The Captiol Corner
Updates from VACEP's lobbying team at HF Consulting are posted here.
If you have any questions, please contact gwenh@vacep.org.
Go to VACEP 2009 GA homepage for information and links to legislation we are tracking
February 20, 2009
We can report two big victories this week! The first was the re-release of the Senate version of the budget. Once we got the numbers for the new projected Virginia shortfall- another $800 million on top of the current $3.2 billion- and the amount of the Federal stimulus package, the Senate Finance committee re-wrote their budget using the stimulus money. With this money, they restored their proposed 3% cuts to the Medicaid physician rates and the hospitals and fully restored funding for the Commonwealth Center for Children and Adolescents (CCCA) and the Southwestern Virginia Mental Health Institute (SWVMHI). The House did not rewrite their budget using the stimulus money, but they had not cut provider rates. So now, when they go into conference, physician rates will not be at issue. The second big victory was the passage of the smoke free restaurant bill, with the support of the Governor, the Speaker of the House, the Medical Society, VACEP, pediatricians and family doctors. Senator Ralph Northam (a pediatric neurosurgeon) and Delegates Cosgrove and Hamilton were the patrons of these momentous bills. SB 1105 passed on Thursday with the Senate agreeing to the conference report 27-13 and the House, 60-39.
All the Senate safety belt bills were killed this week in the House Militia, Police and Public Safety subcommittee either with no motion made or they were tabled. This issue is now dead for the session, as usual. Until the make up of the House changes, these bills will continue to meet the same fate. We are one of at least six groups that stand in support of these bills to no avail. Issue for the Upcoming Week: Budget Actions:
Restore Funding for Poison Centers and have Joint Commission on Health Care study on Consolidation. Constituents: Please call the House conferees and ask them to support restoring the million dollars of funding because of the important work that the Poison Centers do for average Virginians. They get approximately 100,000 calls a year and are able to help folks handle 50-60,000 of those calls in the home, avoiding unnecessary emergency room visits. They also provide valuable regional training and expertise to physicians who call for toxicology assistance. Talking points.
Thank you for your help! - Aimee Perron Seibert |
February 13, 2009
The release of the House and Senate amendments to the budget last Sunday dominated the week, despite not having any new revenue numbers for Virginia or knowing what the Federal stimulus package was going to include. They drew up their budgets using the Governor’s numbers of a 3.2 billion dollar shortfall, while knowing that there is a very good chance after receiving the new revenue numbers on the 16th, that hole in the budget would be bigger. For the physician community, we had a mixed result: the House, specifically Delegate Phil Hamilton, held the line on not cutting Medicaid reimbursement rates. The same could not be said for the Senate. Usually the two health subcommittees are more in line, but this year, the Senate slashed our provider rates by 3% claiming it was a way for all the providers (physicians, hospitals and nursing homes) to take a hit equally. What they failed to realize is that the hospitals and nursing homes took the hit in their inflation increase they usually get every year; physicians have no such automatic increase. They are hitting us directly on our bottom line. Delegate Hamilton has said he will continue to advocate restoring our rates in the budget conference committee and we are confident that he will be a strong voice for us. There was also disagreement on the issue of funding for the Virginia Poison Centers. The Senate included both the language asking for a Joint Commission on Health Care study on the issue of consolidation from the current three centers down to one proposed center and fully restored the $1 million cut. The House didn’t include the study language or restore funding. This too, will be an important conference committee issued. Finally, VACEP was also interested in the issue of closing the Commonwealth Center for Children (CCCA) and the adolescent unit at Southwestern Virginia Mental Health Institute (SWVMHI), both publicly funded inpatient psychiatric safety net services for children. The House fully restored the funding for the CCCA, closed the SWVMHI beds and put in language requesting an advisory committee be formed to study the issue of closure and VACEP was named as a participant. The Senate handled it a little differently by not including any advisory committee language and cutting the capacity of the two centers down to 50 percent, but keeping them both open.
Issue for the Upcoming Week: HB 1703 (Cosgrove) Indoor Clean Air Act; unlawful for any person to smoke in establishment built after July 1, 2010. This bill was heavily amended on the House floor before it was passed on a 61-Y 31-N vote. Now it will be going to Senate Local Government where we will need to strip off the onerous amendments. We need your help to make sure this passes—Please call or email your senator and let them know you support the bill as it came out of the House committee, not the version that passed the House floor. VACEP is actively supporting this bill and working with the Medical Society of Virginia on its passage. SB 1161 (Saslaw) Safety belts; makes non-use a primary offense. Similar House bills failed in the Militia, Police and Public Safety subcommittee #2, so we need your help contacting the members to tell them you support the bill! VACEP is actively supporting this bill.
Budget Actions: House Conferees: Putney, Hamilton, Sherwood, Cox, Hogan, Joannou
Oppose 3% Medicaid Physician Rate Cuts. Please call/email the budget conferees and let them know how detrimental this cut will be and how it will affect Virginian’s access to healthcare. More importantly, tell them about the disproportionate effect it will have on emergency medicine because not only will your rate be cut, but if family doctors or pediatricians stop taking Medicaid patients, those patients will get redirected to the emergency departments where you are required to treat everyone, despite their ability to pay. Restore Funding for Poison Centers and have Joint Commission on Health Care study on Consolidation. Please call the conferees and ask them to support restoring the million dollars of funding because of the important work that the Poison Centers do for average Virginians. They get approximately 100,000 calls a year and are able to help folks handle 50-60,000 of those calls in the home, avoiding unnecessary emergency room visits. They also provide valuable regional training and expertise to physicians who call for toxicology assistance.
Thank you for your help! - Aimee Perron Seibert
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February 6, 2009
The big news this week was the compromise on banning smoking in restaurants. Speaker Howell and Governor Kaine came to an agreement to pass legislation banning smoking in restaurants. There are a few exceptions to the smoking ban, including: lunch carts/street vendors, open porch areas of restaurants, the Philip Morris cafeteria, a separate room with a separate ventilation system in a restaurant, and any private club. VACEP supports this compromise, as does the Medical Society of Virginia and other medical specialties. In a surprising move, the Senate Finance Committee killed the cigarette tax increase on a tied vote- 8 to 8. Right now, that leaves a further $144 million dollar hole in the Medicaid budget, putting provider rates at a much greater risk with no alternative revenue source. MSV held a press conference on Wednesday and Senator Ralph Northam remarked that such state [Medicaid] funding reductions would place greater stress on Virginia's health care network. "When physicians . . . choose not to take Medicaid patients, they end up in emergency rooms," said Northam, a doctor by profession, calling that "inefficient health care." Senator Saslaw’s companion bill requiring a primary seat belt law snuck out of the Transportation Committee on an 8 to 6 vote. It then cleared the Senate floor easily and will likely meet the fate of similar bills in the House- certain death. The bill adding a new license for naturopaths was decisively killed in subcommittee this week as well. On Sunday, the House and Senate money committees will be releasing their subcommittee reports and we’ll see for the first time if provider rates remain untouched. We’ll keep you up to date on what transpires this weekend. Crossover is Tuesday, February 10th when each house has to complete their business- this was a busy week with lots of bill activity!
Issue for the Upcoming Week:
HB 1703 (Cosgrove) Indoor Clean Air Act; unlawful for any person to smoke in establishment built after July 1, 2010. This bill will be on the floor on Monday for a vote. We need your help to make sure this passes—not all the Republicans are in support, despite the support of Speaker Howell. Please call or email your delegate and let them know your support. VACEP is actively supporting this bill and working with the Medical Society of Virginia on its passage.
Thank you for your help! - Aimee Perron Seibert |
January 30, 2009 This was a busy week with lots of action on the bills we are following. One of our perennial priorities- primary seatbelt laws- were killed on both the House and Senate side. More sobering than the death of those bills was the swift demise of the House cigarette tax bills. We certainly knew they would not face a warm reception in the House of Delegates, but because they were so directly tied to filling the budget shortfall in the Medicaid program, we all hoped they would warrant a more viable debate. Not so. The Senate version is expected to pass, which gives us some time to educate the House members about how critical it is to not reduce Medicaid provider reimbursements and how that relates to the cigarette tax. The other tobacco issue- the Smoke Free bills- were heard in Senate Education and Health and were reported, 11-Y 3-N. They will pass the floor easily and are likely to get stuck in the House subcommittee like they did last year. Finally, Delegate Peace has a bill designed to enhance the penalty of assault and battery on emergency room personnel. Because this will have a fiscal impact, the outcome of this bill was doubtful. Advantageously, the Hospital Association had asked Senator Stolle to submit a study bill to examine the rising incidence of violence in the emergency room. That bill, SJR 358, was reported out of Senate Rules this morning. The House Courts of Justice committee has recommended sending HB 2436 (Peace) to the Crime Commission to be studied as directed by SJR 358.
Other Issues for the Upcoming Week: SB 947 (Howell) State cigarette tax, increased. This bill will likely be up in Senate Finance on Tuesday or Wednesday. We need your help to make sure this passes-- this money is slated to go directly to fill the hole in Medicaid, preventing any state cuts to the provider rates. VACEP is actively supporting these bills and working with the Medical Society of Virginia on their passage. HB 1820 (Kilgore) Naturopathy; establishes licensure requirements to practice. This is a re-occurrence of the bill we saw last year. While the patron has altruistic intents-- to increase the access to primary care medicine in underserved Southwest Virginia— the medical community is unified in their opposition to this bill because they believes the lack of evidence-based research findings, as well as the difference in levels of competency upon completion of the naturopathy education, does not support independent practice. This bill will be in House Health, Welfare and Institutions-Health Subcommittee on Monday at 5pm. VACEP opposes this bill. House and Senate Budget Amendments to study the proposed consolidation of the VA Poison Centers (Barker/Morgan) House: Item 297#4h, Item 11 #1h and Senate: Item 297#2s, Item 11#1s. In the current budget, one of the suggested cost saving measures is a line item recommending consolidating the three VA poison centers into one center and cutting close to 70% of the funding- from $1.5 million to $500,000. VACEP has serious concerns about the lack of a plan on how to ensure the current level of service with such a dramatic cut in funding. Emergency departments would be disproportionately affected because not only do they utilize the toxicology services for patients in the ED, the poison centers also reduce visits to the ED by giving callers the tools to mitigate potential poisonings in their home. VACEP supports the proposed study in the Joint Commission on Healthcare, while reinstating the money until there is a well-thought out plan. VACEP supports these budget amendments. Thank you for your help! - Aimee Perron Seibert |
January 23, 2009
VACEP has reviewed almost all of the bills that have been filed in 2009 and as you can see from our list, there are a lot of bills that we will be keeping close tabs on this session. We’ll be supporting some bills we’ve seen in the past-- making seatbelts a primary offense—and some new ones—making it a felony to assault emergency room personnel. We have a separate bill list where we are again tracking all the changes to the mental health laws. Unlike last year, the bills this year are much more technical in nature and do not specifically affect the practice of emergency medicine. Therefore, we will continue to monitor their progress to ensure that they do not get amended to have an impact on emergency medicine. A very important issue that has come up that hasn’t gotten much press is the Governor’s proposed consolidation of the three Virginia Poison Centers and a 66% budget reduction. This is a critical issue for emergency physicians for two reasons: 1. The Poison center staff answer thousands of questions from physicians dealing with unknown toxins in the emergency room; and 2. If the centers lose their funding and have to reduce staff, the number of visits to the emergency room could increase in the Central Virginia area alone by 50-60,000. Stay tuned and keep checking back on the website for the final installment of VACEP’s position on the bills. Other Issues this Week: HB 1820 (Kilgore) Naturopathic doctors; licensure requirements for practice. This bill is on the docket for House Health, Welfare, and Institutions – Health Subcommittee on Monday, Jan 26 at 5pm. The Medical Society and the Academy of Family Physicians have both met with the patron and the naturopaths to discuss their very serious concerns about licensing naturopaths in Virginia; however, the bill was put forth again as an answer to the physician shortage in Southwest Virginia. VACEP opposes this bill.
SB 870(Lucas)/ SB 1002 (Quayle) Indoor Clean Air Act; dealing with local ordinances. These bills address the issue of smoking in restaurants at the local level, not statewide bans like the other bills listed in our comprehensive bill list. VACEP is in favor of these bills and signed on to the Virginians for a Healthy Future coalition working on these issues.
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January 16, 2009 The first three days of session were filled with budget briefings on the dismal state of our economy that also provided a venue for legislators to air their concerns about the Governor’s budget reductions. One of the greatest areas of concerns for legislators occurred in the Health and Human Resources section of the budget- the closure of inpatient psychiatric beds at the Commonwealth Center for Children and Adolescents (CCCA) in Staunton and the adolescent unit at Southwestern Virginia Mental Health Institute (SWVMHI) in Marion. There are already numerous budget amendments in to reverse the Governor’s action and keep the two centers open- Delegate Saxman and Delegate Landes are taking the lead in the House and Senator Wampler and Senator Hanger in the Senate. Time after time, the Administration representatives repeat that they held harmless the reimbursement rates for doctors and the legislators have said they will do the same- we will keep close watch to ensure that promise holds true. The medical malpractice cap was not supposed to be an issue this year- the Virginia Trial Lawyers Association decided not to pursue an increase because the time wasn’t right. However, two legislators have introduced bills on their own--Senator Marsh has introduced one to increase the cap and Senator Stolle has filed a bill that creates a new pot of money that is funded by provider fees. We will continue to oppose these bills because they do nothing but jeopardize patient access to care and drive up the cost of practicing medicine. All the bills are not filed yet, so we will continue to monitor the bills and identify VACEP’s positions as soon as possible. - Aimee Perron Seibert |