Twentieth District State Sen. Bill Stanley (R-Moneta) introduced several pieces of legislation in the Special Session of the General Assembly Friday. The legislative proposals focus on creating solutions for the efficient delivery of quality health care for all Virginians as a comprehensive alternative to the expansion of Medicaid.

Senator Stanley has patroned the following legislation:

• Senate Bill (SB) 5001: Establishment of a Patient-Centered Medical Home Advisory Council.

The Council will advise and make recommendations to the Department of Medical Assistance Services on reforms to the commonwealth's program of medical assistance that would increase the quality of care while containing costs through the use of a patient-centered medical home system. A patient-centered medical home is a physician-led team approach to providing health care that: (i) originates in a primary care setting; (ii) fosters a partnership among the patient, the personal provider and other health care professionals, and where appropriate, the patient's family; (iii) utilizes the partnership to access all medical health-related services and nonmedical health-related services needed by the patient to achieve maximum health potential; and (iv) maintains a centralized, comprehensive record of all health-related services to promote continuity of care.

• SB 5006: Creates Medicaid regional care organizations, which would direct the Department of Medical Assistance Services, subject to approval of the federal Centers for Medicare and Medicaid Services, to enter into contracts in regions of the commonwealth with a regional care organization.

Under the contracts, an regional care organization will provide medical care to Medicaid beneficiaries and receive capitated payments from the department. The department is required to enroll a majority of the commonwealth's Medicaid beneficiaries into regional care organizations. A regional care organization may contract with any willing health care provider to provide services in a Medicaid region if the provider is willing to accept the payments and terms offered to comparable providers. In order to be certified as a regional care organization, an organization is required to be certified by the department as meeting eligibility requirements, including financial standards and service delivery network requirements.

• SB 5007: Medicaid accountable care organizations; this bill directs the Department of Medical Assistance Services to establish a health care delivery system under which a majority of the commonwealth's Medicaid beneficiaries will receive benefits through accountable care organizations.

Accountable care organizations are corporations that provide health care services through their member health care providers and receive Medicaid payments through innovative payment methodologies, which include capitated payments, gainsharing payment arrangements, pay-for-performance, quality-based payments, and other payment arrangements to generate savings from greater coordination and efficiency in service delivery. A portion of these cost savings are to be distributed among the health care providers participating in the accountable care organizations. Prior to contracting with the department, a proposed accountable care organizations shall obtain a certification of authority issued by the State Corporation Commission, which can be issued if the accountable care organizations satisfies requirements regarding working capital and reserves. The commission and the attorney general are further required to determine (i) whether a proposed accountable care organizations is likely to reduce competition in a market for health care services and (ii) that the accountable care organization's pro-competitive benefits are likely to substantially outweigh the anticompetitive effects of any increase in market power. The department is directed to apply for federal waivers required for implementation of the program.

• SB 5008: Medicare reduction tax credit; this bill creates a tax credit for hospitals in the commonwealth who provide free or reduced-cost health care.

The amount of the credit is equal to the amount of expenses incurred by the hospital related to the free or reduced-cost care, not to exceed the difference between the amount of Medicare reimbursements received by the hospital before and after changes implemented by the federal Patient Protection and Affordable Care Act. The aggregate number of credits issued in a given year shall not exceed the total reduction of Medicare reimbursements to all hospitals in the commonwealth. The credit would be available for taxable years 2014, 2015 and 2016.

• SB 5009: Private health insurance exchanges; this provides that one or more private entities may establish private health insurance exchanges within the commonwealth.

The measure requires exchanges to be registered with the State Corporation Commission. Participating employers may elect to purchase health benefit plans for their eligible employees and their dependents from a participating health carrier. Alternatively, a participating employer may authorize its eligible employees to purchase a health benefit plan directly from a participating health carrier using funds provided by the employer, and the employee may use the employee's own funds to supplement the level of coverage that the employer's contribution would cover.

• SB 5010: Board of health, medical school scholarships, which expands eligibility for the medical school scholarship program administered by the board of health for medical students who agree to practice in underserved areas of the commonwealth to include students of any accredited medical school.

Under the current program, only students who attend medical schools in Virginia are eligible.

• SB 5011: Telemedicine, pilot program.

This bill directs the Department of Health in partnership with a hospital licensed in the commonwealth, to establish a three-year telemedicine pilot program designed to reduce patient use of emergency department facilities for the treatment of low-acuity conditions.

Senator Stanley appeared before the Senate Finance Committee on Friday morning to present SB 5008, the Medicare reduction tax credit. This bill seeks to find solutions to close the “Hospital Gap” – that is, the reduction of Medicare payments to health providers by Obamacare, which significantly reduces coverage for the care of our elderly citizens.

The committee sent SB 5008 to Joint Legislative Audit and Review (JLARC) to determine the exact amount of lost Medicare revenue to hospitals in Virginia, in order to enable advancement of the idea.

Stanley said he was pleased the committee was interested in engaging in the discussion as a facet of Stanley’s plan to offer quality healthcare to all Virginians, regardless of where they live in the commonwealth.

“I am very pleased with the proposals that we have offered as alternatives to Medicaid expansion under Obamacare. During tours of health care facilities in our Senate district, we diligently gathered information at hospitals, free clinics, and other facilities, from administrators, doctors, nurse practitioners, nurses, and many others, so that we could create a full spectrum of health care solutions for our citizens, from Galax to Halifax County, without burdening the Virginia taxpayer with the overwhelming costs of Medicaid expansion.

“As I have previously mentioned, the existing Medicaid program in Virginia is an oppressive 21 percent of the state budget, or over $18 billion every two years. This program grows at an average of 8 percent per year, or more than $1 billion every three years for Virginia’s taxpayers without the proposed Medicaid expansion.

“To meet that existing requirement and its increasing financial obligation to the current Medicaid system, Virginia must either take the money from education and public safety or increase taxes.

“When the future costs of Medicaid expansion are added to this equation, such expansion may cost Virginia an additional $1 billion each year. It is an expense that we cannot afford.

“Clearly, we need alternatives to Medicaid expansion. These legislative proposals seek to increase the efficiency of the delivery of quality healthcare to our citizens, while reducing the cost of such healthcare. Those that argue that the only solution to our health care problem is Medicaid expansion fail to comprehend that such expansion does not solve the comprehensive problems now present in our current healthcare system, but rather may compound the problems that we already have.

“We need comprehensive solutions to this very complex problem, and this legislation is a major first step in solving the healthcare needs in our area, while improving efficiencies in its delivery that will result in reduced healthcare costs to the consumer.

“We must collaborate with the health care industry in the commonwealth to find long-term answers to these very important issues. We must formulate innovative solutions, and faithfully execute these plans that are in the citizens’ best interests.

“As I have stated before, ‘All Virginians, no matter their zip code, should have access to quality health care.’ These legislative initiatives, and the referral of SB 5008 to the JLARC, are significant steps toward accomplishing that goal,” Stanley said.