The Latest from the Virginia General Assembly Frontline
The virtual session of the oldest continuous law-making body in the Western Hemisphere (that'd be the General Assembly, est. 1619) concludes on March 1 (Monday). As you know, we have been tracking multiple issues that can impact — and indeed, are currently impacting — emergency medicine in Virginia. Here are critical bills we monitored. Thanks to the many members who responded to our "Action Alerts" and sent messages to lawmakers advocating or opposing certain bills. The work continues, but for now:
ER Utilization Budget Item
The General Assembly declined to act and did NOT remove the offending language in the budget. Background: In July 2020, Virginia implemented the Medicaid ER Utilization program, penalizing emergency physicians and hospitals by automatically downcoding any condition found on a list of 790 Medicaid claims. More on the issue here, along with a video overview from the Virginia Hospital & Healthcare Association. Originally, we proposed a replacement solution to the program. While VACEP and our allies continue to favor the full elimination of the ED utilization penalties, in the final days of the 2021 General Assembly, we asked Virginia lawmakers for a suspension of the program due to the COVID-19 pandemic.
Medical Malpractice Cap Elimination | SB1107
The bill, passed by indefinitely and therefore dead for the year, would have eliminated Virginia’s medical malpractice cap. Caps dictate the maximum amount that a patient, family, and their attorney can recover in a medical malpractice lawsuit. Caps make medical malpractice insurance affordable and ensure access to quality patient care. However, it should be noted that there is a clear feeling in the General Assembly that this issue needs to be revisited, despite us being only eight years into a 20-year deal with the trial lawyers. This issue will be studied in the interim, and we expect to see legislation again in 2022.
Scope of Practice/Nurse Practitioners | HB1737
We opposed a bill (which passed) that will reduce from five to two the number of years of full-time clinical experience a nurse practitioner must have to be eligible to practice without a written or electronic practice agreement. We were able to attach a sunset clause to the bill, which means without further action from the legislature, on July 1, 2022, the clinical requirement will revert back to five years. This gives the Department of Health Professions time to finalize their three-year report on NP independent practice that is due in November. We expect we will have to fight this issue again in the 2022 session.
Scope of Practice/Certified Nurse Midwives | HB1817
After being placed into conference to work out differences between the House and Senate, a bill is likely to pass that will allow Certified Nurse Midwives (CNMs) to deliver babies in all settings, including the home, with 1,000 supervised hours after graduating from a CNM program and obtaining a practice license. Adding 1,000 hours was the compromise reached by legislators. However, we were disappointed a re-enactment clause wasn’t kept, which required the bill to pass again in 2022 before it becomes law. Language around a DHP study was also not kept.
Naturopath licensures |HB2272
The bill, dead for the year, would have licensed naturopaths in Virginia and allowed them to practice outside their education and training. We opposed.
Naloxone and opioid use workgroup amendment|HB2300
We supported a bill after it was amended to make it permissive and not mandatory. The bill passed, and requires hospitals to include language in their protocols about options physicians can employ when discharging a patient after an opioid overdose. The bill also creates a workgroup to examine best practices in the emergency department for treating and discharging individuals experiencing an opioid-related emergency, such as an overdose. We'll have more to share soon, and will be in need of members to serve on the workgroup.
Fair Business Practice Act| HB2274, HB2021, and SB1289
When these bills were introduced, VACEP opposed because they would have added an arbitrary 90-day submission for claims. However, we were able to defeat two of the bills, and they will instead be sent to the Health Insurance Reform Commission to be studied in the interim. The one bill that passed, SB1289, was stripped of the language we opposed and now only includes anti-discriminatory language.
Special thanks to VACEP lobbyist Aimee Perron-Seibert for her hard work (and hundreds of hours on Zoom and watching virtual meetings), along with these recaps.
