SD35 - Health Care for All Virginians
Executive Summary: The Joint Subcommittee on Health Care for all Virginians was created by the 1988 General Assembly. In its report to the 1989 General Assembly, the Joint Subcommittee recommended several steps to address the problems of indigent health care. As a result, legislation was adopted in 1989 as a first step towards recognition of hospital charity care as a societal problem: • Creation of a new indigent health care trust fund to equalize the burden of charity care among hospitals; • Reorganization and strengthening of the State-local hospitalization program; • Partial deregulation of hospitals under the Certificate of Public Need (COPN) program, and continuation of the moratorium on approval of new nursing home beds under COPN; and, • Broadening of financial disclosure requirements on hospitals and nursing homes. Following the 1989 session the Chairman of the Joint Subcommittee, Senator Stanley C. Walker, appointed two subcommittees. A Subcommittee on the Uninsured, chaired by Senator Hunter B. Andrews, and a Subcommittee on Long Term Care, chaired by Delegate Ford C. Quillen, met during the interim. The two subcommittees presented their reports to the Joint Subcommittee on December 4, 1989. Final recommendations were adopted on December 28,1989. This interim report represents a second set of steps to make low-cost health insurance and primary care more available and affordable to the uninsured, and to make long term care more accessible to elderly Virginians. Making Health Insurance More Affordable (1) Create an Advisory Commission on Mandated Health Insurance Benefits, to review all proposed mandated benefits and providers prior to consideration by the General Assembly, and to develop a schedule for eventual evaluation of existing mandates. (2) Require reporting by the insurance industry, on an annual basis to the State Corporation Commission, on the cost of state mandated benefits. (3) Authorize the sale of low-cost health insurance products to individuals, groups, or companies that have not had any health insurance for the preceding twelve months, or to newly organized companies, with a concurrent reduction in the scope of state mandated benefits and providers. (4) Provide an appropriation to the Office of the Secretary of Health and Human Resources for a competitive grant (or series of grants) for the purpose of marketing low-cost health insurance to small businesses across Virginia. The grant(s) should be made to a business organization, coalition, or public-private partnership. Appropriate reporting should be required. (5) Add three business representatives to the Technical Advisory Panel for the Indigent Health Care Trust Fund, to address technical questions relative to contributions to the trust fund by businesses that do not offer health insurance to their employees. (6) Adopt certain technical amendments to the Indigent Health Care Trust Fund as recommended by the Technical Advisory Panel and the Board of Medical Assistance Services. (7) Direct the Department of Medical Assistance Services to study the feasibility of a managed care or buy-in demonstration project, with or without federal funding. Expanding Access to Primary Care (8) Adopt legislation to create a primary care program within the Department of Health, directing the State Board of Health to designate medically underserved areas and authorize a series of initiatives to expand access to primary care, including scholarships, loan repayment, and continuing education, as described in the following recommendations 9,10, and 11. (9) Provide General Funds for scholarships for medical students who agree to practice in the field of primary care in medically underserved areas. (10) Provide General Funds, to be matched with federal funds, for a loan repayment program for medical school graduates who agree to practice in the field of primary care in medically underserved areas. (11) Provide General Funds, to be matched with federal funds, for Area Health Education Centers to expand continuing education for physicians in medically underserved areas; and, (12) Establish a State Local Program to support public-private partnerships at the local and regional level, to improve the delivery of primary care to families and children. Strengthening Coordination of Long Term Care (13) Identify methods of providing support to family caregivers. (14) Establish two positions to strengthen the role of the Long-term Care Coordinating Council. (15) Provide General Funds the second year, for a series of pilot projects to expand the availability of case management services for elderly Virginians, to assist them in remaining in their own homes for as long as possible. (16) Extend the moratorium on approving Certificates of Public Need for new nursing home beds, from January 1 to at least June 30,1991, so that the issue of COPN can be addressed more fully during the 1991 session of the General Assembly. (17) Study the Department of Health nursing home bed need projection methodology. (18) Request that the Joint Legislative Audit and Review Commission conduct a follow-up study of Homes for Adults licensure, along with the eligibility for and level of auxiliary grant assistance for residents of Homes for Adults. (19) Transfer the licensing of Homes for Adults from the Department of Social Services to the Department of Health, effective July 1,1991. (20) Encourage the State Corporation Commission to support coverage of community-based care in long term care insurance policies. (21) Consider the expansion of Medicaid eligibility by eliminating the 209(b) restrictive eligibility criteria as of July, 1990. Continuing the Study (22) Continue the study until the 1992 General Assembly as the Commission on Health Care for all Virginians. The chart on page 4 of the report illustrates the budget amendments requested to support the recommendations included in this report during the 1990-92 biennium. These recommendations total $10.8 million in General Funds. |
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