The 2022 General Assembly session kicked off on January 12 and will run for 60 days. Legislators will be meeting in-person unlike the virtual session they held in 2021. VHCA-VCAL’s advocacy work will largely be focused on Medicaid funding and workforce issues.

VHCA-VCAL’s advocacy will center on these topics:

Staffing Mandates

VHCA-VCAL is working aggressively to highlight the severe staffing crisis and the impact of chronic Medicaid underfunding on nursing facilities. The Joint Commission on Health Care endorsed a recommendation to pursue legislation to implement an acuity-based staffing standard derived from CMS expected direct care hours. Other staffing mandate bills setting minimum direct care staffing standards have also been introduced. VHCA-VCAL opposes these staffing standards and minimums.

VHCA-VCAL will be advocating for allowing implementation of the Medicaid Nursing Facility Value Based-Purchasing (VBP) Program to proceed. The VBP Program, which is set to begin on July 1, 2022, incentivizes increased nursing facility staffing. The VBP Program metrics are designed to achieve exactly the same goal of increased direct care staff hours per resident as backed by the Joint Commission—using incentives to do so as opposed to the threat of sanctions. Forty percent of the funding in the VPB Program is directly related to two clinical staffing metrics, with the other 60 percent for quality improvement metrics.

Grassroots Engagement Needed on Staffing Bills

All members will need to contact their legislators to express opposition to the staffing mandate bills. It will be imperative for legislators to hear directly from you about your staffing challenges. Please encourage your staff and networks to participate in these efforts.

We also anticipate arranging for some of you to have direct conversations with legislators about this issue. We will also be continuing to augment these efforts with our digital campaign as I mentioned previously. Please like and share the content posted on VHCA-VCAL’s social media channels (Facebook, Twitter, and LinkedIn) and use the Staffing/Workforce Social Media Toolkit we created for you.

Medicaid Reforms

VHCA-VCAL supports a package of Medicaid reforms designed to address historic underfunding and encourage reinvestment by nursing facilities in both facilities and quality improvement through permanent reimbursement reforms. VHCA-VCAL’s specific requests would direct the Medicaid program to cover incurred costs for a larger percentage of Medicaid days and remove Medicaid’s non-payment of dually eligible individuals’ patient responsibility under Medicare, remove outdated occupancy assumptions, recognize the need for some amount of private beds for infection prevention and control through reimbursement recognition, and encourage reinvestment in facility infrastructure.

Workforce Development

VHCA-VCAL supports legislation related to the Health Workforce Development Authority to create a position of “Special Advisor to the Governor for Health Workforce Development.” The bill would direct the authority and special advisory to coordinate with health care employers and education institutions to better align education and training initiatives with evolving workforce needs. VHCA-VCAL supports efforts by the Virginia Community College System to obtain funding for its Nursing Capacity Initiative to invest in faculty, equipment, and infrastructure to increase enrollment in nurse training programs.

Employment Issues

Bills have been introduced to addressing numerous workforce and employment issues like vaccine mandates, minimum wage, requirements for paid time off or paid sick leave, and other employment issues. VHCA-VCAL will be closely following these bills and coordinating with other business organizations and employers on advocacy related to them.

General Assembly Schedule and Organization

The 2022 session will be a 60-day session during which the legislature will pass a 2-year state budget for state fiscal years (SFY) 2023 – 2024 and make any final amendments to the budget for the final months of SFY 2022. (The SFY begins on July 1.) The budget and any legislation which passes both chambers must also be approved by Governor-elect Glenn Youngkin. He will be sworn in as Virginia’s 74^th governor on January 15.

The House of Delegates will be led by Republicans in a change from the prior two years. House Republicans hold a 52-48 vote advantage over Democrats in that chamber following the 2021 elections. The Senate is divided 21 Democrats to 19 Republicans with new Lt. Governor Winsome Sears (R) holding a tie-breaking vote. Because of the party shift in the House of Delegates, committee leadership and partisan makeup of the committees will change. The Health, Welfare and Institutions Committee, which oversees much of the legislation affecting nursing facilities and assisted living, will be headed by Del. Bobby Orrock (R-Caroline), who chaired the committee in previous sessions with a Republican majority.

VHCA-VCAL is currently in the process of reviewing bills, communicating with legislators about our key legislative and budget priorities, and responding to agency requests on our positions on bills. We are monitoring legislation as it is posted to the online bill tracking system to assess the impact on members. We will provide weekly updates on the General Assembly session and specific bills in CareConnection.