Direct primary care agreements; the Commonwealth's insurance laws do not apply. (HB2053)

Introduced By

Del. Steve Landes (R-Weyers Cave) with support from 14 copatrons, whose average partisan position is:

Those copatrons are Del. Kathy Byron (R-Lynchburg), Del. Mark Cole (R-Fredericksburg), Del. Peter Farrell (R-Henrico), Del. Buddy Fowler (R-Ashland), Del. Scott Garrett (R-Lynchburg), Del. Riley Ingram (R-Hopewell), Del. Terry Kilgore (R-Gate City), Del. Danny Marshall (R-Danville), Del. Jimmie Massie (R-Richmond), Del. John O'Bannon (R-Richmond), Del. Charles Poindexter (R-Glade Hill), Del. Margaret Ransone (R-Kinsale), Del. Chris Stolle (R-Virginia Beach), Del. Tommy Wright (R-Victoria)

Progress

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

Description

Direct primary care agreements. Provides that the Commonwealth's insurance laws do not apply to direct primary care agreements. The measure further provides that (i) a direct primary care practice is not subject to the jurisdiction of the State Corporation Commission (SCC) and is not required to obtain a certificate of authority or license to market, sell, or offer to sell a direct primary care agreement; (ii) entering into a direct primary care agreement shall not be considered to be engaging in the business of insurance; and (iii) a direct primary care agreement is not a contract of insurance and is not subject to regulation by the SCC. The bill defines a direct primary care agreement as an agreement entered into between a health care provider and an individual patient under which the provider charges a predetermined fee as consideration for providing primary care to the patient, subject to certain conditions. A direct primary care practice is prohibited from submitting a claim to an insurer with respect to services provided to direct primary care patients covered by their direct primary care agreement, unless the services are outside the scope of the agreement. The measure provides that a willful or intentional violation constitutes an act of unprofessional conduct punishable by the Board of Medicine. Read the Bill »

Outcome

Bill Has Passed

History

  • 01/10/2017 Committee
  • 01/10/2017 Prefiled and ordered printed; offered 01/11/17 17102438D
  • 01/10/2017 Referred to Committee on Commerce and Labor
  • 01/18/2017 Impact statement from DPB (HB2053)
  • 01/26/2017 Reported from Commerce and Labor with substitute (21-Y 0-N) (see vote tally)
  • 01/26/2017 Committee substitute printed 17104598D-H1
  • 01/27/2017 Impact statement from DPB (HB2053H1)
  • 01/30/2017 Read first time
  • 01/31/2017 Floor substitute printed 17105005D-H2 (Landes)
  • 01/31/2017 Passed by for the day
  • 02/01/2017 Read second time
  • 02/01/2017 Committee substitute rejected 17104598D-H1
  • 02/01/2017 Substitute by Delegate Landes agreed to 17105005D-H2
  • 02/01/2017 Engrossed by House - floor substitute HB2053H2
  • 02/02/2017 Read third time and passed House (83-Y 12-N)
  • 02/02/2017 VOTE: PASSAGE (83-Y 12-N) (see vote tally)
  • 02/03/2017 Constitutional reading dispensed
  • 02/03/2017 Referred to Committee on Commerce and Labor
  • 02/06/2017 Impact statement from DPB (HB2053H2)
  • 02/13/2017 Reported from Commerce and Labor with substitute (12-Y 0-N) (see vote tally)
  • 02/13/2017 Committee substitute printed 17105281D-S1
  • 02/15/2017 Constitutional reading dispensed (40-Y 0-N) (see vote tally)
  • 02/15/2017 Impact statement from DPB (HB2053S1)
  • 02/16/2017 Read third time
  • 02/16/2017 Reading of substitute waived
  • 02/16/2017 Committee substitute agreed to 17105281D-S1
  • 02/16/2017 Engrossed by Senate - committee substitute HB2053S1
  • 02/16/2017 Passed Senate with substitute (39-Y 0-N 1-A) (see vote tally)
  • 02/20/2017 Placed on Calendar
  • 02/20/2017 Senate substitute rejected by House 17105281D-S1 (1-Y 94-N)
  • 02/20/2017 VOTE: REJECTED (1-Y 94-N) (see vote tally)
  • 02/21/2017 Senate insisted on substitute (39-Y 0-N 1-A) (see vote tally)
  • 02/21/2017 Senate requested conference committee
  • 02/22/2017 House acceded to request
  • 02/23/2017 Conferees appointed by House
  • 02/23/2017 Delegates: Landes, Kilgore, Bagby
  • 02/23/2017 Conferees appointed by Senate
  • 02/23/2017 Senators: Stanley, Dunnavant, Barker
  • 02/24/2017 C Amended by conference committee
  • 02/24/2017 Conference report agreed to by Senate (39-Y 0-N 1-A) (see vote tally)
  • 02/24/2017 Conference report agreed to by House (73-Y 22-N)
  • 02/24/2017 VOTE: ADOPTION (73-Y 22-N) (see vote tally)
  • 03/07/2017 Enrolled
  • 03/07/2017 Bill text as passed House and Senate (HB2053ER)
  • 03/07/2017 Signed by Speaker
  • 03/08/2017 Impact statement from DPB (HB2053ER)
  • 03/10/2017 Signed by President
  • 03/13/2017 Enrolled Bill communicated to Governor on 3/13/17
  • 03/13/2017 G Governor's Action Deadline Midnight, March 27, 2017
  • 03/24/2017 Governor's recommendation received by House
  • 04/05/2017 Placed on Calendar
  • 04/05/2017 House concurred in Governor's recommendation to Amendments 1, 2 and 3 (97-Y 1-N)
  • 04/05/2017 VOTE: ADOPTION (97-Y 1-N) (see vote tally)
  • 04/05/2017 House rejected Governor's recommendation to Amendment #4 (31-Y 67-N)
  • 04/05/2017 VOTE: REJECTED (31-Y 67-N) (see vote tally)
  • 04/05/2017 Senate concurred in Governor's recommendations #1, 2 and 3 (39-Y 0-N 1-A) (see vote tally)
  • 04/05/2017 G Governor's recommendation adopted in-part
  • 04/05/2017 Reenrolled
  • 04/05/2017 Signed by Speaker as reenrolled
  • 04/05/2017 Signed by President as reenrolled
  • 04/05/2017 Communicated to Governor
  • 04/05/2017 Reenrolled bill text (HB2053ER2)
  • 04/05/2017 G Governor's Action Deadline Midnight, May 5, 2017
  • 04/26/2017 G Approved by Governor-Chapter 830 (effective 7/1/17)
  • 04/26/2017 G Acts of Assembly Chapter text (CHAP0830)

Video

This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 3 clips in all, totaling 12 minutes.

Transcript

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



Del. Marcus Simon (D-Falls Church): STATUTES IN THE CODE THAT ALREADY ADDRESS THE VERY NARROW PROBLEM THAT THE PATRON SAYS THIS BILL IS TRYING TO SOLVE. WHAT THIS BILL IS REALLY DOING IS IT IS A MESSAGE BILL. I HAVE PLENTY OF MESSAGE BILLS ON MY SIDE. I KNOW WHAT A MESSAGE BILL LOOKS LIKE. IT IS A MESSAGE BILL. DESIGNED TO SEND A MESSAGE. UNFORTUNATELY, I THINK IT WILL SEND THE WRONG MESSAGE TO THE REST OF THE UNITED STATES. IT IS GOING TO SAY THAT WE ARE ON THE SAME SIDE AS NORTH CAROLINA, THAT WE ARE ON THE WRONG SIDE OF THIS ARGUMENT, THAT WE ARE NOT WELCOMING TO ALL KINDS OF PEOPLE REGARDLESS WHO THEY LOVE, THAT WE ARE GOING TO EMBRACE A CULTURE OF DISCRIMINATION AND NOT AN OPEN CULTURE THAT IS, YOU KNOW, WELCOMING AND INVITING TO EVERYBODY, AND IT IS NOT THE MESSAGE WE WANT TO SEND IF WE WANT TO HAVE A 21ST CENTURY VIRGINIA ECONOMY. WE NEED TO BE IN THE 21ST CENTURY A IN ALL ASPECTS, IF WE WANT TO HAVE A 21ST CENTURY ECONOMY TO COMPETE. I REALLY WANT YOU ALL TO THINK CAREFULLY ABOUT THE MESSAGE THAT YOU ARE SENDING IF YOU VOTE YES ON THIS BILL. I HOPE IT BE THE PLEASURE OF THE BODY NOT TO ENGROSS THE BILL, NOT HAVE IT PASSED ON TO THIRD READING.

[Unknown]: MR. LEVINE. MR. SPEAKER, ALSO SPEAKING TO THE BILL.

Del. Bill Howell (R-Fredericksburg): GENTLEMAN HAS THE FLOOR.

[Unknown]: MR. SPEAKER, THE GENTLEMAN, THE PATRON OF THE BILL HAS, AS FAR AS I CAN SEE, BASICALLY CONCEDED THAT THE FIRST PART OF THE BILL THAT SOMEHOW SOMEONE IS REQUIRED TO PARTICIPATE IN SOLEMNIZATION OF ANY MARRIAGE, THERE REALLY ISN'T ANYONE REQUIRED TO DO THAT. HIS CONCERN, I GUESS, IS WITH THE SECOND PART OF THE BILL THAT PEOPLE MIGHT BE PENALIZED IF THEY SOMEHOW DISCRIMINATE AGAINST GAY FAMILIES. SO I DON'T KNOW AN EXAMPLE IN VIRGINIA, I CONCEDE THAT. BUT I CAN TELL YOU THAT THERE'S A WOMAN AT MY SYNAGOGUE WHO WAS MARRIED TO -- EXCUSE ME, IT WASN'T LEGAL AT THE TIME. WITH HER FEMALE PARTNER IN TEXAS FOR MORE THAN TWENTY YEARS. SHE WAS ALSO ESTRANGED FROM HER FAMILY FOR MORE THAN TWENTY YEARS, BECAUSE HER FAMILY WOULD NOT ACCEPT HER AS A LESBIAN WOMAN. THIS WAS THE WOMAN'S PARTNER. THE WOMAN'S PARTNER DIED, AND AS SHE WAS DYING, THE FAMILY CAME IN, AND EXCLUDED THIS WOMAN, THE WOMAN I KNOW, THE WOMAN THAT SHE HAD BEEN WITH FOR TWENTY YEARS, EX-CLUTDED HER FROM THE HOSPITAL -- EXCLUDED HER FROM THE HOSPITAL ROOM, BECAUSE THERE WERE NO PROTECTIONS IN TEXAS, EXCLUDED HER FROM ANY KIND OF INHERITANCE. THEY DIDN'T HAVE A WILL, AND BASICALLY THE FAMILY CAME IN AND THIS POOR WOMAN DIED WITH PEOPLE THAT SHE DID NOT GET ALONG WITH, AND WAS NOT ALLOWED TO BE WITH HER PARTNER OF TWENTY YEARS. IT SEEMS TO ME THAT HOSPITALS SHOULD ALLOW PEOPLE TO BE WITH THEIR LOVED ONES, AND IF THE PURPOSE OF THIS BILL IS TO SEPARATE LOVED ONES AS THEY ARE DYING, THEN I THINK THAT'S A VERY BAD POINT OF THIS BILL. THANK YOU, MR. SPEAKER.

Del. Bill Howell (R-Fredericksburg): GENTLEMAN FROM CULPEPER. MR. FRIGHT -- FREIGHTAS.

[Unknown]: I CAN'T SAY IT ENOUGH, THE POINT IS NOT TO SEPARATE THIS BILL, THE POINT IS NOT TO BRING OFFENSE WITHIN THE HOMOSEXUAL OR LGBTQ COMMUNITY. REGARDLESS OF MY INTENTION THAT MAY BE THE EFFECT FOR SOME PEOPLE, IT CERTAINLY IS NOT THE INTENT. THE PROBLEM IS THERE ARE GOING TO BE KEY QUESTIONS THAT PEOPLE DIES AGREE ON, AND IF IT WERE UP TO ME, GOVERNMENT WOULD NOT EVEN BE INVOLVED IN THE QUESTION OF MARRIAGE. I WOULD LOVE IT IF GOVERNMENT GOT OUT OF THIS ALTOGETHER AND WE TREATED MARRIAGE LYING -- LIKE A CIVIL CONTRACT. [ APPLAUSE ] I WOULD LIKE IT TO BE A CIVIL CONTRACT BETWEEN TWO PEOPLE, AND THEN MY DEFINITION OF MARRIAGE, WHICH WILL NEVER CHANGE, BECAUSE IT'S GIVEN TO ME BY SCRIPTURE, I CAN GO AND EXERCISE THAT, AND SOMEONE ELSE THAT HAS A DIFFERENT DESCRIPTION OF IT, THEY CAN GO INTO THE PRIVATE SECTOR AND FIND A CHURCH, SYNAGOGUE, MOSQUE, SECULAR INSTITUTION, WHATEVER IT IS, TO DEFINE IT FOR THEM. I WOULD BE HAPPY WITH THAT. BUT THAT'S NOT THE REALITY WE LIVE IN RIGHT NOW. AND UNFORTUNATELY, THIS GOVERNOR HAS DECIDED, BECAUSE WHEN I SEE THIS, MR. SPEAKER, WHAT I SEE IS TARGETING RELIGIOUS ORGANIZATIONS, RELIGIOUS CHARITIES, AGAIN, WE DID -- I HEARD THREE ELOQUENT SPEECHES WITH RESPECT TO REFUGEE RESETTLEMENT YESTERDAY. AND WHILE I AGREE WITH PRESIDENT TRUMP ON CERTAIN THINGS, I DISAGREE ON OTHERS. AND I WILL SAY THIS: THE IDEA THAT WE WOULD TAKE CATHOLIC CHARITIES, OR THIS EXECUTIVE ORDER COULD POTENTIALLY EXCLUDE CATHOLIC CHARITIES FROM BEING ABLE TO SERVE THAT PURPOSE OF SUCCESSFULLY RESETTLING REFUGEES IS A PROBLEM. SO I WOULD JUST SAY THAT, AGAIN, AT THE END OF THE DAY, THERE IS NO OFFENSE MET BY THIS -- MEANT BY THIS BILL. I WISH IT WASN'T NECESSARY. AS LONG AS WE HAVE PEOPLE WILLING TO OCCUPY THE GOVERNOR'S OFFICE, OR COME HERE IN ORDER TO FORCE ONE SIDE OF THIS DEBATE TO AGREE WITH THEM, BY PUNISHING THEM THROUGH THE GOVERNMENT, WE ARE GOING TO CONTINUE TO HAVE BILLS LIKE THIS THAT SEEK TO PROTECT THOSE INSTITUTIONS. SO WITH THAT, MR. SPEAKER, AGAIN, I WOULD JUST REITERATE, I HOPE IT BE THE WILL. BODY TO ENGROSS THE BILL AND MOVE IT TO THIRD READING. SHALL THE BILL ENGROSSED. AS MANY AS FAVOR THAT MOTION SAY AYE. OPPOSED NO. BILL IS ENGROSSED AND PASSED TO THIRD READING. HOUSE BILL 2351, BY FOR THE DAY. HOUSE BILL 2364, BY FOR THE DAY. AID ACCORDINGLY, CONTINUING, HOUSE BILL SECOND READING REGULAR CALENDAR, PAGE 38, PRINTED CALENDAR, HOUSE BILL 2053. A BILL TO AMEND THE CODE OF VIRGINIA RELATING TO DIRECT PRIMARY CARE AGREEMENTS. REPORTS OF COMMITTEE ON COMMERCE AND LABOR WITH SUBSTITUTE, THERE IS ALSO A FLOOR SUBSTITUTE.

Del. Bill Howell (R-Fredericksburg): GENTLEMAN FROM AUGUSTA, MR. LANDES.

Del. Steve Landes (R-Weyers Cave): THANK YOU, MR. SPEAKER. MR. SPEAKER, FIRST I WOULD LIKE TO MOVE THAT THE HOUSE REJECT THE COMMITTEE SUBSTITUTE.

Del. Bill Howell (R-Fredericksburg): THE QUESTION IS ON ADOPTION OF THE COMMITTEE SUBSTITUTE, AS MANY AS FAVOR THAT MOTION SAY AYE. OPPOSED NO. COMMITTEE SUBSTITUTE IS REJECTED. UNDER THE FLOOR SUBSTITUTE.

Del. Steve Landes (R-Weyers Cave): I WOULD LIKE TO NOW MOVE THAT THE HOUSE ACCEPT THE FLOOR SUBSTITUTE.

Del. Bill Howell (R-Fredericksburg): QUESTION IS ON ADOPTION OF THE FLOOR SUBSTITUTE. AS MANY AS FAVOR THAT MOTION SAY AYE. OPPOSED NO. FLOOR SUBSTITUTE AGREED TO. GENTLEMAN FROM AUGUSTA.

[Unknown]: THANK YOU, MR. SPEAKER. MR. SPEAKER, LADIES AND GENTLEMEN OF THE HOUSE, HOUSE BILL 2053 IS A COMPROMISE, AND THE SUBSTITUTE BEFORE YOU WAS REACHED WITH ALL INTERESTED PARTIES, INCLUDING PHYSICIANS GROUPS, BUSINESS GROUPS, AND HEALTH PLANS. THE SUBSTITUTE STATES THAT DIRECT PRIMARY CARE AGREEMENTS ARE SIMPLY NOT INSURANCE, WHICH IS THE MAIN PURPOSE OF THE LEGISLATION. THE BILL INCLUDES TWO PROVISIONS THAT SATISFY THE CONCERNS OF HEALTH PLANS. THESE PROVISIONS ARE TO ENSURE THAT PATIENTS ARE NOT REQUIRED TO PRE-PAY BEFORE THEIR AGREEMENT BEGINS, AND THAT PHYSICIANS MAY BE IN NETWORK WITH THE HEALTH PLANS IF THEY MEET THE TERMS AND CONDITIONS OF THEIR AGREEMENT WITH THE HEALTH PLAN. THERE ARE ALSO GRANDFATHER CLAUSES SO THAT NO HARM COMES TO CURRENT DIRECT PRIMARY CARE AGREEMENTS. MR. SPEAKER, LADIES AND GENTLEMEN OF THE HOUSE, THIS MEASURE IS A REFORM MEASURE TO ALLOW, AGAIN, DOCTORS AND PATIENTS TO HAVE A CONTRACT FOR PRIMARY CARE SERVICES. THE SUBSTITUTE JUST SIMPLIFIES THE LEGISLATION, MAKES SURE IT'S VERY CLEAR WHAT WE ARE ATTEMPTING TO DO, AND DOES IT IN A VERY SIMPLE MANNER. SO MR. SPEAKER, I WOULD MOVE THAT THE HOUSE ENGROSS THE BILL AND MOVE IT TO THIRD READING.

Del. Bill Howell (R-Fredericksburg): GENTLEMAN FROM ARLINGTON, MR. HOPE.

Del. Patrick Hope (D-Arlington): WOULD THE GENTLEMAN YIELD FOR A QUESTION?

[Unknown]: WOULD THE GENTLEMAN YIELD?

Del. Patrick Hope (D-Arlington): MR. SPEAKER, I WOULD BE GLAD TO YIELD.

Del. John O'Bannon (R-Richmond): GENTLEMAN YIELDS.

Del. Steve Landes (R-Weyers Cave): MR. SPEAKER, WE MADE SOME OF THESE POINTS LAST YEAR AFTER THE GOVE GOVERNOR VETOED THE BILL. I APPRECIATE THE GENTLEMAN HAS ACTUALLY GOTTEN GROUPS TOGETHER TO TAKE A LOOK AT IT. PLY CONCERN AT THE TIME WAS -- MY CONCERN WAS THIS HASN'T BEEN STUDIED TO SEE WHAT IMPACT THIS WOULD HAVE ON LOW-INCOME INDIVIDUALS, PEOPLE WITH CHRONIC DISEASES, AND UNDERSERVED POPULATIONS. DOES THE GENTLEMAN HAVING A YEAR TO TAKE A LOOK AT THIS, DOES HE NOW KNOW THE IMPACT OF WHAT THESE DIRECT PRIMARY CARE AGREEMENTS MIGHT HAVE ON THOSE POPULATIONS?

[Unknown]: MR. SPEAKER, I WOULD ANSWER THE GENTLEMAN BY SAYING THAT I DO NOT KNOW WITH THOSE SPECIFIC POPULATIONS WHAT THE OUTCOME WOULD BE, OTHER THAN TO SAY, AND THERE ARE VARIOUS GROUPS THAT OBVIOUSLY HAVE BEEN FOLLOWING THIS, THERE'S 17 OTHER STATES THAT HAVE PUT IN EFFECT SIMILAR LEGISLATION. I WOULD BE GLAD TO TRY TO WORK WITH THE GENTLEMAN TO GET INFORMATION RELATED TO THOSE OTHER STATES, BUT I CAN'T ANSWER HIS QUESTION SPECIFICALLY ON THE FLOOR TODAY. I THANK THE GENTLEMAN. SPEAK TO THE BILL?

Del. Bill Howell (R-Fredericksburg): GENTLEMAN HAS THE FLOOR.

[Unknown]: THANK YOU, MR. SPEAKER. MR. SPEAKER, LADIES AND GENTLEMEN OF THE HOUSE, THIS WAS THE CONCERN LAST YEAR WHEN THE GOVERNOR VETOED THE BILL. HE SAID WE JUST DON'T REALLY KNOW THE IMPACT OF DIRECT PRIMARY CARE AGREEMENTS WOULD HAVE ON LOWER INCOME POPULATIONS, UNDERSERVED POPULATIONS. PARTICULARLY MEMBERS, I WANT TO FLAG THIS IN RURAL PARTS OF OUR STATE, WHERE YOU MAY HAVE TROUBLE FINDING PHYSICIANS, AND FINDING PROVIDERS TO CARE FOR YOUR POPULATION, AND WITH THE TURMOIL THAT WE SEE IN WASHINGTON WITH THE LIKELY REPEAL OF THE AFFORDABLE CARE ACT, THAT COULD LIKELY SEE YOUR UNINSURED NUMBERS GROW AND GROW DRAM THE -- DRAMATICALLY. SO THE QUESTION I THINK IS, IS WHAT IMPACT WILL THAT HAVE ON PEOPLE THAT PHYSICIANS THAT COULD BE LEAVING THE PRACTICE OF SERVING THE UNDERSERVED AREAS, AND HAVING PEOPLE COME