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Legislative Update

By James Pickral
PSV Lobbyist

James Pickral

The Psychiatric Society of Virginia has been hard at work advocating for the profession and working on issues important to psychiatry and medicine in general.  There are several important policy initiatives that directly impact us and our patients that were dealt with during the 2016 session of the General Assembly and that will again be issues during the 2017 session. 

Step Therapy
Several bills were introduced that would have streamlined the step therapy process used by health plans.  While these bills were not successful, they were referred to the Health Insurance Reform Commission (HIRC) for consideration.  During the commission meeting several legislators voiced very strong views on the need to reform the step therapy process as it relates to mental health drugs.  We expect legislation dealing with this issue during the 2017 session.  Below are the 2016 bills:

HB 362 (Davis) Accident and sickness insurance; step therapy protocols, disclosure of information. Requires health insurers that limit coverage for prescription drugs through the use of a step therapy protocol to have in place a process for a prescribing provider to request an override of the protocol for a patient.

SB 331 ( DeSteph) Accident and sickness insurance; step therapy for psychiatric medications. Prohibits a health insurer or other carrier from using step therapy in a manner that results in a denial of or delay in coverage for any psychiatric medication under a health insurance policy or plan. 

SB 332 (DeSteph) Accident and sickness insurance; step therapy protocols. Requires health benefit plans that restrict the use of any prescription drug through the use of a step therapy protocol to have in place a clear, convenient, and expeditious process for a prescribing medical provider to request an override of such restrictions for a patient. 

Reform of our current Certificate of Public Need system was the most contentious health care issue during the 2016 session.  PSV advocated for removing psychiatric beds and mental health facilities from the COPN process.  This was included in the final omnibus reform bill.  However, the bill was ultimately unsuccessful.  COPN will be a major issue once again in the 2017 session.   Recently, a piece of legislation was filed to remove psychiatric hospitals from the process.  We will keep you updated as this issue unfolds in the coming months.
Opioid and Heroin Abuse
Virginia’s opioid and heroin crisis continues to worsen.  We have seen an increase in overdose deaths statewide.  Last year several pieces of legislation were passed to help combat the problem.  We can expect the issue to be a point of emphasis during the 2017 session.  Several items are being discussed including regulation of suboxone clinics, increasing the availability of naloxone, and a requirement that treatment of addiction using suboxone include a counseling component.  There are sure to be several others.
PSV has been active in discussions on how to expand the use of tele-medicine and tele-psychiatry.  We have participated in this area with the Deeds Commission as well as the Medical Society of Virginia work group.  The final touches are currently being put on legislation that will hopefully accomplish this goal.

The State Budget
Virginia’s budget currently has a 1.5 billion dollar revenue shortfall.  The Governor has mandated 5% cuts across all agencies and has released a reduction plan.  During the last session PSV was very active in budget negotiations.  We were successful in removing funding that was to be used to plan the closing of Catawba.  We also successfully advocated for the establishment of a substance use disorder benefit under Medicaid.   We will closely monitor upcoming budget negotiations.

Medical School Visits

During the summer PSV travelled to UVA, VCU, and EVMS to speak to residents and students about the society and our advocacy efforts on behalf of psychiatry.  We were pleased to have several legislators join us.  Our UVA visit included Delegate Scott Garrett, VCU included Delegate Jennifer McClellan, and Lt. Governor Ralph Northam joined us at EVMS.


2016 Elections Shake up Virginia’s Political Environment
in Expected and Unexpected Ways

By James Pickral
PSV Lobbyist

Republican Donald Trump’s upset win over Democrat Hillary Clinton for the U.S. presidency instantly changed the dynamic of Virginia’s upcoming gubernatorial and other state races. Clinton’s Vice Presidential nominee Tim Kaine will return to the U.S. Senate where he has already said he wants to stay, effectively launching his 2018 reelection campaign. Terry McAuliffe, who was speculated to take a high-level post in a Clinton Administration, will stay in the governor’s mansion. Congressman Bobby Scott, considered a leading candidate to be appointed by Governor McAuliffe to fill Senator Kaine’s seat had Kaine been elected Vice President, will remain in the House of Representatives.

Ralph Northam will also serve out his term as Lieutenant Governor instead of being elevated to Governor had McAuliffe joined the Clinton Administration, denying Northam a high-profile incumbency as he seeks to succeed McAuliffe who cannot run for a second consecutive term under Virginia’s constitution. However, Virginia has historically elected a governor of the opposite party occupying the White House (with the recent exception of Democrat McAuliffe elected during President Obama’s term). With Trump ushering in a Republican presidency, Northam may look to Virginia’s political history as he potentially faces GOP presumed front-runner Ed Gillespie should he win the June 2017 primary against at least three other challengers seeking the nomination, including Prince William County Board of Supervisors Chairman Corey A. Stewart, state Senator Frank Wagner and U.S. Representative Rob Wittman.

In Virginia’s open congressional seats, as expected, Delegate Scott Taylor (R-Va Beach) won in the 2nd District, state Senator Donald McEachin (D-Richmond/Henrico) won in the 4th District and state Senator Tom Garrett (R-Louisa) won in the 5th District. These victories create openings in their respective General Assembly seats that candidates are already lining up to fill. In House District 85 (Taylor), Republican “Rocky” Holcomb is expected to square off against Democrat Cheryl Turpin. In Senate District 9 (McEachin), sitting Delegate Jennifer McClellan has declared her candidacy.  If elected, her House seat would then become vacant and some Richmond public officials are expressing interest. In Senate District 22 (Garrett), Republicans Mark Peake and Goochland County Supervisor Ken Peterson have filed. Stay tuned as special elections and the state-wide general elections unfold in Virginia.

For more information on Virginia politics, please contact us or visit


White Coats on Call Recap

By James Pickral
PSV Lobbyist

The next White Coats on Call will be held on January 30, 2017

Several PSV members attended White Coats on Call this year with the Medical Society of Virginia. Physicians and students spent the morning at the General Assembly building in Richmond meeting with legislators. They discussed a range of issues including:

Certificate of Public Need (COPN)
COPN was the focus of healthcare legislation during the 2016 session. There were numerous bills filed to reform the current process. While reform didn't happen this year, COPN will once again be a major focus in 2017.

Preserving Team-Based Care
There were several bills introduced that would have allowed Advanced Practice Registered Nurses to practice independently. Most of these bills were defeated and a compromise reached establishing a telemedicine pilot program.

Step Therapy
Several bills dealing with step therapy were introduced. These bills sought to either streamline the process or prohibit step therapy all together. These bills were not successful but will return in 2017.

Catawba Hospital
There was language in the Governor's introduced budget to fund plans for the closure of Catawba.  PSV and other groups were successful in having this money stripped from the final budget.

Thanks to all who participated in our White Coats on Call day and to all of those who assisted with PSV's legislative priorities.




A Resident’s Perspective of White Coats on Call

By Peter Breslin, MD
VCU Chief Resident

The day of White Coats on Call was filled with energy, enthusiasm and anxiety. The thought of appealing to our legislators regarding mental health was intimidating to say the least. However, with the help of experienced mentors such as Dr. Helen Foster, Dr. Susan Waller, James Pickral and Andrew Mann, we as a group were able to direct our passion about mental health toward those who mattered. Senator Creigh Deeds was among many of the legislative members that listened to us with open ears and an open heart. His own experience in advocating for mental health encouraged all of us to stay strong throughout the day as well as at future opportunities to support mental health. We are very thankful for the many residents who came to spread their passion and we look forward to seeing many more residents attending future events.

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