Spring 2018 Issue


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Legislative Update

By James Pickral
PSV Lobbyist

James Pickral

Sine Die, Budget Impasse, Special Session and Veto Session
Saturday, March 10, 2018 was Sine Die, the last day of this year’s General Assembly regular session, but legislators finished without producing a final budget. The two chambers are at an impasse over the expansion of Medicaid and the half billion-dollar difference between their two versions of the budgets. The House passed a “conservative” version of Medicaid expansion while the Senate did not. In addition to the philosophical and dollar differences, each chamber diverges in its spending priorities within the budget, so we do not expect the conference committee appointed to hammer out a compromise to be successful.

Governor Ralph Northam has called a special session of the General Assembly to convene on April 11. As the budget bills were not acted upon before the 2018 session adjourned, they are no longer before the legislature. As such, the Governor will send down a budget bill on April 11 that is virtually identical to Governor McAuliffe's introduced budget. It is then expected that the House of Delegates and the Senate will conform that budget to be identical to their previous versions, which will be rejected by the opposite chamber, placing them back in conference. Once this is done, it is expected that the General Assembly will recess with members returning to their districts while the budget conferees work to craft a compromise budget. 

Once a compromise is reached, the General Assembly will return and pass the budget which will then be sent to Governor Northam. At this point the Governor will have the ability to offer amendments. Upon the completion of the Governor’s review and any amendments, the General Assembly will reconvene to act on the Governor's recommendations and send a final budget to him for his signature, all before June 30, 2018. 

The Governor’s office is also reviewing passed bills to either sign, veto or amend. The General Assembly reconvened on April 19 to vote on the Governor’s actions on bills. 

Certificate of Public Need (COPN)
Since 2016 the physician community has been actively involved in efforts to engage the General Assembly in dialogue which would result in the passage of a thoughtful, statewide phase-out of the COPN regulatory process. Following the 2017 General Assembly Session and much discussion with senior members of the House of Delegates and Senate, it was decided to try a different approach and introduce individual project exemption legislation.

The Coalition to Reform COPN began reaching out to physician practices across the Commonwealth which resulted in twenty-five individual COPN exemption bills being introduced during the 2018 General Assembly Session – fifteen House bills and ten Senate bills. Of the original fifteen House bills, one bill calling for statewide repeal of COPN was carried over to the 2019 Session; twelve House bills did not advance beyond the subcommittee level, and two House bills survived the House but were also carried over to next year in the Senate. Of the ten Senate bills, one made it through the committee process but did not pass the full Senate; one was carried over to the 2019 Session and one was withdrawn by the patron at the request of the physician practice. The remaining seven bills were combined into one omnibus bill which passed out of the Senate but did not survive the House committee. Two of the COPN bills, HB 1606 and SB 757, were related to psychiatric beds and services – see below for details on those specific bills.

The Coalition to Reform COPN has over 2,000 individuals who have signed up to receive legislative action alerts. In addition, the coalition provided action alert links to physician practices around the state who included the links in their electronic communications.

Because of the large number of bills introduced this year and the increased focus on the ongoing problems inherent to the COPN process, more legislators say the process is broken and must be fixed. The political landscape in Virginia is also significantly different than a few years ago. Last November, Virginia held statewide elections, but more importantly all 100 seats in the House of Delegates were up for election and the House went from a 66-seat Republican majority to a 51-49 Republican majority. It should be noted several key legislators who have consistently supported COPN reform efforts since 2016 did not return to the House of Delegates for the 2018 Session either due to retirement or defeat during November’s elections. There is a learning curve for the new members and a lot of educating that has been undertaken but must be continued.

House Health, Welfare and Institutions Committee Chairman Bobby Orrock announced that he will convene a workgroup in April to study COPN during the off-session.

Step Therapy and Prior Authorization
Physician groups, patient advocates, and pharmaceutical companies continue to seek policy changes that will reduce burdens of insurance company practices that deny or delay prescriptions for patients. Insurance lobbyists argue that these are necessary to control costs based on clinical practice guidelines. Senator Bill DeSteph and Delegate Glen Davis introduced bills that have received a lot of attention but have not advanced during the last few sessions. MSV intends to lead this effort as a priority item this year.

Nurse Practitioner Independent Practice
Legislation to expand Nurse Practitioner (NP) autonomy has passed the General Assembly and awaits Governor Northam’s action by April 9. The legislation will allow an NP who has practiced for five years under a physician-NP collaborative practice agreement to practice independently within the practice area the NP is licensed and certified (primary care, psychiatry, emergency, etc.). The collaborating physician must attest to the required experience.

Credentialing Reimbursement
Delegate Chris Head introduced HB 139 which would require insurance companies to reimburse physicians during a credentialing application period. Reimbursement will occur retroactively upon completion of credentialing. MSV estimates that, on average, this has the potential to avoid lost revenue of $100,000 - $150,000 per physician over a 90-day period.

Specific/Other Legislation of Interest
HB 886 - Mental health treatment; admission regulations, toxicology results

HB 1606 and SB 757 - Certificate of public need; psychiatric beds and services

SB 726 and HB 1251 - CBD oil and THC-A oil; certification for use, dispensing

PSV Spring Meeting Legislative Reception
New Virginia Health and Human Resources Secretary Dan Carey gave remarks at our legislative reception the evening before Sine Die. We were also joined by Dels. Matthew James, Betsy Carr, and Sam Rasoul. Special thanks to the Secretary and Delegates for their attendance!

PSYCHMD PAC has a current balance of $3,369. The PAC raised $3,975 in 2017.

Mountainside SoftwareThank you to all of our donors!

Rizwan Ali, MD, DFAPA
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Varun Choudhary, MD, MA, DFAPA
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Steve Cunningham, MD
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Gregory Fisher, MD, DFAPA
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Christopher Kogut, MD, MSW, FAPA
Stuart Kyllo, MD
Meredith Lee, DO, FAPA
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Andrew Matz, MD
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Shaheen Mustafa, MD
Dorothy O'Keefe, MD, DFAPA
Ashvin Patel, MD, DLFAPA
John Shemo, MD, DLFAPA
Susan Waller, MD, DFAPA
Brian E. Wood, DO, DFAPA

For the past few years, we’ve had a successful PAC that has allowed us to compete for attention in a crowded and contentious political environment. Our PAC has provided us opportunities to engage directly with policy leaders in Virginia. Recently, we have seen a decline in the number of members contributing to our PAC and we do not have the resources we once had.

PsychMD PAC is a critical tool in our advocacy program. It allows us to support legislators who are friendly to our profession and issues in the General Assembly. Every year, the legislature considers bills that could potentially impact our profession and patients. It is imperative that we have a seat at the table when these decisions are being discussed. A strong PAC provides us that opportunity. Our PAC enables us to support legislators who support psychiatry. Political contributions support legislators’ and candidates’ election efforts. It is our goal to keep Delegates and Senators who are friendly to our issues in the legislature. 

2017 was an important election year in Virginia. Voters elected a new Governor and Lieutenant Governor. In addition, all 100 seats in the House of Delegates were up for election and resulted in 19 new faces, 15 of whom defeated incumbents. All but two of the legislators we donated to through the PAC were reelected.

It’s a crucial time to support our PsychMD PAC to raise the visibility and profile of psychiatrists, connect you to new and returning legislators, and continue to build productive relationships with key General Assembly members and staff. We also need to grow PAC resources as we prepare for the 2019 elections in Virginia when the full General Assembly – all 40 Senators and 100 Delegates – will be up for election.

Please Donate to PsychMD PAC today!

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