2017 Legislative Priorities
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 and have created a legislative work group to monitor the changes in the ACA and determine their impact on Virginia.
Mental health reform remained a consistent topic of discussion, but without a lot of true reform occurring. 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.
The opioid epidemic was a huge focus of the 2017 legislature. As part of the opioid conversation, VA AAP supported bills that focused on the most vulnerable victims of the opioid epidemic- babies suffering from Neonatal Abstinence Syndrome (NAS). Below are the opioid related bills and budget items:
Every year we face bills that seek to change the scope of practice for mid-level providers. We saw a bill that was the first in the nation- a bill to create a doctorate of medical science put forth by Lincoln Memorial University in Tennessee.
Final Budget Items
Budget Item 30#2c:
This amendment adds language directing the Joint Commission on Health Care to examine and identify strategies to increase public awareness of the risks and concerns related to the use of psychiatric medications used to treat Attention Deficit Hyperactivity Disorder (ADHD) and other disorders.
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 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.
2016 Legislative Session, Final Update
March 14, 2016 – The 2016 Virginia General Assembly adjourned a day early this year. Sine Die was on Friday, March 11 and the legislators returned home after passing over 1,700 bills and sending a budget to Governor McAuliffe. It was a successful session, but certainly had its share of controversial issues. Legislation regarding the Certificate of Public Need Program was a hot topic this year, as well as the appointment of a judge to the Virginia Supreme Court. While these issues brought out partisan politics, we also saw the parties working collaboratively to advance good policy measures for Virginia. Governor McAuliffe and Republican leadership were able to work together to pass historic, compromise legislation regarding firearms. The Virginia General Assembly continues to be an example for the rest of the nation on how to govern effectively, despite political differences.
Speaking specifically to pediatric issues, we had a very successful session and are pleased with the outcomes!
Smoking in Cars
After seven years, we were finally able to pass legislation prohibiting smoking in cars with children! HB 1348 (Pillion) will make it a secondary offense to smoke in a car when a child under the age of eight is present, tying it to the current car seat laws. The bill passed both the House of Delegates and Senate and is awaiting Governor McAuliffe’s signature. Thank you to everyone for their advocacy this year and past sessions on this critical legislation that will truly make a difference for Virginia children!
Independent Practice for Nurse Practitioners
There were numerous bills introduced at the beginning of session that would have granted various types of independent practice for nurse practitioners. Luckily, we were able to work out compromise language with the patrons that addressed their concerns, but does not grant independent practice. The amended bills now address what happens in the event a NP’s collaborating physician dies, loses his or her license, retires, or becomes disabled or relocates his or her practice. NPs will now have a 60-day grace period where they can continue to provide care if any of these situations arise, as long as they notify the Board of Medicine and Nursing and the NP will only be able to prescribe those drugs previously authorized by the practice agreement and have access to appropriate physician input in complex clinical cases and patient emergencies and for referrals.
Another bill, SB 369 was amended to create a pilot program that would encourage the use of telemedicine in the collaboration between NPs and physicians, a practice that is already allowed within the current framework. The final budget report included $200,000 in funding for this pilot program and VA AAP is named as one of the stakeholders in the bill for the pilot program.
Prescription Monitoring Program/Substance Abuse
There were several bills regarding the prescription monitoring program and benzodiazepine/opioid abuse. The physician community was able to amend the bills to address initial concerns and removed benzodiazepines from the legislation. SB 513 (Dunnavant) and HB 293 (Herring) both require prescribers to check the PMP before prescribing opioids for 14 days or more, except in certain cases.
HB 657, a bill developing criteria for indicators of inappropriate prescribing patterns carried by Del. O’Bannon, was signed into law by the governor on Mar. 1.
In addition, the final budget included a new program establishing Medicaid benefits for substance abuse disorder treatment, . We are thrilled the final budget includes $11 million in general funds and $11 million in federal matching funds over the biennium to implement a comprehensive Medicaid benefit package for substance abuse disorder treatment. This will be especially helpful for women who are abusing substances and are pregnant so they can get the treatment they need.
The benefits will include:
- Expand short-term inpatient detox for up to 15 days to all existing Medicaid members (currently only available to children);
- Expand short-term residential substance abuse treatment for up to 30 days to all existing Medicaid members (currently only available to children and pregnant women);
- Increase rates for existing substance abuse treatment services currently covered by Medicaid by 50% for Residential Treatment and Substance Abuse Day Treatment for Pregnant Women and Substance Abuse Case Management and by 400% for Substance Abuse Day Treatment, Substance Abuse Intensive Outpatient, and Opioid Treatment – the counseling component of Medication Assisted Treatment (MAT) for opioid addiction. These rate increases would create sustainable Medicaid funding streams allowing doctors to hire counselors and social workers who can support them in providing addiction treatment.
Unfortunately, legislation to prohibit indoor tanning for minors under the age of 18 was not successful. HB 356 (Garrett) was defeated in subcommittee by a tie vote of 5-5. However, the FDA has proposed indoor tanning regulations that would ban it for minors. We are hopeful these regulations will move forward and legislation on the state level will no longer be necessary to protect Virginia’s children.
We saw the infamous “raw milk” legislation again this year. Luckily, working with our agriculture colleagues, we were able to defeat HB 62 (Morris) once again. Thank you to Dr. Sam Bartle for testifying against the bill and informing legislators on the dangers of raw milk! On another note, West Virginia recently passed legislation allowing this and legislators shared a round of raw milk in celebration. Unfortunately, they quickly felt the effects and suffered from stomach illness. Hopefully that will serve as a warning to other states!
Unfortunately, our amendment to create a pediatric mental health collaborative program was not included in the final budget. However, we plan to regroup and figure out if we can move forward without the budget amendment so that we can come back next year and ask for specific pilot programs to be created and funded instead. We will continue to work with Voices for Virginia’s Children and Secretary Hazel.
We are pleased the budget does include other funding initiatives focused toward children’s health. Both Children’s Hospital of The King’s Daughters and Children’s National Health System received additional funding toward inflation and physician payments. Funding was also included to extend foster care and adoption assistance to age 21 through the Fostering Futures Program- an initiative advocates have been working on for the last couple years.
The budget also includes an additional $13.5 million for home visiting programs and $4.2 million to increase funds for early intervention (Part C) services.
The budget also creates 25 new graduate medical education residency slots ($2,500,000 in FY2018). Of the 25 slots, 13 shall be for primary care and 12 shall be for high need specialties. Preference shall be given for residency slots located in underserved areas
Governor McAuliffe now has 30 days to review passed legislation and the budget. He will use this time to sign bills, veto bills or offer amendments. He also has the ability to line-item veto or amend the budget. The legislature will reconvene on Wednesday, April 20 to review and vote to accept or reject his recommendations. We look forward to updating you once again in late April.
2016 Legislative Priorities
Preservation of Team-Based Patient Care
Oppose NP Independent Practice bills
- In 2012, the physician community and the nurse practitioners agreed upon a new model for care that was a team based and led by a physician. This model is collaborative and we believe provides the best patient care while allowing everyone to practice to the fullest extent of their education and training.
- We would support compromise language that has been proposed raising the ratio of nurse practitioners and physicians from 1 to 6 to 1 to 9 for free clinics and Federally Qualified Health Centers in underserved areas.
- We also support compromise language that allows nurse practitioners whose collaborating physician dies, moves away or loses their license to practice for a limited time with the local health director serving as their collaborating physician until a new private physician can be found.
HB 1342 (Filler-Corn/Stolle)
- Support legislation to only allow children to be exempted from the school entrance required vaccines if there are medical contraindications.
- Routine childhood immunization is one of our crowning achievements in public health over the past century. A 2013 New England Journal of Medicine study estimated that childhood vaccination programs have prevented 103.1 million cases of diphtheria, hepatitis A, measles, mumps, pertussis, polio and rubella since 1924. A 2005 Archives of Pediatric and Adolescent Medicine study estimated that for every dollar spent in the US, vaccination programs saved more than $5 in direct costs and approximately $11 in additional costs to society.
- 71.6% of children between the ages of 19 and 35 months were immunized according to ACIP/AAP/AAFP/ACOG recommendations in 2014.
- However, challenges remain. 28,660 cases of whooping cough (pertussis) were reported in the US in 2014. A multistate outbreak of measles linked to an amusement park in California led to 188 cases in 24 states from Jan 1 to Aug 21, 2015. Most measles patients were unvaccinated against the disease.
Child Safety: Ban Tanning for Children under 18 Support
HB 356 (Garrett)
- Support legislation to prohibit minors younger than 18 from using tanning facilities.
- Sunlamps and tanning beds are the main sources of deliberate artificial UVR exposures. The intensity of UVA radiation produced by large, powerful tanning units may be 10 to 15 times higher than that of the midday sun.
- •rtificial tanning is a common practice among teenagers. Use of a tanning facility at least once in their lives was reported by 24% of non-Hispanic white teenagers 13 to 19 years of age in a US sample.
In another national survey, 10% of youths 11 to 18 years of age reported using indoor tanning sunlamps in the previous year.
Protect Children from Secondhand Smoke in Cars Support
HB 1348 (Pillion)
- Support legislation to prohibit smoking in cars when children under the age of eight are present.
- Exposure to secondhand smoke in cars is especially dangerous for children
- Secondhand smoke in motor vehicles can be up to 27 times more concentrated than in a smoker’s home.
Virginia Pediatric Mental Health Collaborative Support
House: Item 306 #33h (Garrett) Senate: Item 310 #4s (Barker) FY17: $50,000
The VA AAP recognizes that the unmet mental health needs of young children, especially those who have not yet entered school, are great. We are committed to addressing the mental health needs of diverse children and their families through culturally competent and family focused initiatives. Our goal as pediatricians is to improve the integration of mental health in pediatric primary care for children in the Commonwealth, paying particular attention to the needs of infants, toddlers and preschoolers.
“2. The Virginia Center for Healthcare Innovation shall establish the Virginia Pediatric Mental Health Collaborative with the Virginia Chapter, American Academy of Pediatrics, Voices for Virginia’s Children, the Psychiatric Society of Virginia, VCU and UVA’s Department of Psychiatry, the Virginia Academy of Family Physicians, the Department of Medical Assistance Services (DMAS), the Department of Behavioral Health and Developmental Services (DBHDS), the Virginia Association of Community Services Boards and other relevant stakeholders. The goal of the Collaborative is to improve the integration of mental health in primary pediatric care for children in the Commonwealth.
By October 1, 2016, the Collaborative shall survey existing collaborative efforts between pediatricians, family physicians and the children’s mental health system and create a plan to implement pilot programs creating child mental health access projects through which a mental health consultation team is available by telephone to respond promptly to pediatricians who need assistance with managing their patients’ mental health needs. The consultation teams provide clinical consultation to enhance pediatricians’ abilities to evaluate, treat, co-manage and refer children with mental health problems.
During this planning grant, the Center shall be assisted when necessary by DMAS, the Virginia Center for Healthcare Innovation, and DBHDS, with technical assistance provided by Children’s National Health System, a co-founder of the DC Collaborative for Mental Health in Pediatric Primary Care.”
Medicaid Substance Use Disorder Benefit (SUD) SUPPORT
Item 306, MMMM and NNNN in Introduced Budget FY17 $2M FY18 $8M
Current community and inpatient options for substance abuse treatment programs are significantly limited, particularly for Medicaid patients. With the current opioid and prescription drug abuse crisis, we need to ensure that patients, especially pregnant woman, who seek treatment are able to receive it.
- Neglect due to SUD was the #2 reason that children entered foster care in Virginia in 2013 but 91% of caregivers with children in Virginia’s foster care system and substance abuse treatment needs reported they had not received treatment in the past 12 months.
- 1,085 Medicaid babies were born with Neonatal Abstinence Syndrome in Virginia in 2014, resulting in expensive NICU stays. Many of their moms couldn’t obtain opiate addiction treatment during pregnancy.
Therefore, we support the language in the introduced budget that makes more inpatient and residential treatment available, as well as raising rates for the provision of such services.