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Bill Wrap Up: Nurse Staffing Ratios, Survey Frequency, Hospice Reimbursement, and More

Bill Wrap Up: Nurse Staffing Ratios, Survey Frequency, Hospice Reimbursement, and More

Highlights of bills tracked by VHCA-VCAL.

Nurse Staffing Ratios HB 309, introduced by Del. Vivian Watts (D-Annandale), would establish requirements for a minimum number of hours for direct care services provided to each nursing center resident per 24-hour period.  It would require the Board of Health to amend regulations to require a minimum of 3.5 hours of nursing services by July 1, 2019; 3.9 hours by July 1, 2024; and 4.1 hours by July 1, 2029 or upon adoption of a standard by the Federal government.  The Department of Planning and Budget estimates that this proposal would have $32.2 million impact on the state budget in fiscal year 2020, with similar amounts thereafter increasing with inflation, because Medicaid is the largest payer of nursing center costs in Virginia. 

VHCA-VCAL met with Del. Watts on January 16 to outline why the association opposes a regulated staffing ratio. VHCA-VCAL explained that overall staffing and training needs should be considered in the context of the patient population at each specific center. Placing additional direct care staffing requirements or general staffing ratios on nursing facilities would insert a one-size-fits-all approach on facilities without providing needed flexibility under existing workforce limitations, such as staffing shortages in certain geographic areas of the Commonwealth.

HB 309 is pending consideration by the House Health, Welfare and Institutions Committee. Del. Watts also submitted a budget amendment to provide funding for the increased staffing.

Frequency of InspectionsHB 879 addresses the frequency of nursing facility and hospital inspections. It clarifies that a second inspection of a hospital or nursing facility that has previously been inspected may be performed before all other hospitals and nursing facilities homes in the Commonwealth have been inspected only in cases in which the subsequent inspection is performed in conjunction with an inspection required by the Centers for Medicare and Medicaid Services.  VHCA-VCAL supports this bill that addresses the issue of Office of Licensure and Certification surveyors needing to visit a nursing facility more than once to conduct annual Medicare certification and state licensure surveys. This bill is pending consideration in the House Health, Welfare and Institutions Committee. 

Reimbursement for Hospice Care – HB 731 directs the Department of Medical Assistance Services to implement a process for direct payment of nursing facility or ICF/MR services for hospice patients receiving services in a nursing facility or ICF/MR if such patient would be eligible for medical assistance for nursing facility or ICF/MR services had he not elected to receive hospice care.  VHCA-VCAL met with the bill patron Del. Chris Head (R-Roanoke) earlier this week to discuss our concerns with the impact of the bill on VHCA-VCAL members since hospice providers are reimbursed at 95 percent of the RUG rate, while nursing centers are generally paid at 100% of the RUG rate per their contracts with hospice providers.  VHCA-VCAL is working on crafting an amendment to the bill to address this discrepancy in payment since the nursing center still provides 24-hour care to the hospice patient.

Loss of Consortium – VHCA-VCAL wrote to Sen. Ben Chafin (R-Russell Co.) thanking him for carrying over his bill SB 380, which would have created a cause of action for loss of consortium.  The motion to carry over the bill to the 2019 session effectively ends its consideration during the 2018 session.  VHCA-VCAL was opposed to this bill as introduced because of its unintended impact allowing a spouse, parent of a minor child, or an adult child of a patient to bring a cause of action for loss of consortium outside of Virginia’s Medical Malpractice Act (VA Code § 8.01-581.1).  VHCA-VCAL members currently purchase professional liability insurance (medical malpractice liability insurance) coverage that generally contains coverage language specific to incidents arising out of delivery of health care to a patient. A spouse, parent of a minor child, or an adult child of a patient is not the patient of the health care provider, thus the professional liability insurance coverage carried by our members would not cover loss of consortium claims.  If enacted, this bill would create uninsured and uncapped unlimited liability for our member centers and the health care providers who work in these facilities.  Del. Jeff Campbell (R-Smyth Co.) has introduced a similar measure, HB 323, which has not been heard in subcommittee yet.