Certificate of public need; changes to Medical Care Facilities Certificate of Public Need Program. (HB350)

Introduced By

Del. Kathy Byron (R-Lynchburg) with support from co-patron Del. Chris Peace (R-Mechanicsville)

Progress

Introduced
Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law

Description

Certificate of public need. Makes changes to the Medical Care Facilities Certificate of Public Need Program. The bill (i) defines "charity care" for purposes of the certificate of public need program; (ii) removes mental hospitals from the list of reviewable medical care facilities; (iii) establishes an expedited 21-day review process for applicants for projects determined by the Department of Health (the Department) to be uncontested and to present minimal health planning impacts and for which the applicant agrees to comply with quality assurance requirements established by the Board of Health (the Board) and consents to provide charity care in an amount specified by the Board; (iv) establishes an expedited 45-day review process for applicants for projects identified by the Department to be uncontested and to present limited health planning impacts that require an intermediate level of scrutiny and for which the applicant agrees to comply with quality assurance requirements established by the Board and consents to provide charity care in an amount specified by the Board; (v) clarifies the content of a completed application for a certificate; (vi) reduces the timeline from 80 calendar days to four days for a person to be made party to the case for good cause following completion of the review and submission of recommendations related to an application; (vii) requires the Department to establish a website to make information about the certificate of public need program, including information about letters of intent received by the Department, available to the public; and (viii) establishes a permit process for projects that are no longer subject to the requirement for a certificate of public need which includes provisions for charity care requirements and quality assurance. The bill also (a) directs the Secretary of Health and Human Resources to review requirements governing imposition and satisfaction of charity care requirements for certificates of public need, including provisions for defining charity care and calculating the amount and value of charity care required and provided, develop recommendations for standardizing and enforcing such requirements, and report his recommendations to the Governor and the General Assembly by December 1, 2016, and (b) requires the Department to work cooperatively with Virginia Health Information to develop a process for the collection of utilization data for recipients of certificates of public need describing specific types of equipment utilized. Read the Bill »

Status

03/03/2016: passed committee

History

DateAction
01/05/2016Committee
01/05/2016Prefiled and ordered printed; offered 01/13/16 16101162D
01/05/2016Referred to Committee on Health, Welfare and Institutions
01/14/2016Assigned to sub: Subcommittee Subcommittee #3
01/14/2016Assigned to sub: Subcommittee #3
01/14/2016Assigned HWI sub: Subcommittee #3
01/27/2016Subcommittee recommends reporting with amendment(s) (4-Y 1-N)
01/28/2016Committee draft substitute available 16104743D-H1
02/04/2016Committee substitute printed 16105165D-H1
02/04/2016Reported from Health, Welfare and Institutions with substitute (21-Y 1-N) (see vote tally)
02/04/2016Committee substitute printed 16105312D-H1
02/04/2016Substitute bill reprinted 16105312D-H1
02/05/2016Read first time
02/08/2016Passed by until Thursday, February 11, 2016
02/11/2016Passed by for the day
02/12/2016Passed by temporarily
02/12/2016Read second time
02/12/2016Committee substitute agreed to 16105312D-H1
02/12/2016Engrossed by House - committee substitute HB350H1
02/15/2016Passed by temporarily
02/15/2016Read third time and passed House (94-Y 4-N 1-A)
02/15/2016VOTE: PASSAGE (94-Y 4-N 1-A) (see vote tally)
02/16/2016Constitutional reading dispensed
02/16/2016Referred to Committee on Education and Health
02/17/2016Impact statement from VDH (HB350H1)
03/03/2016Reported from Education and Health with substitute (13-Y 2-N) (see vote tally)
03/03/2016Committee substitute printed 16106036D-S1
03/04/2016Constitutional reading dispensed (38-Y 0-N) (see vote tally)
03/04/2016Read third time
03/04/2016Passed by for the day
03/07/2016Read third time
03/07/2016Reading of substitute waived
03/07/2016Committee substitute rejected 16106036D-S1
03/07/2016Floor substitute printed 16106109D-S2 (Newman)
03/07/2016Motion to rerefer to committee agreed to
03/07/2016Rereferred to Finance
03/07/2016Continued to 2017 in Finance

Video

This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 2 clips in all, totaling 30 minutes.

Transcript

This is a transcript of the video clips in which this bill is discussed.

AYES 39, NOS 0. THE BILL PASSES. HOUSE BILL 350, A BILL RELATING TO THE CERTIFICATE OF PUBLIC NEED PROGRAM REPORT. REPORTED FROM THE COMMITTEE ON EDUCATION AND HEALTH WITH A SUBSTITUTE. SENATOR FROM LYNCHBURG, SENATOR NEWMAN.

Sen. Steve Newman (R-Forest): I WOULD LAKE LAKE THE BILL TO GO -- I WOULD LIKE THE BILL TO GO BYE FOR THE DAY, BUT I WOULD LAKE TO SPEAK TO THE STAT.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. Steve Newman (R-Forest): THERE'S BEEN END SNORE US IN AMOUNT OF WORK GOING ON IN THE SUBCOMMITTEE AND COMMITTEE ON THIS. COMING OUT OF COMMITTEE, IT WAS APPARENTLY CLEAR THAT SOME OF THE LATE NATE WORK PRODUCED A FAU ERRORS IN THE BILL AND THEY NAED TO MAKE SURE YOU UNDERSTAND THAT THOSY QUICKLY REPAIRED. ONE OF THOSE ERRORS IS THAT THERE WAS AN AGREEMENT AMONG THE CHAIR AND OTHERS THAT IF THE FUNDS, WHICH WILL GO TO INDIGENT CARE FOR VIRGINIANS, DID NOT GET APPROVED BY CMS, THAT THE BILL WOULD NOT TAKE EFFECT. AND THAT PROVISION, WHILE TALKED ABOUT IN COMMITTEE AND OTHERWISE, WHEN YOU GO THROUGH IT, IT JUST WASN'T INCLUDED IN THE BILL AND THAT WAS MY AGREEMENT. I WILL ATTEMPT TO FIX THAT ON MONDAY. MR. PRESIDENT, THERE WAS ALSO AN AGREEMENT TRYING TO WORK WITH CHESAPEAKE HOSPITAL TO SAY THAT THERE WAS A FEE AND SOME CAN LIKE THE FAE AND NOT LIKE THAT FEE, BUT THE WAY THE BILL IS WRITTEN, ANYONE IN THAT ENTIRE PLANNING DISTRICTS GETS PUD INTO THAT FUND AND THAT WAS NEVER AEPZ. WHAT WE EXPLAINED IN THE COMMITTEE ROOM IS WHAT WE PLAN TO DO. THAT NARROWS THAT DOWN VERILY. AND I KNOW THERE ARE MEMBERS HERE THAT ARE JUST NOT IN FAVOR OF THE EXEMPTIONS. I GET IT, AND THERE WILL BE SOME DISCUSSION ABOUT THAT ON MONDAY, BUT I THINK THAT THERE ARE A COUPLE OF OTHER CLEAN-UPS THAT ARE TAKING PLACE IN THE BILL, BUT IN GENERAL, A LOT OF THE THINGS THAT YOU MAY HAVE HEARD ABOUT FROM YOUR HOSPITALS, I THINK THERE WERE EIGHT ITEMS, WE'VE AGREED AND FOUND A WAY TO FIX SEVEN OF THOSE. THOSE WILL ALL BE BEFORE YOU. THERE'S PLENTY OF REASONS TO SUPPORT THIS BILL, THERE ARE PLENTY OF REASONS TO HAVE THOUGHTS ABOUT THIS BILL THAT ARE NOT AS POSITIVE, BUT I THINK THE TECHNICAL ITEMS WILL ALL BE BEFORE OUS MONDAY. MR. PRESIDENT, I APPRECIATE YOU ALLOWING PLEA TO SPEAK STOIT. I HOPE WE ALLOW IT TO GO BYE FOR THE DAY.

Del. Bill Howell (R-Fredericksburg): THANK YOU, SENATOR. WITHOUT OBJECTION, HOUSE BILL


[Unknown]: THE THE SENATOR HAS THE FLOOR. I MOVE THAT HOUSE BILL 883 PASS. THANK YOU, SENATOR. THE REQUEST HE IS SHALL HOUSE BILL 883 PASS? ALL IN FAVOR OF THE MOTION WILLA YE, THOSE OPPOSED NO. ARE THE SENATORS READY TO VOTE? HAVE ALL THE SENATORS VOTED? DO ANY SENATORS DESIRE TO CH ANGE THEIR VOTE? THE CLERK WILL CLOSE THE ROL. S1 40, NOS 0. THE BILL PASSESS. HOUSE BILL 350 A BILL RELATING TO THE CERT CAL OF PUCK LIVE NEED PROGRAM REPORT REPORTED FROM THE COMMITTEE ON EDUCATION WITH HEALTH A WITH SUBSTITUTE AND THERE FLOOR SUBSTITUTE. THE SENATOR FROM LYNCHBURG, SENATOR NEWMAN. I MOVE THAT COMMITTEE SUBSTITUTE BE AED TO.

Sen. Steve Newman (R-Forest): ALL IN NERVE OF ANOTHER, NOSE TOISONSED PO. THE NOS HAVE IT. THE IT. I WOULD MOVE THAT THE COMMITTEE SUBSTITUTE BE AGREED TO AND WIN NAVE THE READING OF THE NASCAR SUBSTITUTE.

[Unknown]: THE QUESTION IS THAT WILL THE YETING WE GIVED. ALL IF NAVAR ASSAY, THOSE OPPOSED, NAY.

Sen. Steve Newman (R-Forest): I MOVE WE HAVE THE LOOR IN PEEKING TO THAT THIS MOSQUITOS. HE KNOW THAT THE MEMBERS OF THE EDUCATION HEALTH COMMITTEE HAVE HEARD AS MUCH OF THIS BILL AS THEY THOUGHT THEY WOULD. MR. PRESIDENT, THE BILL BRINGS UP AN IMPORTANT MATTER THAT I BELIEVE THAT THIS SENATE MUST DEAL WITH. OVER THE LAST COUPLE OF WEEKS WE HAVE PUT TOGETHER WHAT I THINK IS A STRONG AND REASONABLE AND BALANCED BILL. IT WAS NOT AN EASY DECISION TO COME TO THE SUBSTITUTE. BUT I THINK WE PUT TOGETHER A BILL THAT I THINK ULTIMATELY WILL BE THE PATH THAT WE WILL MOST LIKELY REFORM COPN. WE IT TAKE STEPS. WE RECOGNIZED WE NEED TO DO SOMETHING ABOUT INNOVATION AND WE NEEDED TO DO SOMETHING ABOUT FUNDING FOR OUR HOSPITALS. MR. PRESIDENT, THE BILL THAT CAME TO US FROM THE HOUSE OF DELEGATES THAT WE ARE CONSIDERING AMENDING WAS A COMPLETE REFORM OF THE BILL IN EVERY WAY. WE WOULD ULTIMATE PLAY PHASE OUT ALMOST ALL OF COPN AND WE WOULD REPLACE THE GUNS WITH BASE EXALLY NOTHING AND THERE WERE SOME AND SOME IN THIS BODY THAT ARE ANY IN FAVOR OF THAT TOP OF REFORM. WE TOOK A DIFFERENT PATH. TOOK WHAT I THINK IS A BALANCED PATH. OUR SUBCOMMITTEE HAD MEETINGS AND HAD DISCUSSIONS WITH THE ON THES AND DISCUSSIONS WITH THE PHYSICIANS AND CUBS WITH EXPERTS THAT LOOK -- I THINK THE SENATOR DID A REMARKABLE JOB IN DRATTING THE SUBSTITUTE BEFORE US. WE HAD MAJOR MEETINGS AND SHOCKED TO FIND THERE HAS NEVER BEEN ONE WITH THE HOSPITALS ABOUT WHAT WOULD BE A POTENTIAL OF -- LEGISLATION OF THIS MAGNITUDE.

[Unknown]: OF THE TO BE CLEAR EVEN THOUGH WE WET WITH NELLY ALL THEIR CEOS AND TO BE CLEAR, THIS IS NOT A ABOUT I WILL THAT THEY SUPPORT. THIS IS A BILL HOWEVER, THAT I THINK IS THE MODEL FOR US FOR GOING FORWARD. THE SUBSTITUTE CLEANS UP A NUMBER THINGS. ONE, YOU WILL REMEMBER THAT COMING OUT OF THE COMMITTEE THERE WAS A DRAFTING ERROR THAT RELATED TO CHESAPEAKE HOSPITAL THAT BROUGHT IN ALL OF PLANNING DISTRICT 23. CLEARLY IT SUBSTITUTE FIXES THAT. OVER WEEKEND FEE SOUND THERE COULD ABOUT HE A CONDITIONKY TUBESSAL PROBLEM WITH INTERESTING THE SMALL FEET ON THE NEWS INDIVIDUALS THAT SIM INTO AREAY AND SAID THAT THE CHESAPEAKE AUTHORITY DOES THE HAVE AN OPPORTUNITY TO APPROPRIATION OUT OF THE FUND. WHAT WE PUT TOGETHER IN MAY OPINION IS WHAT THE SENATE DOES BEST -- AND THAT IS WE TAKE DIFFICULT PROBLEMS OFTEN COLLOQUYING FROM THE HOUSE, WE REMOVE THE EMOSQUITOS AND WE POLLED UPON LEMES UNDERWHAT 1 WHAT THIS BILL OF THE MEANT TO DO. IT JUST A OVER WITH A AFTEROF LOW MOTIONS. SOME CON STRIVED. IT CERTAINLY WAS APRON LEM. I WOULD LIKE TO MENTION TO YOU OF THE A COUPLE OF QUICK THIN IS. WHY AND WHAT AND HOW AND WHEN. ONE IS WHAT. WHAT IS COPN. YOU IS SEEN US GOING THROUGH REFORM BEFORE. SOME OF YOU REMEMBER THE BOEINB COMMISSION AND WORK BELLING DOEN THERE. WE ARE TRIED TO SOLVE IN THIS YEAR. HE NEED WE NEEDED TO A CONCERN AMOUNT OF FUNDING. SOME MAY REMEMBER THE NIXON ERA WHERE THE PRESIDENT WENT ON TELEVISION TO SAY HE IS ORDERING A FREEZE ON ALL PRICES AND ALL WAGES. REMEMBER THAT? HE SAID WE WILL PUT A FREEZE ON EVERYTHING AND ENDED UP PUTTING IN TWO YOUNG MEN NAMED RUMSFELD AND CHENEY TO RUN THE DEPARTMENT AND THEY CAME UP WITH A NEW PRICE TORE EVERYTHING AND DETERMINED HOW MUCH WAGES COULD GO UP FOR EVERYTHING UNDER A REPUBLICAN ADMINISTRATION. , THAT DIDN'T LAST LONG. IT ENDED UP BEING DISMENTLED RELATIVELY QUICKLY. THERE ARE VEST ANDS LEFT OVER. AND COPN IS ONE OF THOSE ITEMS S THAT IS LEFT OVER FROM ERA. MR. PRESIDENT, TODAY YOU NEED TO UNDERSTAND FROM THE NCSL, V. VIRGINIA IS A FULLY REGULATED COPN STATE. AS A MATTER OF FACT, IF YOU HAVE A CHANCE TO ED RAT BILL THE PARTS -- HAVE THAN TO READ THE BILL THE MARTS THAT AREN'T UNDERLINED IT IS INCREDIBLE. IT RECOMMENDED A NUMBER OF CHANGES BECAUSE IT SO BROKEN. MR. PRESIDENT, THE COMMISSION AGREED THAT WE NEEDED TO HAVE OFF SETS. THEY DIDN'T COME BACK WITH THE OFFSETS IN THE FINAL RECOMMENDATION BUT AGREED ME NEEDED TO HAVE MORE THAN JUST THE ULTIMATE BILL THEY SET FORWARD. MR. PRESIDENT, THE NEXT QUESTION IS WHY ARE WE TEAR HOOD? WE ARE WAR HERE 150 YEARS LATER AFTER THE BOGEY COMMISSION LOOKED AT THAT AND WE HERE TODAY BECAUSE WE ARE IN A DIFFERENT MEDICAL ENVIRONMENT THAN WE WERE BEFORE. YOU KNOW IN YOUR COMMUNITIES AND IF YOU DON'T KNOW YOU NEED TO CHECK IT IS LIKELY THAT YOUR COMMUNITY IS LIKE MINE AND THAT IS THAT THE HOSPITALS ARE EITHER BEING FORCED OR THEY ARE BEING ENCOURAGED TO BUY UP EVERYTHING IN THE COMMUNITY. IN MY COMMUNITY IT HAS HAPPENED. IN KNOW ROKO, IT IS HAPPENING. HARRISONBURG THROUGHOUT THE. AND IT IS HOOPING KURT THE COUNTRY A MOVE TOWARD CONSOLIDATION IN HEALTHCARE AND HAS PROPOED THE BILLS EVERYWHERE IN THE COUNTRY. VERY A BILL THAT GOES TOWARD IMAGING. IT WOULD MEAN THAT VIRGINIA WOULD CONSIDER IMAGING WHICH IS ONLY ONE OF 13 STATES THAT HAVE IMAGING LEFT TO BRING IT OUT FROM UNDER COPN. MR. PRESIDENT, I WOULD GIVE YOU ANOTHER REASON WHY THIS BILL IS HERE TODAY. AND THAT IS BECAUSE OF WHAT IS HAPPENING IN NORTHERN VIRGINIA, WE HAD ENOUGH TOMORROW THOSE THAT DO KNOW KNOW THIS IS TRUE. MARYLAND IS LINNING UP THE BORTER WITH IMPANELMY KISS MEMBERS AND IT TOOKSES FROM ALL OH OVER NAN LOUISIANA MR. BE TACKING IT RATE OVER THE BORDER. IF WE DON'T TO SOMETHING IN THE NEXT FIVE YEARS AND I PREDICT WE WILL GET AT A CONDITION AT SOME POINT SOON WHERE WE WILL SAY WE HAVE GOT TO HAVE TOMORROW COMPE. THE OTHER IS THE HOW. HOW DO WE DO THIS? A REASONABLE BILL. WE BASICALLY SAID THAT WE ARE GOING TO SEE FORM THE PROCESS BY TAKING OUT CTs AND MRIs AND A COUPLE OF OTHER ITEMS. WE DIDN'T TAKE THE STILL STEP. WE DIDN'T TAKE THE FULL STEP, WE TOOK THE SMALLER STEP TOWARDS PULL REFORM. THE OTHER QUESTION IS HOW WE DECIDED TO GO FUNDING ORGANIZATION. SOME THAT WE THINK TO MUCH INTO IT AND MOTT SOME THINK YOU SHOULDN'T BUT A NIGHT TO ABOUT, IT. A LOGICAL NECK US TO THE BILL. WHAT WE GOT BACK FROM THE HOSPITALS AS THE QUOTE DAMAGE ON THE LOWER END WOULD BE ABOUT $186 MILLION AND FROM SECRETARY HAZEL'S OFFICE THE NEW FEDERAL RULES PUT THAT ABOUT IN HALF AND PRODUCES AN IMPACT IN VIRGINIA OF 2 MILLIONED OUR COMMITTEE WAS WILLING TO JUST LET THAT GOO BOEINB WITHOUTING TO SOMETHING ABOUT AT WE PRODUE THE WHAT I THISSISM THINK OF THE MOST MOST VIRTUAL EDUCATION WAY TO TAKE CARE OF PEOPLE POOR AND AGE DID I I WOULD WITHOUT EXPANDING. THIS IS IT THE FIRST TIME IN THIS SLATE SLEDGE LATURE IN MANY WE WILL YEARS WE HAVE BEENIBLE TO THESE THESE PEOPLE WITH THOSE PROBLEMS INJURE THE TUALATIN DOES NOT HAVE 90 MILLIONED IN IT BECAUSE OF OF A DISCUSSION WITH THE APARTMENT IN LAKES AND THE NUMBER 1 HIP 9. THE FULL IN THE BILL IS A DILL DIFFERENT THAN WHAT WE HAD BEFORE. THE QUESTION THEN BECOMES OF WHEN THE BILL DOES HAVE 25019 AS THE FEE AGAINING OF THIS BILL AND IT DOES WITH WITHOUTYING INTO SEN TRILLION FUNDS. MR. PRESIDENT, IT IS REASONABLE TO SAY MOST HOSPITALS STILL ARE NOT IN FAVOR OF IT OR WOULD RATHER US TO THIS FOR POSTPONE THIS AND TALK ABOUT THIS MORE. IT IS ALSO REASON ONLY TO SAY THAT MOST DOCK RIVALRIES TWOING THINK WE IT NOT GO GOVERNOR. THIS GREAT A GREAT, GREAT HELPING IN PREPPING PRODUCE A PROCESS. PATHWAY FORWARD. LOW PRESSURE SYSTEM, I KNOW, I HAVE HEARD FROM THE FROM AUGUSTA AND OTHERS THAT THERE IS A REVENUE BILL PROBLEM ON THIS BILL. AND I HAVE TALK TO THE FINANCE ABOUT THAT ISSUE AND I UNDERSTAND. THE FACT IS THAT IN THE PAST WE HAVE HAD A DISAGREEMENT BETWEEN THE HOUSE AND THE SENATE ON REVENUE WILLS. THE NOT HAS BEEN MORE GENEROUS I THINK ON REVENUE BILLS. THE HOUSE OF DELEGATES CONTINUED WITH THE BELIEF THAT EVEN IF IT DATES OR BEYOND THE BI ANDSNNAU, EIGHT FREE IS IT IN RAISES MONEY FOR SPENDS MONEY IT IS A REVENUE BILL. HE THINK THERE IS GOING TO BE A MOTION ON THAT THAT FEW MINUTES. MR. PRESIDENT, I WOULD TELL YOU THAT WHATEVER HAPPENS ON THAT AND I HAVE NOT LOBBIED THIS BILL, NOT ONE PENZANCE WE CAME OUT OF COMMITTEE. I NO YOU HAVE BEEN LOBBIED A LOT. I HAVE NOT PLENTY OF DREW TO VOTE ANYWAY. IF WE TOOK A VOTE RIGHT NOW IT WOULD BE A CLOSE POPULAR VOTE. THAT IS FOR SURE. I THANK WE SET OUT A PATHWAY FOR THE FUTURE. I HOPE THE HOT OF DELEGATES IS LOOK THE A THE THIS AND UNDERSTAND YOU COULD NOT HAVE ABSOLUTE REFORM WITHOUT CONSIDERING THE IMPACT ON OUR HOSPITALS. I LOVE MY HOSPITAL. WHEN MY CHILDREN OR MY PARENTS ARE ILL THEY TAKE CASE OF US. WE NEED TO TAKE CARE OF THEM. WE TAKE CARE OF THEM BY THE STATE DOING MORE OF WHAT THEY SHOULD DO AND THAT IS NOT SPENDING 66 CENTS ON A DOLLAR UNDER THE MED DENIDATION. THIS TAYS THAT THE MONTESSORI I IN BASED WOULD GO INTO THE REIMBURSEMENTS TO RAISE THE 67 CENTS UP INTO THE 70s. AND SAYS WE WILL FUND SOME OF THE GAP PROGRAMS. WE ARE NOT FARR AWAY FROM HELPING SOLVE A BIG PROBLEM LEM AND THIS WOULD HELP US. I HAVE A LONGS PRESENTATION AND A SHORT PRESENTATION. I DON'T SPEAK OFTEN ON THE FLOOR BUT I THINK THIS IS AN ISSUE NEEDS TO BE SOLVED. I WOULD LIKE TO MAYBE HAVE AN OPPORTUNITY, MR. PRESIDENT, AT THE RIGHT TIME IF THE MOSQUITOS IS MADE ON THIS BEING A REVENUE BILL THAT WE HAVE A CHANCE TO TALK ABOUT THAT. THE NUMBER OF SENATORS IN THE BUILDING HAVE TON EMOM RUSS WORK AND ONE IS THE -- ENORMOUS RUSS, THE JUNIOR SENATOR FROM HENRICO, SENATOR DUNNAVANT. I WOULD LIKE TO YIELD TO THE SENATOR FOR OTHER COMMENTS. THE JUNIOR SENATOR FROM HENRICO, FLORIDA CURSE. SPEAK TO THE BILL I. I AM GRATEFUL AND I WANT TO SPEAK TO IT A LITTLE BIT. OUR MARKETPLACE IS UNDER EXTREME DURESS AND MUCH OF THE RESPONSIBILITY IN ASSISTING THE MARKETPLACE WILL FALL TO THIS BODY. AND PARTICULARLY WE HAVE [PLEASE STAND BY] IF WE ARE GOING TO CHANGE THE DYNAMIC WE HAVE A FIND A WAY TO OFF SET THE LOSSES AND THAT IS WHAT THE FUND DOES. IT IS NOT ONLY MEDICAID EXPANSION. AND THIS IS NOT MEDICAID EXPANSION. CHARITY CARE REFERS TO AMOUNT OF MONEY WE ARE PAYING FOR THE PATIENTS INSURED THAT ARE BEING TAKEN CARE OF BY OUR DOCTORS AND HOSPITALS AND WE NEED TO FIND A RESOURCEFUL WAY TO INCREASE THE RATES IN ORDER TO HELP THEM BE WHOLE SO WE CAN IMPROVE THE MARKETPLACE AND PROVIDE MORE COMPETITION. AND PHYSICIANS ARE BEING ABSORB INSIDE EMPLOYED SITUATIONS BECAUSE THEY CANNOT COMPETE IN THE MARKETPLACE AND HAVING THE OPPORTUNITY TO HAVE SERVICES FOR WHICH THEY CAN BE BETTER REIMBURSED BEGINS TO OFF SET THAT TREND. I DON'T PERSONALLY AND I HOPE EVERYTHING IN THE ROOM WOULD PREFER US TO HAVE SOME PRIVATIZATION OF HEALTHCARE. I THINK WE HAVE THE FINEST HEALTHCARE SYSTEM IN THE WORLD. BUT WE NEED TO HAVE SOME MPETITION. TO ENSURE THAT EXISTS. A BALANCED APPROACH TO DISAI'MABLING AN ARCHAIC SYSTEM OF REGULATING SERVICES IN THE MARKETPLACE THAT WILL HELP US MAKE A REAL DIFFERENCE IN HOW WE PROVIDE HEALTHCARE IN VIRGINIA AND I HOPE THAT THE SENATE WILL HE ABOUT ABLE TOO LEVERAGE THAT ARGUMENT SO THAT WE CAN MAKE TRUE PROGRESS IN RESOLVING THIS PROBLEM BECAUSE JUST DISASSEMBLING COPN WILL CAUSE UNTOLD CONSEQUENCES. DEREGULATED AND LOST 30% OF REHAVE SEEN ONE STATE THAT THEIR HOSPITAL. WE NEED TO HAVE A RESPONSIBLE APPROACH TO THIS AND THIS BILL PROVIDES THAT. THANK YOU FOR YOUR TIME. THANK YOU, SENATOR. THE SENATOR FROM AUGUSTA, SENATOR HANG.

Sen. Emmett Hanger (R-Mount Solon): I RICE FOR PURPOSES OF A MOTION BUT WOULD LIKE TO SPEAK ON THE BILL FIRST I SLUGLE WITH HOW WE CAN ACCESS ADDITIONAL FUNDS AND CERTAINLY TAKE CARE OF THOSE THAT ARE IN NEED OF CARE WITHOUT PUTTING THEM INTO NKRUPTCY. INDEED, LAST YEAR AS PART OF THE BUDGET PROCESS I WAS ASKED AND OUR HHR SUBSTITUTE COMMITTEE AGREED TO PUT LANGUAGE IN THE BUDGET WHICH REQUIRED A TASK FORCE AND THAT WORK WAS ENGAMED OVER THIS PAST YEAR. ANOTHER REASON THAT I STRUGGLE HERE IS THAT MY FRIEND AND I ENJOY A GOOD WORKING RELATIONSHIP AND HE ALSO HAS A GREAT PASSION FOR THIS PARTICULAR ENDEAVOR. AND, INDEED, AS I REFLECT BACK ON THE BEGINNING OF THIS SESSION, MR. PRESIDENT, WHEN WE WERE REORGANIZING COMMITTEES I THINK THERE WAS SOME RELUCTANCE, SOME OF US ENCOURAGED THE SENATOR FROM LYNCHBURG TO UNDERTAKE THE CHAIRMANSHIP OF THE EDUCATION AND HEALTH COMMITTEE. HE HAD RELUCTANCE BECAUSE HE VIEWED IT IF YOU ARE GOING TO DO IT RIGHT AS A LARGE UNDERTAKING WHERE HE WAS GOING TO ASK TO COMMIT TIME HERE AWAY FROM HIS BUSINESS AND HIS FAMILY. HE AGREED TO DO THAT AND I WOULD SAY HAS DONE A TREMENDOUS JOB AND I LOOK FORWARD TO THE GOOD WORK HE WILL BE ABLE TO DO IN THAT CAPACITY OVER NEXT SEVERAL YEARS. HAVING SAID THAT, WE WORKED LAST NIGHT IN THE HHR SUB COMMITTEE ON THIS ISSUE AND PERHAPS HAVE SOME DISAGREEMENT AND SOME AGREEMENT. I CERTAINLY AGREE THAT SIGNIFICANT WORK NEEDS TO BE ACCOMPLISHED OVER THE NEXT SEVERAL YEARS BUT ALSO THE OTHER PART OF THIS THAT I STRUGGLE WITH, MR. PRESIDENT, AS HAS BEEN ALLUDED TO, WE OPERATE UNDER RULES. AND ONE OF THOSE RULES IS ANYTHING LABELED A REVENUE BILL HAS A ADVANCE ON A CERTAIN CALENDAR AND TIME TABLE AND ALTHOUGH IT HAS BEEN WORKED EVEN TREMENDOUSLY IN THE EDUCATION COMMITTEE WITH LOTS OF TIME COMMITTED BY NOT ONLY THE SENATOR FROM LYNCHBURG BUT THE JUNIOR SENATOR FROM HENRICO AND MANY OTHERS, AND MADE GREAT PROGRESS IN BRINGING TOGETHER DIFFERENT VIEW POINTS ON HOW TO PROCEED AND I APPLAUD THEM FOR THAT. BUT IT ALSO I, I WOULD POINT OUT, MR. PRESIDENT, THAT THE BILL HAS NEVER BEEN IN FINANCE ME COMMITTEE AND I WOULD DRAW YOUR ATTENTION TO PAGE 8. WELL, PAGE 34, LINES 844 THROUGH 848. WHERE CAREERLY IT TALKS ABOUT CONSIDERATIONS THAT ARE TO BE REQUIRED FROM PROVIDERS BASED ON THE LEVEL OF CHARITY CARE AND BASED ON THEIR NET OPERATING INCOME. WHICH WOULD NOT EXCEED $109 MILLION IN ANY GIVEN YEAR. CLEARLY, MR. PRESIDENT, IT IS A REVENUE BILL. CLEARLY WHEN IT REQUIRES APPROPRIATE REGULATIONS FOR THIS TO WORK IT SHOULD BE CONSIDERED PREVIEWED IN A TIMELY MAN ARE. SO, MR. PRESIDENT, IT IS FOR THAT REASON THAT I WOULD MOVE THAT UNDER RULE 20 G WE COMMIT THIS BILL BACK TO THE SENATE FINANCE COMMITTEE TO BE CARRIED OVER FOR THE YEAR AND HAVING MADE THAT MOTION, MR. PRESIDENT, I WOULD YIELD TO THE SENATOR FROM LYNCHBURG.

[Unknown]: THE SENATOR FROM LYNCHBURG, SENATOR NEWMAN.

Sen. Steve Newman (R-Forest): MR. PRESIDENT, CLEARLY I DO NOT WANT THIS BILL TO GO AWAY. THIS BILL I THINK REPRESENTS THE FLAME WORK FOR THE FUTURE. I HAD A CONVERSATION WITH THE GENTLEMAN FROM AUGUSTA, LIEUTENANT GOVERNOR, TALKED TO SENATE FINANCE STAFF ABOUT THE RULES. MR. PRESIDENT, I CARE PASSIONATELY ABOUT THIS BILL. I THINK IT IS SOMETHING THAT WE HAVE TO SOLVE. MR. PRESIDENT, OVER THE YEARS I HAVE CARED PASSIONATELY ABOUT THE RULES OF THE SENATE AS WELL. I WILL NEVER FORGET WE HAD A RULE RELATED TO PARENTAL NOTIFICATION. THE QUESTION WAS IF WE BREAK THE RULES CAN WE GET IT PASSED. AND WE DECIDED NOT TO BREAK THE RULES. THIS BILL PAINS ME. IT RAISES MONEY AND SPENDS MONEY AND I AM TOLD THAT THAT MEANS IT AS REVENUE BILL. I HAVE GONE THROUGH GYRATIONS AND DATES PUSHED OUT AND GOTTEN NONGENERAL FUNDS AND BACK FLIPS ON HOW THE FUNDS TAKE LACE. I DON'T KNOW IT WAS PERFECT POLICY. MY LAST ATTEMPT WAS THAT AMERICANING TO LOOK AT A REENACTMENT CLAUSE AND I AM TOLD VERY CLEARLY THAT THE RULES OF THE SENATE ARE THAT DESPITE THAT IS THE WAY IT WAS 10 YEARS AGO IF IT RAISES AND EASTBOUND PENDS MONEY IT IS A -- EXPENDS MONEY IT AS REVENUE BILL. FOR THAT, MR. PRESIDENT, ALTHOUGH IT IS OF GREAT TROUBLESOME TO ME, I WOULD ASK THAT WE AGREE WITH THE SENATOR FROM AUGUSTA AND RETURN THE BILL BACK TO COMMITTEE. I WILL TELL YOU THIS. I DON'T KNOW IF WE WOULD HAVE WON OR LOST. I DON'T KNOW. I KNOW SOME PEOPLE ON THE DEMOCRATIC SIDE WERE WITH IT AND SOME PEOPLE SAYING LET'S TAKE OUT THE FEES AND PASS REFORM AND SEE WHAT HAPPENS AND I GET IT. I THINK THAT IF WE ARE GOING TO CONTINUE TO OPERATE UNDER THE RULES AND RESPECT THE RULES THE RIGHT THING TO DO IS TO DO IT ON BILLS YOU ARE PASSION AATE ABOU. A LOT OF PEOPLE HAVE A LOT OF THOUGHTS ON THE BILL. I RELUCTANTLY RISE TO SUPPORT THE MOTION OF THE SENATOR FROM AUGUSTA.

[Unknown]: THE SENATOR FROM CHESAPEAKE, SENATOR COSGROVE.

Sen. John Cosgrove (R-Chesapeake): THANK YOU, MR. PRESIDENT. SPEAKING TO THE MOTION.

[Unknown]: THE SENATOR HAS THE FLOOR.

Sen. John Cosgrove (R-Chesapeake): I AGREE WITH THE MOTION BUT I HAVE A COUPLE OF THINGS TO SAY ABOUT THIS IN PARTICULAR ABOUT SENATOR NEWMAN AND ABOUT SENATOR DUNNAVANT. I AM PROBABLY THE MOST IMPACTED SENATOR HAVING TO DEAL WITH THE COPO BILL BECAUSE OF CHESAPEAKE WHICH IS DIFFERENT. THE SENATOR FROM LYNCHBURG AND THE JUNIOR SENATOR FROM HENRICO HAVE WORKED TIRELESSLY ON THIS AND I HAVE THE UTMOST RESPECT FOR THE SENATOR FROM LYNCHBURG FOR AGREEING TO GO WITH THE RULES OF THE SENATE WHEN HE IS SO PASSIONATELY IN FAVOR OF THIS BILL. I STAND IN AWE OF THAT AND I THINK HE SERVED THAT BODY EXCEPTIONALLY WELL. THANK YOU, SIR.

[Unknown]: THE SENIOR SENATOR, SENATOR SASLAW. I SUPPORT THE MOTION TO SEND IT BACK. I THINK THERE IS A GENERAL CONSENSUS IT IS A REVENUE BILL. THERE IS SOME OTHER QUESTIONS THAT I HAVE ABOUT THIS. BUT I WILL TELL YOU I HAVE BEEN UP HERE AWHILE AND I HAVE NEVER SEEN ANYBODY AND THIS IS COME POLITIC KATEED TOPIC WORK HARDER THAN SENATOR NEWMAN HAS AND SENATOR DUNNAVANT TO TRY TO PUT TOGETHER SOMETHING. REGULATION IS NOT EASY. AND REGULATION -- I MEAN DEREGULATION AND DEREGULATION DOESN'T ALWAYS NECESSARILY MEAN THAT YOU ARE GOING TO GET A GOOD DEAL PRICE WISE. YOU HEARD THE STORY FROM THE SENATOR TALKING TO SENATOR BARKER THIS IS NOT THE FIRST TIME WE DEREGULATED MRIS AND MACHINE IS LIKE THAT. BUT, BACK IN 1978, BEFORE OOH AW OF YOU IN HERE WERE BORN THEY DECIDED TO DEREGULATE THE AIRLINE INDUSTRY ON THE PREMISE IT WOULD BRING MORE COMPETITION AND DRIVE FARES DOWN AND EVERYTHING WOULD BE FINE. WHEN THEY WENT INTO DEREGULATION THAT WAS AIRLINES, NORTHEAST AND EASTERN AND PAN A.M. AND NORTHWEST AND TRANS WORLD AIRLINES, BRANIFF. CONTINENTAL. AND I GO GO ON. PRIOR TO DEREGULATIONS, CANCELED FLIGHTS, I CAN'T REMEMBER HAVING ONE. I USED TO TRAVEL QUITE A BIT ALL OVER THE GLOBE. NOW THEY ARE COMMON PLACE. IT IS NOT ALWAYS WHAT IT SEEMS. THIS IS A COMPLICATED FIELD. THIS IS NOT YOUR NORMAL FIELD WHERE ECONOMICS WOULD WORK IN BUILDING WIDGETS WOULD WORK HERE. THIS BILL IS A THOUSAND PERCENT BETTER THAN WHAT WE GOT LARGELY THANKS TO THE COMMITTEE CHAIRMAN AND THE WORK ALSO OF SENATOR DUNNAVANT ON THIS. I WOULD HOPE WE WOULD SUPPORT THE MOTION AND SEND IT BACK. THERE IS A SUBSTITUTE MOTION ON THE FLOOR TO RE-REFER BILL 350 TO FINANCE AND CONTINUE INTO