2017 General Assembly Ends, Funds Emergency Department Information Exchange program
2017 Legislative Priorities
Final General Assembly Report
The 2017 Virginia General Assembly session adjourned on Saturday, February 25. While this was a “short session,” the legislature was still very productive and considered over 2,000 bills in 46 days. The last agenda item they completed was voting on the final budget conference report, which passed the House 99-1 and 40-0 in the Senate.
This was Governor McAuliffe’s final legislative session and his last opportunity to get his policy priorities through. It is also an election year, with the entire House of Delegates and the statewide offices up for election in November.
As usual, healthcare continued to be a focus for the legislature. They were hesitant to pass any major reform bills due to the uncertainty at the federal level with the Affordable Care Act. One issue that was debated extensively is whether to reform the Certificate of Public Need program. Similar to last year, there was support in the House for reform, but the efforts came to a halt in the Senate. However, the Senate has said they will study this issue again over the next year, in context with the other changes coming down from the federal level.
One of the key healthcare innovation bills this session was one of VACEPs- establishing the Emergency Department Care Coordination Program. VACEP has been working on this project since the 2016 legislative session, including a study all last year with DMAS and VDH. It has culminated in the passage of two bills- HB2209 (O’Bannon) and SB161 (Dunnavant) and a budget amendment of $370K in general funds to leverage $3.7M in federal HITECH funds for every hospital in Virginia to deploy software to connect all the EDs in the state, as well as help to coordinate patient’s care and connect them to primary care.
HB2209 (O’Bannon) & SB1561 (Dunnavant) SUPPORT: ED Care Coordination – Budget Item 300 #3c
- Both bills have passed their respective houses unanimously and the budget language and $370,000 of state general fund dollars needed as the 10% match to apply for $3.3M in Federal HITECH funds were included in both the House and Senate budgets, as released on February 5th.
Mental health reform remained a consistent topic of discussion, but without a lot of true reform occurring. Money was included in the budget to implement “same-day access” standards at Virginia’s community services boards- $6,200,000. Also, the budget includes a $5M increase in permanent supportive housing funding, which is designed to help get patients out of state hospitals and prevent unnecessary hospitalizations, homelessness, or interactions with the criminal justice system. Finally, the General Assembly allocated a total of $500K for two different studies of the mental health system- half to the Secretary of HHR and then the other half to the Deeds Commission, which has been extended for another two years.
Mental Health bills we followed:
HB1777 (Stolle) SUPPORT: Establish a Protocol for Physician-to-Physician Communication During TDO Denials
- Signed into law by the Governor; effective July 1, 2017
- Stemming from situations that have occurred at Riverside Hospital, requires the Board of Health to promulgate regulations that require each hospital that provides inpatient psychiatric services to establish a protocol that (i) requires, for any refusal to admit a medically stable patient referred to its psychiatric unit, direct verbal communication between the on-call physician in the psychiatric unit and the referring physician, if requested by the referring physician, and (ii) prohibits on-call physicians or other hospital staff from refusing a request for such direct verbal communication by a referring physician.
SB1233 (Chafin) SUPPORT: Temporary Detention; Certified Evaluator
- Passed by indefinitely in Finance with a letter asking DBHDS to study the issue. Dead for the year.
- Would have allowed emergency physicians, along with several other mental health professionals, to perform Temporary Detention Order evaluations in cases in which the community services board is not available to perform an evaluation within two hours of receiving notification that an evaluated is needed.
The opioid epidemic was a focus of the 2017 legislature, the need for changes supported by preliminary numbers from VDH showing a 33 percent increase in opioid overdoses in 2016 with over 1,000 deaths. We were able to successfully divert bills that targeted emergency physicians with statutory prescribing limits by instead working together with MSV and the other specialty societies to instead direct the Board of Medicine to issue emergency regulations for opioid prescribing. In addition, a bill passed that authorized a new needle exchange program in at-risk communities; others made a number of changes to increase the availability of naloxone, an overdose-reversal drug. Another will require that all opioid prescriptions be made electronically by 2020.
HB2167 (Pillion) & SB1180 (Chafin) HB1885 (Hugo) & SB 1232 (Dunnavant) SUPPORT: Opioid Guidelines & Prescription Monitoring Program Requirements
- All four bills have passed and have either been signed by the Governor or are on his desk awaiting his signature.
- HB2167 & SB1180 directs the Boards of Medicine and Dentistry to adopt regulations for the prescribing of opioids and products containing buprenorphine.
- HB1885 and SB1232 (as amended) will mandate physicians check the Prescription Monitoring Program any time they prescribe a controlled substance containing an opioid for 7 or more days.
Other items we followed are below:
SB1327 (Carrico) OPPOSE: Doctor of Medical Science Licensure
- Passed by indefinitely in Education and Health and will be studied over the summer in a special legislative subcommittee.
- Establishes criteria for a brand new, first in the country, license for a ‘Doctor of Medical Science’
- Would create a pathway for physician assistants to practice independently with this new degree
- HB 1813 passed the House Commerce and Labor Committee, 14-7, but after significant opposition was raised by the Health Plans, the patron asked for the bill to be re-referred to committee to avoid a negative floor vote and to keep us in a favorable position and is dead for the year.
- The Senate bill failed to report in Senate Commerce and Labor and the patron asked for the bill to be referred to the Health Insurance Reform Commission to be studied in the interim. Senator Wagner then attempted to attach a floor amendment to a bill dealing with a similar code section, but it was ruled ‘not germane,’ meaning that it did not relate to original intent of the bill and was out of order.
HB 1728 (Ransone) PASSED: Creates a study group to review the processes involved in air ambulance transports. VACEP requested an amendment to add an emergency physician to the work group and the patron agreed. An EM physician will now be on the workgroup when the bill passes.
Budget Item 291#1c: This amendment requires the state teaching hospitals to work with the Department of Health and Division of Vital Records to fully implement use of the Electronic Death Registration System (EDRS) for all deaths occurring within any Virginia state teaching hospital’s facilities. Full implementation shall occur and be reported, by the Division of Vital Records, to the Chairmen of the House Appropriations and Senate Finance Committees by April 15, 2018, in alignment with Vital Records plans to promulgate and market the EDRS.
Budget Item 302#1c: This amendment put forth by MSV directs the Dept of Health Professions to develop and implement a real time prescription drug monitoring demonstration program with Medicaid prescribers using HITECH funds.
Budget Item 30#1c: This amendment directs the Joint Commission on Health Care to study options for increasing the use of telemental health services in the Commonwealth.
Budget Item 1#13c: This amendment adds language creating a joint subcommittee of the House Appropriations and Senate Finance Committees to respond to federal health care changes, provide oversight of the Medicaid and children’s health insurance programs, and provide oversight of Health and Human Resources agency operations.
The legislature will reconvene on Wednesday, April 5. They will review all of the Governor’s actions on bills, including the budget and vote whether to accept or reject his vetoes and amendments. Overall, it was a positive legislation session for VACEP. We don’t anticipate any issues to arise during veto session, but will update you if anything should change.