Where Emergency Medicine Stands at Crossover — VACEP | Virginia College of Emergency Physicians

Feb 7

Feb 7 Where Emergency Medicine Stands at Crossover

Tuesday was Crossover at the Virginia General Assembly, the time when active bills in the House of Delegates and Senate flip to the other chamber for review.

Thanks in part to an election year, mixed with a shorter 45-day session, 2025 has been a slower year for lawmakers and government affairs teams. Still, it doesn’t feel that way for those in Richmond: the organized chaos of lawmaking at the General Assembly is around-the-clock, and plenty of bills and proposals touch emergency medicine. VACEP is tracking nearly 100 pieces of legislation related to healthcare.

Here’s an update on a few key bills emergency physicians should care about, and where they stand. Session adjourns Feb. 22.

***Pulling a Double:*** Eastern Virginia Medical School emergency medicine resident Dr. Emory Newkirk (‘26) spoke at a press conference on January 22 in Richmond on a bill related to illicit cannabis enforcement, then returned to the Capitol this month to testify in support of legislation to require hospitals to report threats of violence or battery against healthcare workers.

Bills VACEP Opposes

Raising the Med Mal Cap in Certain Cases SB904 (Sen. Bill Stanley, R-Franklin)

Status: Defeated

Would have eliminated the medical malpractice cap in cases where a patient is age 10 or younger.

Why VACEP opposed: Virginia’s medical malpractice cap is $2.65 million. It applies to all med mal claims, including those tried by a jury or judge. The cap increases by $50,000 each year until reaching $3 million on July 1, 2031.

Removing or modifying the med mal cap will significantly increase the cost of providing and receiving healthcare in Virginia. Under the existing cap, liability costs for doctors or hospitals will increase by 11%. Without a cap and a claim as high as $50 million, costs would rise more than 112%, according to a study by Milliman.

Consider also: The Commonwealth faces a healthcare professional workforce crisis, and many providers on the front lines are already strained, dealing with career fatigue, and other mental health issues.

Where we stand: Healthcare providers and the Virginia Trial Lawyers Association support Virginia's current medical malpractice laws. In 2010 and 2011, VACEP worked with the trial lawyers to reach a consensus on updates to the cap. Lawmakers approved an increase of $50,000 per year until 2032. This model was created to give stability and certainty for all stakeholders.

A study on physician assistant (PA) independent practice HB2489 (Del. Rozia Henson, D-Prince William)

Status as of Feb. 7: Passed House, under review in Senate

The legislation directs the Department of Health Professions to conduct a study on expanding scope of practice for physician assistants in Virginia to increase their autonomy. In addition to reviewing the education and training requirements for PAs in the Commonwealth and other states, the study includes an analysis of the costs and benefits to patients should PAs be given increased autonomy. The study would be due to the House Committee on Health and Human Services by Nov. 1.

Eliminating supervision of Certified Registered Nurse Anesthetists HB2391 (Del. Mark Sickles, D-Fairfax)

Status: Defeated

This bill would have eliminated the requirement that certified registered nurse anesthetists (CRNAs) practice under the supervision of a physician.

Instead, it would require them to practice in consultation with a physician and in accordance with regulations jointly overseen by the Virginia Board of Medicine and Virginia Board of Nursing.

Why do we oppose Scope of Practice bills? Here’s an explainer.

Equalizing insurance reimbursements for all providers SB1290 (Sen. R Creigh Deeds, D-Albemarle)

Status: Failed

The bill would have paid all practitioners the same for providing similar care. While the bill is dead for the year, it is being studied, and VACEP will continue to monitor it.

Bills VACEP Supports

VACEP President Jesse Spangler, MD, FACEP offers a look at EM Advocacy Day 2025, along with photos from the day.

Reporting of violent threats or battery against healthcare providers HBB2269 (Kathy L. Tran, D-Fairfax) & SB1260 (Lachrecse Aird, D-Henrico)

Status as of Feb. 7: Both bills have unanimous support in their respective chambers and continue to work through the process.

The bills require Virginia hospitals to report any threat or battery against a working healthcare provider while on premises of a medical facility. Hospitals would have to report relevant data quarterly, and the Department of Health would publish aggregate numbers on its website.

ED Workplace Violence statistics:

91% of emergency physicians have been attacked or threatened in the past year.
One-quarter report being assaulted multiple times per week. Many ER workers decline or are encouraged not to report assaults.
And only 2% of hospitals press charges.

Source: ACEP

Why VACEP supports: Every Virginia emergency physician and ER nurse has a story of workplace violence — likely from that day or week — that they have experienced from unruly patients or visitors. Transparency in hospital reporting is good for patient, physician, and staff safety. Passage of the bill will allow hospitals to collect data to more deeply understand, and respond, to the issue of workplace violence.

More flexibility for Psychiatric Emergency Departments HB1895 (Rodney Willett, D-Henrico) & SB1094 (Sen. Emily Jordan, R-Suffolk)

Status as of Feb. 7: Both bills have unanimous, bipartisan support and are moving through the opposite chamber.

The busy and often chaotic emergency department is not the proper setting for patients having a mental or behavioral health episode. In fact, the ER can make their symptoms worse. Psychiatric emergency departments are specifically made — in design, and in resources — for these vulnerable patients. The goal is to give them a more appropriate setting for care, reduce boarding, and get patients the help they need faster.

The bill would: Strike “adjacent” from the Code language to allow for greater flexibility in the location of a psychiatric ED. An amendment requires a physician be physically present in the psychiatric ED 24/7/365 (a law that goes into effect July 1, 2025).

VACEP’s position: We support the bill with the amendment, aligning standards for a psychiatric ED to the requirements of all Virginia emergency departments as written in the Code of Virginia § 32.1-127 B.2.

Keep in mind: Federal law (the Emergency Medical Treatment and Labor Act, or EMTALA) requires participating Medicare facilities provide emergency care to anyone who needs it, regardless of insurance or ability to pay. EMTALA ensures all people get the care they need.

A carveout for narcotic treatment programs on the PMP HB2649 (Del. H. Otto Wachsmann Jr., R-Isle of Wight)

Status as of Feb. 7: Passed the House unanimously and moving through the Senate.

Removes the current exemption that licensed narcotic maintenance treatment programs are not required to be reported in the Prescription Monitoring Program.

What it means: These treatment programs would now be obligated to be reported to the state's monitoring system. This means you will be able to see when methadone and similar treatments have been prescribed to your patients. The bill has a delayed effective date of July 1, 2026.

Delayed reporting of medical records HB1732 (Del. Cia Price, D-Newport News)

Status: Failed

Would require healthcare entities to wait 72 hours before disclosing test results that could indicate malignancy or genetic markers as part of a patient's health records. The bill is supported by medical providers but met some opposition from the Children’s Hospital of The King’s Daughters (CHKD) with concerns over implementation. Discussions will continue this year and VACEP is committed to working out the issues.