By Catherine Ford
Commonwealth Strategy Group
The Virginia General Assembly adjourned on March 9th concluding the 2024 legislative session. As a reminder, after the redistricting election this past fall, 54 new “freshman” legislators joined Virginia’s General Assembly. 1,545 bills were introduced in the House and 736 bills were introduced in the Senate. The Medical Society tracked 450 pieces of legislation and the Psychiatric Society tracked and impacted over 20 bills related to behavioral health care. Here is a recap of a few items of interest and some general healthcare policy updates.
Prior Authorization
As you may recall, Senator Favola and Delegate Willett’s SB 98 and HB 1134 to extend the prior authorization grace period from 30 to 90 days and prohibit retrospective prior authorization denials passed both chambers and are making their way, unopposed, through the other chambers. These bills were signed into law on April 2. PSV strongly supported these bills.
Proposed Changes to the Practice of Nursing
Senator Jennifer Boysko and Delegate Rodney Willett introduced SB 351 and HB 978 to remove the requirement that the Boards of Nursing and Medicine oversee Advanced Practice Registered Nurses (APRNs). Dissolving the joint boards would create different disciplinary bodies for providers who practice medicine. Both bills were heard in their respective subcommittees, and both failed to advance.
Regarding the practice of Nursing, Delegate Kathy Tran introduced HB 971 to reduce the years of full-time clinical experience required for NPs to practice autonomously from 5 to 2 years AND allow NPs to serve as a care-team lead. After meeting with every member of the House Health and Human Services committee, it was clear that many of the freshman legislators were hopeful of a compromise and not persuaded to maintain the current 5-year standard. The physician community has long opposed this legislation as an important component of preserving consistent, high standards for independent providers and the team-based care model.
Thanks to the physician community’s lobbying efforts, Delegate Tran made it known she intended to change her bill and remove the language allowing NPs to lead the patient care team. In addition, the new bill would lower the years of experience required for autonomous practice for APRNs to 3 years. Given the precarious vote count in the HHS committee, we then worked with the Virginia Council of Nurse Practitioners to craft reporting language that more strictly tracks independent APRNs workforce and disciplinary data, putting the issue to rest for a period of 4 years. The MSV and specialty societies firmly clarified our expectations that similar legislation would not be introduced until 2028.
While not a perfect outcome, the new 3-year requirement keeps Virginia at the highest training standard when compared to other states that allow for NP independent practice. Further, the new reporting requirements will allow Virginia to better track the effects of the legislation and better inform decision making in the future.
The Health Insurance Reform Commission
Shepherded by the Medical Society of Virginia, Senator Head and Delegate Hayes introduced SB 132 and HB 1210, which will impose a 24-month timeline for the review of all pieces of legislation given to HIRC.
The Health Insurance Reform Commission (HIRC) was established to assess newly proposed mandated benefits for consideration under the state plan in a 24-month timeline. In recent years, HIRC has been assigned other pieces of legislation for consideration, but there is nothing in the code that outlines the timeline for their review. These bills were signed into law in early April.
Budget Updates
At the time of writing, the state budget has gone through three iterations, the latest being Gov. Youngkin’s amended version of the General Assembly approved budget. The legislature will have the opportunity to accept or reject the Governor’s 233 amendments at the reconvene session on April 17.
So, what is in the budget back under consideration by the legislature? Most importantly, this maintains the Governor’s significant investments in the behavioral health system transformation, including the additional $3.9 million dollars for the Virginia Mental Health Access Program (VMAP), $10 million for mobile crisis units and contributes another $7 million dollars to the behavioral health provider loan repayment program. Additionally, it includes funding to continue the STEP-VA program within Virginia’s 40 community services boards to expand the variety of services offered within each CSB. The budget also provides for $6 million towards discharge planning for individuals on the extraordinary barriers list.
In the realm of developmental disability waivers, the budget funds 3,096 additional DD waivers and increases the reimbursement by 3% per fiscal year. The DD waiver slot funding totals 191.4 million dollars.
As for budget items we defeated: Item 285 #1c would have required all practitioners under the Board of Medicine and Board of Nursing with the ability to prescribe behavioral health medication to children to be available telephonically or electronically after-hours, on weekends, on holidays, and in emergencies. Failure to comply with this new language could have resulted in disciplinary action from the board up to and including the removal of licensure. PSV lead the lobbying efforts to remove this language and educate staff and policymakers on why this was terrible precedent, unworkable for DHP to enforce, and a chilling gesture to the behavioral health workforce. I am pleased to say the Governor removed this harmful language and we are working with the General Assembly’s leadership to adopt the amendment and keep the language out.
Lastly, the budget includes language to direct the Department of Behavioral Health and Developmental Services to develop guidance and policies to assist primary care practices in standing up Collaborative Care models. This is a major move forward for CoCM, which has been a long time PSV and APA priority.
PsychMD PAC Impact
None of this good and impactful work would be possible without the PsychMD PAC, which helps us build relationships with legislators on PSV’s behalf. Recently, we have had a difficult time raising PAC funds to facilitate our lobbying work. If you learned something new from this report or appreciate the efforts on your behalf, please consider donating to the PsychMD PAC to further this critical work. You can donate here!
Looking Ahead
Turning to the spring and summer, we will be monitoring the Joint Commission on Health Care’s 2024 studies: the Performance of Health Care Workforce Programs and Strategies to Extend Health Care Access to Vulnerable Populations. Both topics will require our attention and possibly, advisement, so stay tuned to volunteer your expertise for these important studies!
The Behavioral Health Commission has not scheduled their 2024 meeting schedule but will continue to report on STEP-VA, Project BRAVO, and developing a wholistic map of current efforts to improve the behavioral health system.
On a personal note, with mixed emotions I will be leaving Commonwealth Strategy Group at the end of April. Thankfully, I am not going far: I have accepted an extraordinary opportunity with the Medical Society of Virginia Foundation to lead a new mental health care access program. In my new role I will still get to work with PSV and will no doubt still be in your inboxes. You can reach me at [email protected] or at 434-284-1137.
Further, we are planning a smooth transition for PSV/WPS. We pledge that ongoing communication, as well as your specific initiatives and projects will not be disrupted. Cal Whitehead and Trevor Moncure will remain as your contacts. Please contact us with any questions or concerns. You can reach Cal at [email protected] or 804-389-2825 and Trevor at [email protected] or 804-873-0206.
