SD34 - Interim Report of the Commission on Health Care for All Virginians
Executive Summary: Pursuant to Senate Joint Resolution No. 118, adopted in the 1990 Session of the General Assembly, the Joint Subcommittee on Health Care for All Virginians was continued as the Commission on Health Care for All Virginians. The Commission was charged with specific directives to guide its examinations of various health care issues in the Commonwealth. The Commission was directed to study: • Issues related to the Certificate of Public Need Program: a review of the current methodology for projecting the need for new nursing facility beds, recommendations for this methodology, and the future of the COPN program in Virginia. • The feasibility of expanding the Virginia Indigent Health Care Trust Fund by adding contributors or covered services and the efficacy of consolidating the Trust Fund and the State/Local Hospitalization Program. • The need for providing assistance to certain hospitals in order to preserve access to acute care in isolated areas of the Commonwealth and to study also the current mechanism for the state/local cooperative budget allocation to determine appropriate ways to provide for the equitable allocation of state funds. • Health insurance issues, including incentives for businesses to offer health insurance to their employees; means to ensure that health insurance is provided for children by absent parents as an essential component of child-support orders; the impact of mandated insurance benefits on providers and a process for evaluating the social and financial effects of these mandates; means of determining fairly and objectively whether new medical technologies and procedures are reimbursable or are excluded from coverage as experimental and investigative under medical insurance policies applicable to citizens in the Commonwealth; and means to encourage the availability of private long-term care insurance which covers institutional and community-based care. • Medicaid issues, including the impact of new federal mandates on reducing the numbers of uninsured Virginians and improving their health; the concept of managed care and its effects on access and costs; the relationship between recent expansions of Medicaid eligibility and initiatives to expand the role of local health departments in the delivery of primary care for families with children; and Medicaid reimbursement for physicians' services, hospitals, and nursing homes. • Long-term care issues, including services that foster independence for as long as possible; the need to recognize the family as the primary source of care for elderly Virginians and to identify methods to increase support of family caregivers; the development of pilot programs to ensure appropriate types and levels of services to elderly Virginians; eligibility for and the level of auxiliary grants for residents of homes for adults; and the efficacy of making case management available to all elderly Virginians on a sliding fee basis. Among the conclusions emerging from these several deliberations of the Commission was the recognition that while attention must be given to specific concerns, those concerns cannot be examined in isolation; rather, within the broad integration of the total health care delivery system in the Commonwealth. Solutions to the health care concerns of Virginia citizens are not singular for any issue and, indeed, are intrinsically bound to each other in the larger scope and on-going challenges of the Commonwealth to provide and ensure quality health care for all of its citizens. The Commission also recognizes that inherent in any deliberations of health care concerns are other considerations directly impacting the state's role as provider, regulator, licensor, and consumer of health services. Complex tenets such as entitlement, ethics, service efficacy, and service outcomes necessarily accompany any examinations and proffered resolutions to health care issues. Furthermore, the Joint Subcommittee readily accepted from its inception the implied directive that any initiatives to address health care issues must be not only morally responsible, but also fiscally responsible. That same humanitarian philosophy balanced by prudence has continued to guide the Commission on Health Care for All Virginians. Thus, while attempting to expand the accessibility and availability of health care in the Commonwealth, the Commission is cognizant that Virginia's legacy for future citizens must not include cumbersome, financial burdens devised and legislated irresponsibly as solutions to meet immediate needs. The criterion of fiscal responsibility has historically been an integral component of any proposals designed and any decisions rendered, and that criterion has gained greater significance in the present fiscal climate. Health care -- its quality, its delivery, its provision -- has become an eminent issue of the 1990's in the Commonwealth and the nation and grows exponentially in its dilemmas. The Commission is aware of the issues that confront the Commonwealth: - the changing demographics of the state's aging population; - the advances in medical technology that, while enhancing recovery, drive costs; - the shortage of primary care providers in the Commonwealth's remote areas; - the cost of medical education and subsequent incurred debts affecting graduates' practice choices; - the citizens who by occupation or financial status are precluded from purchasing health insurance; - the spiraling costs of health insurance that restrict employers' coverage offerings and employees' choices of coverage; and - the most vulnerable Virginians in need of health care who do not receive that care. The General Assembly has adopted into legislation numerous recommendations proposed by the Joint Subcommittee in its history to address health care concerns. No closure, however, is finite on any singular issue in the ever-evolving dynamics of health care; certainly, no solutions can be effected without the cooperative partnership of health care providers, health care professionals, insurers, private industry, clients, and the Commonwealth. Summarily, the stated mission of the Commission on Health Care for All Virginians is to ensure that the Commonwealth as provider and regulator adopts the most cost-effective and most efficacious means of delivery of its health care services, so that the greatest number of Virginians may receive quality health care. To effect that goal, the Commission adopted the following recommendations and proposed them as legislation for the 1991 Session of the General Assembly: • Authorized significant changes in the statutory and regulatory framework of the Commonwealth's Homes for Adults to ensure quality of care for residents and provided for intermediate sanctions to be imposed for violations. • Authorized changes to the Virginia Medical Care Facilities Certificate of Public Need Program. • Authorized limited prescriptive authority for certain licensed nurse practitioners on a statewide basis. • Directed district health directors of the Virginia Department of Health to assess their district's primary care needs and to develop a cost-effective plan to meet those needs. • Directed the Joint Legislative and Audit Review Commission to study the state Medicaid program and the indigent care appropriations to the state teaching hospitals. • Directed the Bureau of Insurance to develop proposals to increase health insurance access for small businesses. • Directed the Small Business Advisory Board to promote the low-cost insurance packages for small businesses. • Directed the Virginia Health Services Cost Review Council with the Virginia Health Planning Board to study the possible establishment of a patient level data base. Appendix A of this document contains the legislation proposed by the Health Commission as adopted by the 1991 General Assembly. |
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