Throughout the current legislative session in Richmond, taking place from Jan. 14 to March 14, Virginia legislators have proposed policies that could change patient care, impact U.Va. Health’s revenue cycle, help alleviate workforce shortages and influence physician employment contracts. In addition to these key subjects, the University’s health system is also monitoring budget proposals in light of a potential state budget deficit due to decreased federal funding to public health state programs from the federal government.
Crossover — the date for bills to move to the other chamber for consideration — occurred in the General Assembly Tuesday. Crossover cut the number of bills that still stand for voting.
Following a passing vote from both chambers, the bills will then move to the governor in the following weeks to be signed into law. As a result, U.Va. Health would feel the operational impact of these bills in the coming months, with bills passed going into effect July 1.
U.Va. Health representatives regularly meet with legislators to discuss the system’s priorities and share developments the system has seen over the past year, both when the General Assembly is in session considering legislation and not in session.
According to Jennifer Siciliano, U.Va. Health’s chief external affairs officer, one policy area that representatives from the health system have been monitoring and supporting is policy that affects telehealth coverage — coverage for virtual appointments — for patients through state-funded Medicaid programs. Siciliano said that the health system is particularly interested in tracking and advising legislators on House Bill 1284, presented by Del. Mark Downey (D-69).
HB1284 further clarifies coverage for telehealth services — specifically, how Medicaid programs should reimburse providers for provider-to-provider consultations. The proposed telehealth services include remote patient monitoring, emergency medicine services provided via telehealth and remote ultrasound procedures.
Specifically, this bill would mandate Medicaid coverage for remote patient monitoring for certain high-risk patients — such as patients who have undergone an organ transplant, those with high-risk pregnancies and medically complex infants and children. Siciliano shared that this bill is especially important for patients in rural communities, many of which rely on Medicaid for insurance coverage.
Under the current Code of Virginia, provider-to-provider consultation may be covered under Medicaid policy, but this coverage is not explicitly spelled out. The bill primarily serves to codify Medicaid reimbursement for telehealth services.
Siciliano shared that HB1284 is of interest to the University’s health system because around 25 percent of the total revenue of U.Va. Health stems from Medicaid programs.
Another piece of legislation that the University’s health system has been tracking is HB627, proposed by Del. Charniele L. Herring (D-4). This bill will prevent employers and health care professionals from entering into non-compete clauses in employment contracts. These clauses within physician contracts restrict clinical professionals from working within a specific radius after exiting a position with U.Va. Health for a period of time.
Siciliano said that the University’s health system somewhat opposes this bill because they believe it will negatively impact the financial position of the health system.
According to the fiscal impact statement presented by U.Va. Health, VCU Health and the Department of Labor and Industry, both systems expect to have an increase in their employee turnover rates. VCU expects its turnover rate to rise from 6 percent to roughly 7 percent, resulting in about $31.4 million in losses. U.Va. Health reported that their turnover rate could increase from 7.3 percent to 10 percent, resulting in a possible $11.9 million dollar loss to the University Medical Center alone.
Siciliano shared that her team is continuing to work with the patron to attempt to find a middle ground.
“We are working with the patron of the bill to try and get it to a point where it would be acceptable … [and] get it to a place where the fiscal impact isn’t as significant,” Siciliano said. “Nobody’s going to be happy [all of the time] but that is part of the nuance of this job is trying to find the balance.”
The health system is also actively working to support bills that will help promote workplace safety for its employees. One bill in particular that aligns with this mission is SB173, proposed by Sen. Angelia Graves, (D-21) Jan. 8. This bill will make it a class one misdemeanor to enter the building of any hospital providing mental health services or emergency room with a firearm, knife with a blade over 3.5 inches or other dangerous weapon. A class one misdemeanor is the highest-level serious misdemeanor charge and can result in jail time of up to 12 months in a local or regional jail and up to a $2,500 fine.
In addition to SB173, Siciliano said she and her team are advocating for HB1489, proposed by Del. Kathy Tran, (D-18) Jan. 23, which will mandate more in-depth reporting of instances of workplace violence in hospitals. The bill will require additional formal documentation of workplace violence events, require hospitals to report these instances to additional parties such as the Virginia Department of Health and will mandate that the Department of Health publish an annual report summarizing this data.
On the academic side of the health system, representatives are also monitoring bills that could directly influence the School of Medicine. SB625, presented by Del. Rodney Willett (D-58) Jan. 13 would establish a new program known as the “Medical Education Loan-for-Service Fund and Program” if passed.
This program would allow students receiving a medical education from an accredited institution to receive a state-funded loan for the medical education, under the condition that they work in a rural or underserved community following their education. The bill would allow for $3 million to be distributed annually in $50,000 loan amounts. Siciliano shared that she believes this bill will not only help to address workforce shortages, but also improve patient care in rural regions of the Commonwealth.
“We want to keep the [doctors] that we educate here in Virginia,” Sicilano said. “We have a workforce shortage … and helping our medical students manage some of that debt that they’ve got coming out of medical school, while at the same time encouraging service … to rural communities.
An important cornerstone of the health system’s work in Richmond, according to Sicilano, is working with other Virginia-based health systems to present a united front on pieces of legislation and issues on which they align. Siciliano shared that U.Va. Health is a member of the Virginia Health Care and Hospital Association, where they advocate for particular pieces of legislation of interest alongside like-minded systems like VCU Health.
“We have weekly meetings during the session to talk about bills to work out any issues that individual hospitals have so that we can provide a united front on some of these bills,” Siciliano said. “[Inevitably] you’re going to have things that people disagree on, but for the most part, we all support each other.”
Siciliano said that the health system is also facing some challenges in light of cuts of funding from the federal government, which is requiring them to change how they prioritize delivering their patient care and community services. Siciliano shared that they do not know the long-term effects of the cuts, but she said the cuts increase the need for a “safety-net” for community members who cannot afford healthcare.
Some bills have already been passed in the Virginia House of Delegates, including HB483, which was passed Feb. 13 and was proposed by Del. Karrie Delaney (D-9). The bill will establish a new board in the Commonwealth of Virginia known as the “Prescription Drug Affordability Board.” This board will serve to monitor drug prices in the Commonwealth and ensure that drug prices remain affordable for Virginians and the healthcare system.
This bill has since moved to the State Senate for consideration. If it is passed in the State Senate, it will be presented to Gov. Abigail Spanberger to be signed into law following the conclusion of the session March 14. Gov. Spanberger will have 30 days following the conclusion of the legislative session to approve, modify or veto legislation passed in the General Assembly.
This year’s legislative session will run through Mar. 14, and bills will continue to be voted on in the two chambers throughout the legislative session. After voting, the remaining bills will be signed into law by the governor after the session concludes. Bills that are signed off on by the governor will go into effect July 1.
