardless of the final diagnosis.

Physicians and patients will need to continue this partnership over the coming months to encourage legislators to adopt a practical solution to end emergency balance billing. Stay tuned for next steps you can take in the coming weeks.

Health Insurance

HB 2515 (Hugo) and SB 1596 (Dunnavant) co-pay accumulator bills are now on the Governor’s desk for signature.

These bills would require any insurance carrier in the Commonwealth to count any payments made by another person on the enrollee’s behalf, including prescription drug coupons, toward a patient’s out-of-pocket maximum or cost-sharing requirement.

Physician Assistants

Both HB 1952 (Campbell) and SB 1209 (Peake) have been sent to the Governor for signature. Both bills will make administrative updates to Physician Assistant practice, bringing Virginia’s code in line with current Board of Medicine regulations. MSV has worked closely with our Physician Assistant members as well as the Virginia Academy of Physician Assistants to get these bills passed. The Governor has signed SB 1209 into law and has HB 1952 on his desk, awaiting his signature.


SB 1619 (Obenshain) This bill initially proposed creating a duty to preserve evidence that may be relevant to a reasonably foreseeable lawsuit, which aligns with federal rules.  The bill moved through the process unamended until the end when a reenactment clause was added by the House Committee at the patron’s request.  This sent the bill into conference committee, where the patron put forth significant changes. The proposed substitute provides jury instruction allowing a negative presumption even when the evidence was accidentally lost or destroyed in a regular course of business.  This is significant because it applies to litigation that has not been filed yet but is “reasonably foreseeable.”  MSV and other stakeholders are working to defeat the proposed substitute and keep the bill in its original form.

Maintenance of Certification

This week MSV joined Del. Sam Rasoul, representatives from the Richmond Academy of Medicine, Carilion Clinic, Virginia Hospital and Healthcare Association, American Board of Medical Specialties, Virginia Department of Health, and the American Association of Physician and Surgeons to discuss concepts and concerns with HB 1967. MSV will continue to work to address physicians’ concerns with MOC at both a state and national level.

Public Health

SB 1727 (Norment) and HB 2748 (Stolle) increases the minimum age to 21 years old to sell, purchase or possess tobacco products, nicotine vapor products, and alternative nicotine products. Both bills have been signed into law by the Governor.

HB 2026 (Stolle) would include a screening for congenital cytomegalovirus in newborns who fail the initial newborn hearing screen. The bill has passed the House and Senate and is on its way to the Governor’s desk for signature.