The Captiol Corner
Updates from VACEP's lobbying team are posted here.
If you have any questions, please contact gwenh@vacep.org.
March 7, 2008 As you can see, there are still a few outstanding bills in conference, which should be completed by tomorrow.
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February 29, 2008
First, I want to thank everyone that came to Richmond for VACEP’s bi-annual legislative lobby day and legislative reception. We had a very successful day with over 20 emergency physicians taking the day off to travel to the Capitol city to talk to their legislators about the issues you face in the emergency department every day, especially in the mental health arena.
Having our lobby day later in the session proved to be fortuitous since the legislators’ schedules were more open and they were available to meet directly with our VACEP members. We also had many delegates and senators, as well as executive branch officials attend our evening legislative reception. Thanks to all who participated and to the great job of Gwen and her staff for putting on such a well-planned event.
As the session draws to a close, the legislature has acted on all of our ‘active support’ and ‘active oppose’ bills and the legislature is now focused on coming up with a compromise budget. We fared well in the budget, however, in the House debate late last week on the Standards of Quality for Education, there was a floor amendment made to the HHR section of the budget- not vetted by the HHR subcommittee- that stripped funds from the Trauma Center fund that was established in 2004 to help defray the critical shortfall by directing higher DUI fees to this special fund.
This year’s trauma fund was expected to yield roughly $10 million for trauma centers (relative to a $60 million shortfall). The Senate budget redirects $2.2 million per year from the dedicated trauma fund to the General Fund and the House goes further to redirect $4.2 million per year to correct an education funding issue.
Trauma services remain seriously under funded and this will have a significant impact on the trauma centers and we encourage our members who live in the budget conferees districts to call and ask them to reverse the diversion of funds from the dedicated Trauma Fund.
Thank you for your help!
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February 22, 2008
This past week was dominated by the release of the House and Senate budgets on Sunday the 17th. Neither budget cut the Medicaid reimbursement for physicians, essentially following the Governor’s lead. Here are the highlights from the two budgets in the Health arena:
Senate HHR Budget: Mental Health:
Other:
House HHR Budget: Mental Health:
Other:
On Thursday the House and Senate approved their respective budgets. While the House passed its budget unanimously, a newly divided Senate passed its budget along party lines by a 21-Y 19-N vote. Procedurally, each chamber will now ‘reject’ the budget passed by the other body and the budget will be put in "conference" to reach a compromise on all the different pieces of the budget that they disagree on. It is rumored that the budget work will not be completed by the scheduled last day of session- March 8th.
Other Issues this Week:
HB 403 (Hamilton)/SB 567 (Newman) Health care providers; those responding to disaster immune from liability. After much compromise, these bills have now passed each other’s respective houses and will be sent to the Governor for his signature. Both bills will enhance physician liability protections during disasters in the absence of gross negligence or willful misconduct. VACEP supports these bills.
SB 649 (Ticer) Seat Belts; Makes non-use of motor vehicle safety belts a "primary offense.” This bill passed the Senate and allowed police officers to cite a driver for not wearing a seat belt independently from any other reasons for a traffic stop. Currently, such a violation is only a secondary offense and cannot be the sole reason for a traffic stop. However, both House companion bills were quietly killed before Crossover. SB 649 received a hearing in the Militia, Police and Public Safety subcommittee with at least eight organizations (including VACEP) testifying in favor of the bill. However, the bill was still tabled for the year on a 4-Y 1-N vote. VACEP supported these bills.
HB 805 (Englin)/SB 290 (Barker) Advance Health Care Directive Registry. This bill directs the Department of Health to develop a secure online central registry for advance health care directives. The House version is now on the verge of passing the Senate with no opposition and SB 290 is awaiting a hearing in House Appropriations- Health & Human Resources subcommittee. HB 805 also had to go through the Appropriations subcommittee, but it was reported unanimously. We expect the same result for SB 290 this week. VACEP supports these bills.
Thank you for your help!
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February 15, 2008: Post Crossover
Each house has completed their work on their bills and many bills have ended up by the wayside- either left in committee and not acted upon or killed because of their fiscal impact. According to a recent story in the Richmond Times Dispatch, at the start of session, 1,441 bills originated in the House, of which only 616 (42%) have ‘crossed over’ to the Senate. Likewise, there were 683 Senate bills, of which 433 (63%) survived and have been sent to the House for consideration.
Officially, two bills that we opposed were left in committee, killing them for the year: Delegate Cox’s balance billing legislation (HB 318) and Delegate Kilgore’s HB 143 allowing lawyers to obtain medical bills at no cost. Unfortunately, Delegate Hamilton’s HB 593, the VirginiaShare plan was also left in Appropriations. We now only have Senator Saslaw’s SB 578 as a vehicle for this important initiative, which leads me to the update on the ever shrinking budget in the Commonwealth.
On Tuesday, Governor Timothy M. Kaine issued a revised revenue forecast for 2008-2010 indicating an even greater shortfall than originally projected. On top of the original projections, we face an additional $339 million shortfall in FY 2008, $520.1 million in FY 2009 and $532.2 in FY 2010 for a grand total of an over $2 billion shortfall. The Governor proposed additional cuts to his proposed budget but did not cut the Medicaid reimbursement rate for physicians. The only Medicaid related cuts were to eliminate the yearly Medicaid inflation adjustments to hospitals and nursing homes; adjustments physicians do not receive regularly.
As part of his cuts, Governor Kaine also removed $5.8 million from the VirginiaShare program, leaving less than $2 million to begin a smaller, regional pilot program. On Sunday, the House Appropriations committee and the Senate Finance committee will release their versions of the budget based off of the Governor’s introduced budget. It is very likely these two versions will be very, very different. We will be watching to make sure neither house cuts the Medicaid reimbursement rate.
In the mental health arena, we are preparing ourselves for eventual compromise because the House and Senate versions vary quite a bit, but luckily not in the areas that we care the most about. However, we will remain vigilant to ensure that the pieces we have worked so diligently on that affect emergency departments directly – petitioning magistrates directly for TDO’s, increased time for ECO’s, increased accountability for CSB’s, changing the standard for involuntary commitment, allowing emergency physicians that may be required to participate in a TDO hearing to do so via electronic means, and increasing crisis stabilization centers – stay in the final bills.
Also, we will continue to monitor the budget amendments related to mental health reform to ensure that the money is spent in ways to take some of the burden off emergency departments, such as to include language in the budget that as a condition of the funding for CSB’s, they must develop reporting mechanisms to track CSB performance in crisis intervention, emergency custody, temporary detention and commitment procedures. As we know now, there is a severe lack of accountability that leaves our emergency physicians frustrated and our departments drained of resources.
For the rest of our priority bills, many of them are likely to face little opposition as they repeat the committee process, especially our healthcare immunity bills in disaster emergencies, the bills to create advance health care directive registries and Athey’s Good Samaritan statute bill to extend immunity during screenings. We can expect resistance on the VirginiaShare program despite the Governor’s recommendation to cut the funding and its likely Ticer’s safety belt bill will suffer the same fate (death) as the companion house bills. |
February 1, 2008
As we inch closer to the mid-point of session commonly referred to as “Crossover,” committee action is picking up as the members realize they have to complete their committee work by Friday, February 8th. The mental health subcommittees completed their work and the majority of the bills are now being reviewed by the Finance and Appropriations committees for their fiscal impact. We do have a special vehicle to ensure that the treating physician will be able to petition directly for a TDO- HB 1323 (Toscano) that has no fiscal impact and is not tied directly to the omnibus reform bills. Originally, it was drafted to specify that magistrates should consider the recommendations of “… any emergency physician who has been trained to perform emergency psychiatric evaluations.” This language was a concern since it implied emergency physicians would need an additional ‘merit badge’ to be qualified to do such evaluations. With the concurrence of the patron, the Supreme Court, the CSB’s and MSV, we amended the bill to instead specify that “treating physicians” could petition directly for a TDO to be inclusive of all physicians that practice in emergency departments. VACEP supports this bill.
Other Issues this Week:
HB 403 (Hamilton)/SB 657 (Newman) Health care providers; those responding to disaster immune from liability. This bill was finally amended with less grumbling from the VTLA and passed out of committee unanimously and passed the House floor unanimously as well. The Senate companion bill, SB 657 (Newman) was recommended to report by the Senate Courts Civil subcommittee and should come up for full committee vote on Monday. Both are in good shape and shouldn’t receive any more opposition. Both bills will enhance physician liability during disasters in the absence of gross negligence or willful misconduct. VACEP supports this bill.
SB 693 (Edwards) Physician assistants; agreement with supervising physician detailing activities. This bill would allow physician assistants to render a final diagnosis and end of treatment plan ONLY if it is expressly permitted by the physician/physician assistant practice protocol agreement. MSV worked throughout the fall to come to this compromise and if this bill passes, there is an understanding that there will be at least a two year moratorium on PA’s coming back to ask for more responsibility. VACEP originally opposed this bill, but since MSV worked out a compromise and moratorium, we have downgraded to monitoring its progress.
HB 593 (Hamilton)/SB 578 (Saslaw) VirginiaShare Health Insurance Program established. These bills would provide health insurance premium assistance to allow eligible low-income working individuals to purchase health insurance coverage through a certified VaShare Health Insurance Policy. VACEP members were urged to contact their legislators on the committees hearing these bills last week. While there has been no movement on the House side, the Senate Commerce and Labor committee did report it out with substitute (11-Y 3-N 1-A) and the bill has subsequently been rereferred to Senate Finance. VACEP supports these bills. HB 805 (Englin)/SB 290 (Barker) would create an Advance Health Care Directive Registry. HB 805 reported from HWI with substitute (22-Y 0-N)and was rereferred to Appropriations; while SB 290 sailed through Senate Education and Health with substitute (15-Y 0-N) ; Passed the full Senate (40-Y 0-N) and now heads to the House. VACEP supports these bills.
HB 1294 (Athey) Good Samaritan statute; where protection extends; what is considered compensation. Provides that immunity under the statute extends to those providing care at a location for screening or stabilization in addition to the scene of the accident and en route to the hospital. Also the bill clarifies that reimbursement for expenses is not considered compensation under the statute.VACEP supports this bill. (SB 289 (Whipple)/SB 202 (Quayle)/SB 501 (Locke/Northam)/SB 344 (Blevins) Smoke Free Air bills. On Thursday, the Senate Education and Health committee reported out all the bills that ban smoking in some form or another on a 12-Y 3-N vote. These are the highest margins of approval such bills have ever received in the Senate. Whipple’s bill is the comprehensive, smoke-free workplace bill and SB 501 is the bill banning smoking in restaurants that is supported by the Governor. The companion House bills will be heard in subcommittee on Thursday but they are not likely to advance. Please call or email the House subcommittee members and ask them to support HB 500 (Hamilton), HB 821 (Morgan), HB 572 (Howell, A) and HB 1063 (Brink). VACEP is in favor of these bills and signed on to the Virginians for a Healthy Future coalition working on this issue.
HB 1273 (Spruill) Relating to health care costs for prisoners. This bill would have cut the reimbursement rate for providing healthcare to prisoners, which would have had a disparate impact on emergency departments who tend to care most often for these patients. This bill was stricken from the docket by the patron and is dead for the year. VACEP was not in favor of this bill. Thank you for your help!
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Mental Health Update, January 30, 2008
The session got off to a fast start when it came to mental health reform. The House Courts of Justice committee set up a special Mental Health subcommittee to hear the bills that address the involuntary commitment process. They heard over 50 bills and whittled them down to about a dozen. More importantly, VACEP members, Dr. Greg Christensen and Dr. Gary Kavit have dedicated innumerable hours participating in the House and Senate subcommittee meetings. Not only have they offered excellent, real-life testimony about how TDO’s really happen in emergency departments, but they have also sat through late night meetings, monitoring the constant language changes. Without their help, the legislators would never have been as keenly aware as they are now of the serious flaws in our mental health system and the resulting strain on your emergency departments. It is so important for VACEP to continue to be involved in this process to ensure the changes we need get included in the final bills. The House bills:
In addition, more bills dealing with other pieces of the mental health system, including outpatient services, were heard in House Courts and House Health, Welfare and Institutions. Now, all the bills that have passed committee muster have been re-referred to the Appropriations committee to decide on the fiscal impact of the changes to the system. This money process will continue until crossover on February 12. In the Senate, the process was more collaborative between the Health and Courts committee designating a joint subcommittee of the committee members to study all the mental health bills filed in the Senate. Rather than keeping each policy in separate bills, the Joint Subcommittee worked mainly with one omnibus bill, SB 246. Again, the pieces included that affect emergency physicians are:
There are some differences in the House and Senate reforms, which will likely be worked out when the bills “crossover” to the other chamber. As in the House, the bills that have passed out of the full Senate committees were re-referred to the Senate Finance committee to work out the fiscal impact. We will continue to monitor the bills as their fiscal impact is discussed and debated in the House Appropriations and Senate Finance committees. |
January 26, 2008
This week brought more mental health meetings and hearings to hash out reform to our current system, mainly relating to the involuntary commitment process. The House Courts committee has completed their mental health work and the Senate began their joint subcommittee of the Education and Health and Courts of Justice committee’s work this week as well. We were able to amend the bills in both houses to: clarify that the treating physician has the authority to petition the magistrate directly in the temporary detention process, extend the time of the emergency custody orders an additional 2 hours in the House and 4 hours in the Senate, and change the standard for commitment from “imminent danger” to “a substantial likelihood.” We still have quite a ways to go in the process, but we will be participating closely to ensure our concerns continue to be heard.
Where We Need Your Help: HB 403 (Hamilton) Health care providers; those responding to disaster immune from liability. This bill is hanging on life support in House Courts and is being actively opposed by the Trial Lawyers. It has been amended in an effort to compromise, but that apparently did not achieve the results the VTLA were hoping for. This is certainly a bill that could use some help from our members, especially if your legislator is on the House Courts Civil subcommittee. VACEP supports this bill.
Victories this past week:
HB 784 Kilgore Naturopathic doctors; licensure requirements for practice. This bill was continued to 2009 (dead for the year) in House Health, Welfare, and Institutions after the Medical Society met with the patron and the naturopaths to discuss their very serious concerns about licensing naturopaths in Virginia. We expect to see this issue arise again in the future. VACEP opposed this bill.
HB 1173 Lingamfelter Motorcyclists; allows certain persons at least 21 years of age to ride without helmets. This perennial bill was killed this week in House Transportation on a (7-Y 14-N) vote. In years past, the bill made it out of committee and was always killed on the floor; this year opposition was higher and it died even more quickly! VACEP opposed this bill.
SB 290 - Barker - Advance Health Care Directive Registry; created. Reported from Senate Education and Health with substitute. This will go to the full Senate for a vote this week. No real opposition is expected. VACEP supports this bill. SB 649 - Ticer - Motor vehicle safety belt systems; repeals language that makes nonuse secondary offense. Another bill that has failed in years past, passed the Senate this week and moves to the House for consideration. A companion bill, HB 1065 is sitting in House Committee on Militia, Police and Public Safety where these bills have died in the past. We'll need a lot of help from all of you to put pressure on these committee members to move these bills forward. VACEP supports this bill. Other Issues Put to Rest this Week: HB 253 - O'Bannon - Health Insurance, Bureau of; establishes division within State Corporation Commission. Carried over to 2009. VACEP supported. HB 784 - Kilgore - Naturopathic doctors; licensure requirements for practice. Carried over to 2009. VACEP opposed. SB 340 - Cuccinelli - Hospitals and health care providers; reducing medical fraud. Passed by in committee. VACEP supported.
Thank you for your help!
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January 20, 2008 As the first full week of the 2008 session drew to a close, we are already able to calculate some early victories. First, we want to thank Dr. Greg Christiansen and Dr. Gary Kavit for giving so generously of their time and expertise to the important issue of mental health reform. As we all know, this is a crucial year for beginning to make changes in our seriously flawed mental health system. Both Greg and Gary have attended two House Courts of Justice Mental Health Subcommittee meetings and offered very compelling testimony about their personal experiences with mentally ill patients in their emergency departments; a phenomenon that we know is repeated in many, if not all, geographic parts of our Commonwealth. The discussion and bill review in the mental health arena is just beginning and we have much work ahead of us, but plenty of opportunities yet to make our voices heard. Early Victories:
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