MEDICAL SOCIETY OF VIRGINIA HOUSE OF DELEGATES Report of Reference Committee 2. Dr. Jonathan Schaaf, Chair

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1 Page DISCLAIMER The following is a preliminary report of actions taken by the House of Delegates at its 2018 Annual Meeting and should not be considered final. Only the Official Proceedings of the House of Delegates reflect official policy of the Society. MEDICAL SOCIETY OF VIRGINIA HOUSE OF DELEGATES Report of Reference Committee 2 Dr. Jonathan Schaaf, Chair The Reference Committee recommends the following consent calendar for acceptance: RECOMMENDED FOR ADOPTION Establishment of a Reinsurance Program RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED Uninsured Payment Protection Investigation into Healthcare Insurance Copay Accumulator Programs Improve the Insurance Claims Process Regulate and License Pharmacy Benefit Managers Who Serve Virginians RECOMMENDED FOR REFERRAL TO BOARD OF DIRECTORS Remove Restrictive Covenants for Healthcare Providers in Virginia RECOMMENDED FOR NOT ADOPTION Truth in Advertising Certificate of Public Need Reform Opposing Work Requirements for Virginia Medicaid Eligibility 1

2 Page ) TRUTH IN ADVERTISING Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, the Medical Society of Virginia supports specifying that board-certified must refer to an American Board of Medical Specialties (ABMS), American Osteopathic Association Board Certification (AOA), or other boards that maintain similarly high standards of certification. Resolution asks that our Medical Society of Virginia adopt new policy defining specific circumstances under which a physician may refer to himself or herself as board-certified. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony about the concerns from the plastic surgery community regarding inadequately trained providers being able to identify themselves as board certified. Your Reference Committee also heard opposing testimony that there are no established standards across specialty boards, and not all quality boards fall under ABMS and AOA. Also, the AMA has an anti- MOC resolution they re going to vote on in November and the outcome of that could impact this issue. Your Reference Committee feels that until the conflicts with boards regarding certification is sorted out, it is not in MSV s best interest to take action. Additionally, more evidence is needed to support that certification by a specific board improves patient outcomes. Currently there is no standard dictating what constitutes a quality board. Accordingly, your Reference Committee recommends the resolution be not adopted. 2) REMOVE RESTRICTIVE COVENANTS FOR HEALTHCARE PROVIDERS IN VIRGINIA Mr. Speaker, your Reference Committee recommends that Resolution be referred to the Board of Directors. RESOLVED, that the Medical Society of Virginia conduct a study to evaluate and consider the impact of Restrictive Covenant agreements for healthcare providers and how it impacts patient access in Virginia. This study shall include evaluation of other states where elimination of Restrictive Covenant agreements has been successful. Further, a report of findings shall be provided to members by December 31, Resolution asks that our Medical Society of Virginia study restrictive covenants and provide a report to the membership by December 31, Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that employed physicians are being abused by big health systems and hospitals through restrictive covenants. Even if these covenants would not hold up in court, an individual physician does not typically have the resources to fight a legal battle. MSV does not currently have policy on this issue, and a study would help develop some. Your Reference Committee also heard opposing testimony that these covenants are used by small, independent practices as well, and help protect the investments made to recruit and employ new physicians. Doing away with covenants could severely hurt independent practices. Your Reference Committee heard testimony on both sides and recognizes there are pros and cons to restrictive covenants. Further evaluation is deemed appropriate to fully understand the impact of 2

3 Page restrictive covenants on health care providers across practice settings and how it impacts patient access and care. Accordingly, your Reference Committee recommends this resolution be referred to the MSV Board of Directors. 3) CERTIFICATE OF PUBLIC NEED REFORM Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the MSV strongly support the reform of the Commonwealth s COPN law to allow for the establishment of private medical facilities to increase treatment options which would lower health care costs and increase access to all health care consumers. Resolution asks that our Medical Society of Virginia adopt policy supporting COPN reform. Your Reference Committee heard limited testimony on Resolution , supporting our existing COPN policy. Your Reference Committee did not hear testimony on the resolution by the author, and furthermore, MSV has an existing policy on COPN reform. Accordingly, your Reference Committee recommends this resolution be not adopted. 6) OPPOSING WORK REQUIREMENTS FOR VIRGINIA MEDICAID ELIGIBILITY Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia promote legislation to oppose work requirements as a condition of eligibility for Medicaid. Resolution asks that our Medical Society of Virginia adopt new policy to oppose Medicaid work requirements. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that work requirements place an undue burden on patients and physicians and impedes access to care. Your Reference Committee also heard opposing testimony that Medicaid Expansion was a very difficult lift and turning around and creating policy that opposes the key element that allowed the legislation to pass would be short sighted. Your Reference Committee recognizes that Medicaid Expansion only recently passed the legislature and with a very narrow margin. It would be premature to oppose something that has not been implemented yet. The Committee believes that waiting until these requirements are executed to determine what if any issues may arise. Accordingly, your Reference Committee recommends this resolution be not adopted. 3

4 Page ) UNINSURED PAYMENT PROTECTION Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, the Medical Society of Virginia acknowledges the deleterious financial impact that cost shifting in hospitals can have on uninsured or inadequately insured patients and support the development of a Medicare based reasonable fee-schedule for uninsured or inadequately insured patients receiving inpatient and outpatient care. Resolution asks that our Medical Society of Virginia adopt new policy to support a Medicarebased fee schedule for uninsured patients. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony about concern for uninsured patients being unable to pay their hospital bills. Your Reference Committee also heard opposing testimony that this resolution does not distinguish between those who choose not to purchase insurance and those that cannot afford insurance. Testimony was heard that a Medicare fee schedule is not an acceptable rate. Your Reference Committee agreed that while the intent of this resolution is admirable, MSV has traditionally opposed a Medicare based fee schedule for most services, as it usually represents a significant deficit from the actual cost to provide care. However, these uninsured or inadequately insured patients are being penalized because they have no access to any type of discounted care. MSV should continue to work with policymakers to ensure that the uninsured have access to affordable insurance and that out of pocket costs do not interfere with an individual s ability to access needed medical services. Accordingly, your Reference Committee recommends the resolution be adopted as amended. 8) INVESTIGATION INTO HEALTHCARE INSURANCE COPAY ACCUMULATOR PROGRAMS Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, the Medical Society of Virginia urge the Virginia State Corporation Commission Bureau of Insurance to undertake an investigation into Healthcare Insurance Co-pay Accumulator programs to ensure patients can afford their medications. RESOLVED, the Medical Society of Virginia opposes copay accumulator programs or any program that does not apply all patient payments toward deductibles and out of pocket maximums. Resolution asks that our Medical Society of Virginia advocate for a state government investigation of co-pay accumulator programs. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that this practice is egregious, and MSV should take a stand. Your Reference Committee also heard no opposing testimony. Your Reference Committee concluded that accumulator programs place an unjustified burden on patients who have insurance by placing a barrier to reaching their deductible to be able to apply their insurance 4

5 Page benefits. In order to ensure our policy compendium stays evergreen, the reference committee recommends substituting the original resolved clause with the staff recommendation. Any legislative or regulatory action should be directed to the MSV Advocacy Summit. Accordingly, your Reference Committee recommends this resolution be adopted as amended. 9) ESTABLISHMENT OF A REINSURANCE PROGRAM Mr. Speaker, your Reference Committee recommends that Resolution be adopted. RESOLVED, that the Medical Society of Virginia work to bring additional insurance carriers into the individual and small group marketplace, in addition to creating a more favorable environment for lower premiums and coverage of persons with costly medical issues. Resolution asks that our Medical Society of Virginia support the establishment of a reinsurance program in Virginia. Your Reference Committee only heard testimony from the presenter of Resolution Your Reference Committee only heard testimony in support of this resolution, and the staff recommended adoption as well. Reinsurance programs are a good first step to ensuring stability to Virginia s insurance marketplace. Accordingly, your Reference Committee recommends this resolution be adopted. 10) IMPROVE THE INSURANCE CLAIMS PROCESS Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. Policy 1: Bill Submission Timelines RESOLVED, the Medical Society of Virginia support the implementation of a mandatory deadline of no less than twelve months from the date of service for physicians to submit claims; and further be it RESOLVED, the Medical Society of Virginia support legislation a requirement that requires insurers to add a minimum of 30 days to the submission deadline every time they kick a claim back to a physician for any reason, and be it further Policy 2: Prior Authorization Retroactive Denials RESOLVED, that the Medical Society of Virginia support legislation a requirement that enforces coverage for pre-authorized services by insurance companies and prevents later reversal of already granted preauthorization. Resolution asks that our Medical Society of Virginia to adopt new policy that supports extended deadlines for insurance claims and enforced coverage of pre-authorized services. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony from the Richmond Academy of Medicine in support of the staff recommendation to split the resolution into two separate policies. 5

6 Page Your Reference Committee also heard no opposing testimony. Your Reference Committee agreed with the staff recommendation that this resolution addresses two separate issues billing submission timelines and pre-authorization retroactive denials and therefore should be split into two separate policies. Additionally, the committee decided to remove references to legislative actions, in keeping with MSV s custom. Accordingly, your Reference Committee recommends this resolution be adopted as amended. 11) REGULATE AND LICENSE PHARMACY BENEFIT MANAGERS WHO SERVE VIRGINIANS Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, that the Medical Society of Virginia, in concert and collaboration with local and specialty physician organizations, pharmacist organizations, patient organizations and any other interested and affected parties work to develop and institute appropriate legislative and/or regulatory processes to ensure that the Virginia Insurance Commissioner has authority to appropriately oversee the actions of PBMs providing services to Virginians similar to the recently enacted Arkansas legislation (HB 1010) so PBM's are brought under oversight and are held accountable for their actions in the pricing, management and dispensing of medications to Virginians. Resolution asks that our Medical Society of Virginia support regulation of pharmacy benefit managers in Virginia. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard universal support of this resolution. Your Reference Committee believes this is both an important state and national issue that requires a multi-faceted approach. The Committee agreed with the staff recommendation to remove references to specific legislative actions and bills from other states. Accordingly, your Reference Committee recommends this resolution be adopted as amended. 6

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