I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

Requesting information

Radford University has a rich heritage of educating health care professionals in the Commonwealth of Virginia. The University is committed to providing an exceptional professional education and building a robust health professions talent pipeline with health science programs offered both on main campus in Radford and Radford University Carilion (RUC), which is the University’s health sciences campus facility in Roanoke. Radford University is an active participant in the Blue Ridge Partnership for Health Science Careers, which is a regional initiative to establish a K-12 to higher education to workforce health professions pipeline for Southwest Virginia, and the entire Commonwealth of Virginia. Radford University supports HB 191 and increased investment by the Commonwealth to expand the health professions pipeline.

Please support HB191. With mental healthcare facilities understaffed, this is a step in the right direction to provide a direct line to the governor of effective changes that need to be made. Please support HB98. Obtaining guardianship is a difficult process. The more open and easier to navigate will help families in crisis.

Healthcare employees support this bill for the following reasons: 1. Coordination across the Commonwealth will create the best use of workforce resources while preventing duplication. 2. All healthcare entities in Virginia need an education and training roadmap and funding to close our workforce gap now and in the future. 3. An identified leader for healthcare workforce training builds in focus and accountability.

The Roanoke Regional Chamber strongly supports HB 191. Thank you for your consideration.

I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

Would you want someone who is not trained to perform laser on your mother, father, daughter or relative's eyes? The risks are greater when these procedures are performed by non medical doctors. The level of training is significantly higher as medical physician. The qualifications for medical physicians/ophthalmologist include 4 years medical school and 4 years of residency training (total 8 years) versus an optometrist it's only 4 years. The risks and liability of the laser will be passed onto to medical doctor if complications arise from the procedure.

Comments Document

Letter of opposition to HB 213.

Please oppose optometric bill 1. Optometrists do not have the same Surgical mentors that have the same experience as ophthalmologists do. It is important to learn from the best to be the best 2. Optometrist cannot manage complications of lasers such as internal bleeding ( hyphema). Pressing on the eye is not enough. These patients have to be referred to a surgical ophthalmologist to perform a washout procedure in the operating room. The optometrist cannot manage their own complications. A doctor should only perform procedures when they can manage the complications. 3. Currently there is a cordial relationship in the community between optometrist who perform general eye exams and glasses and ophthalmologist who perform surgery and more complex care. This bill would propagate unhealthy competition. Optometrist would perform at the same as costs as ophthalmologists so the cost to medical care will not be reduced 4. Ophthalmologist spend up to 12 years after college getting trained. Optometrist only spend 4 to 5 years. The bill would deter doctors from going into medicine if they can perform surgery and save 7 years of training. An ophthalmologist is in their early 30s before they can operate this bill would allow an optometrist to be in their mid 20s to perform surgery 5. Prior poor outcomes and malpractice cases are not a good judge . As good doctor patient relationships can prevent a law suit but doesn’t protect a patient from harm. 6. Currently over 40 states have banned optometrist from performing surgery as it is not safe.. Virginia would be in the minority. There are plenty of ophthalmologist so access to care is not an issue 7. Finally new talented ophthalmologist would relocate to Maryland or DC where there is no optometric surgery. Virginia would loose talented ophthalmologists. Please oppose this bill.

Dear Honored Delegates, In the few states that permit non-surgeon optometrists to operate on patients, the certification process includes a course that often has zero proctored cases on living human beings, and in one state, there is the potential for one proctored case. Although typically successful, these procedures carry the potential for ocular hypertension, glare, decreased vision, bleeding, dislocated lenses, floaters, retinal tears, retinal detachments and vision loss. In my career, I and my partners have seen patients with each of these complications. Is the state of Virginia best served by allowing non-surgeons who have had zero to one proctored cases on living individuals perform these surgeries on the public unsupervised? Is this legislation truly considering the safety and protection of our people by allowing a course with little to no actual supervised cases on living individuals? Would you want your mother to be the first case performed by someone who has never been supervised on a living person? The state of Virginia would never think to change the law regarding first time drivers to not include substantial numbers of proctored hours driving an actual car before releasing that person to drive in public. Even if the course to get a license required 200 hours of classes, getting behind the wheel in a supervised fashion is critical to safe driving. Similarly, safe surgery requires hundreds of hours or more of proctored cases and proctored management of post-operative complications before it is safe to operate unsupervised. I am stunned this legislative body is even considering putting the health of the public in the hands of those who have never been supervised performing these procedures without creating substantial requirements of proctored cases prior to certification to operate. To do anything else is simply irresponsible legislating. Thank you for your consideration.

Comments Document

Please Oppose House Bill 213 Leslie S. Jones, MD Associate Professor and Chair Howard University College of Medicine (Writing as an individual not on behalf of Howard University)

Laser eye surgery is actual surgery on the eye. Like all surgery, it requires years of training - both didactic and in practice, with training supervision by medical doctors who are surgeons. Optometrists get none of this training during their time in optometry school. Furthermore, the Board of Optometry is not qualified to certify a physician to perform surgery, since the Board of Optometry has no surgical expertise. Optometrists are not trained to be surgeons during their schooling, unlike ophthalmologists who train for multiple years under the supervision of experienced surgeons. This bill is created to grant surgical privileges by legislation, rather than through education and years of surgical training. This is bad for patients and is simply a way to try to open a revenue stream for unqualified providers. This bill should NOT get out of committee - it is dangerous to the public.

Karin Addison/Troutman Pepper Strategies on behalf of the Virginia Ambulatory Surgery Association (VASA), please vote no to expanding optometry scope of practice without a thorough and impartial review by the Department of Health Professions. Ambulatory Surgical Centers (ASCs) are centers of excellence in the communities they serve. The mission of ophthalmic ASCs is to provide the highest quality care by highly trained ophthalmic surgeons (“eye surgeons”). Eye surgeons, optometrists, nurses and other health care professionals work together in a multi-disciplinary team within the ASC to ensure the best outcomes for patients. Patients are referred by optometrists in the community and eye surgeons within ASCs perform eye surgery using a number of modalities primarily with lasers. Patients are ensured their eye doctor is fully trained during a surgical residency to use state of the art equipment. ASCs are required by state and federal regulations to have important protections for patient safety including:  Infection control  Life Safety and emergency management  Nursing and anesthesia standards and personnel  Power backup The Department of Health Professions and individual licensing boards do not uniformly require comprehensive patient safety standards for office-based surgery settings. Certainly, health profession boards without proficiency in surgery oversight will be incapable of adequate regulation in this area. Continuity of eye care is extremely important, especially when treating glaucoma. VASA recommends that a glaucoma specialist trained in ophthalmology should be part of the patient care team to ensure a better prognosis and immediate care if surgery is needed. Glaucoma is a long-term disease that requires ongoing treatment. VASA members proudly provide access to ophthalmic care and surgery for the entire Commonwealth. Our members have demonstrated a commitment to underserved areas, recently opening ASCs in Wytheville and Martinsville. Thank you for your consideration.

Comments Document

Thank you for reviewing this comment. HB213 would expand the scope of optometric practice to include 3 intraocular laser surgeries. A similar bill was passed through the senate subcommittee last week. I was present at that hearing. A robust debate and responsible motion to put the topic to study at the board of health was aborted at the last minute with the following argument: optometrists asserted that over 100,000 of these laser surgeries have been performed by optometrists over the last 20 years in states like OK, KY, AK, LA resulting in no malpractice suits or complaints to the board of optometry. "If no malpractice cases or complaints were filed, it can't be that risky." A substitute motion to pass the bill was raised and votes were collected before we could refute the optometrists' assertion. I urge you to review the enclosed attachment for a comprehensive study performed by the Vermont Office of Professional Regulation in 2020. Please draw your attention to page 23, which directly addresses the "lack of malpractice cases." Not only did malpractice cases exist, but general malpractice cases against optometrists were significantly underreported by the OK Board of Optometry. Why would the optometric board underreport malpractice cases? The Board of Optometry has a vested interest in expanding the scope of optometric practice -- a clear conflict of interest to report adverse events. A pubmed search of peer-reviewed literature for "optometry patient safety" returns 235 results. "Ophthalmology patient safety" returns 2,338 results. Optometrists outnumber ophthalmologists 1.5:1 in the US, but optometrists produce only 10% of the data on patient safety. How is this different from the scope of practice debates around nurse practitioners, physician assistants, and even dentists performing surgeries? Unlike these health professionals, optometrists do not train under direct supervision for years, months, or even weeks to perform surgeries on living humans. Optometrists will not disclose curricular details of their weekend training certification programs or optometry school classes. The reality is that no single classroom experience or weekend training program can prepare anyone for surgery. The United States has evolved over 150 years to require multiple years of surgical residency for this exact reason. For a quick illustration of how experience and training can literally save a life, consider asking the optometrists and ophthalmologists in the House hearing how they would manage this scenario: A 68 year old male patient with narrow angle glaucoma experiences chest palpitations during his Laser Peripheral Iridotomy. What would you do next? Does Virginia want non-surgeons performing surgery? Does Virginia find it appropriate for non-surgeons who perform surgery to answer to a Board of Optometry, which is made of non-surgeons and has financial incentive to discourage safety reporting? Please oppose HB213. If you are not sure, then please least support a motion to put this bill to study with the health department. Please call me at 540-682-3734 with any questions. Thank you.

Comments Document

Opposition to HB 213 - laser surgery by optometrists for treatment of glaucoma Summary points: We feel this would jeopardize the safety of your constituents and result in unnecessary billing and surgical procedures which would be grossly cost inefficient. Allowing optometrists to perform laser surgery for glaucoma could create larger inequities in care adversely affecting the elderly and minorities. These procedures require years of training and practicing, on real humans to be able to perform correctly and safely. Please see the attached letter for details and supporting information. Thank you.

Please pass HB234 . But, please provide adequate instruction to require action on findings. For decades studies have been done which reach the same conclusion as the multiple studies done in prior years. But, no action is taken on the findings. It merely associates officials with a popular cause which garners more votes without effective progress or change for the better. Please study the frequency of surprise inspections of the facilities you regulate or oversee. CMS policy allows for next re-inspection to fall between one (1) and fifteen months (15). Most people would check on farm animals and vacation homes more often. It has been said that a facility knows it is in the "window of inspection" in the twelfth (12) and fifteen (15) months after the last inspection. Not much of a surprise. Please study the written policies governing the working relationships between inspectors and the Administrators of the facilities they inspect. While it should not be adversarial, neither should it be so friendly that inspection visits are partly for work and partly to catch up at lunch. Please study the finances of Long term Care facilities and put in place an internal position in your new organization that can truly and effectively see where the money facilities receive is being spent. Your organization needs to understand the profit margins and costs of long term care facilities to judge the fiscal hardships, if there are any, to increasing staffing levels, employee pay, and any new mandates for more highly trained staff. Please study how to allow for more transparency to the public of standardized ratings and inspection results for each Long term Care facility. It needs to be easier for families to know about the care and safety of a facility prior to registering their loved one as a patient. Please add in oversight which makes it easier for Long Term Care Facilities to discover workers fired for cause through their application process or background checks to prevent offenders from being quietly dismissed only to hired at a new facility. Thank you.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As an occupational therapist working directly with wheelchair users, I am in support of H.B. 241. I have worked with motivated and hardworking patients who have been done everything on their part to heal and recover from their injuries. Based on their needs, they qualified for custom equipment but this gap in care left them stuck with difficult decisions. They either had to languish in the hospital waiting for a placement that would accept them and their equipment needs or go to a facility with equipment that was not custom and not appropriate. Many times, both options led to significant harm for these people, both mentally and physically. I had one patient who passed away because of this gap in care. Please support H.B. 241, which will prevent this dilemma and make sure these patients no longer have to make unnecessary compromises in their health care.

I am writing in support of H.B. 241. It is my experience as a clinician working with patients with complex rehab needs that everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility. It is a common for patients to discharge to a skilled nursing facility or similar initially after a significant injury as patients are attempting to organize the care or home modifications needed for home. Without being able to access the custom medical equipment that they need and are entitled to, these patients are at risk of developing secondary conditions further limiting their ability to return home. It is imperative to these patients life and wellbeing that they have access to the medical equipment they require to regain independence and mobility..

Thank you for the opportunity to provide comment on HB241 and the related Fiscal Impact Statement. We appreciate the hard work of the individuals at DMAS who work to ensure that this bill has the appropriate funding to close the gap in care. However, we are in disagreement of what the impact of the bill will actually be. 1. The average cost of a custom/specialty wheelchair is not $15,000. We believe the information provided by DMAS is simply an average of the MSRP of the most and least expensive equipment. This is not what the insurance company actually pays to the DME provider (they are reimbursed at a much lower rate than the MSRP and what is billed to the insurance company). Additionally, there are far fewer individuals who need the MOST expensive equipment than who need the least expensive equipment. While it is true that a power wheelchair with many accessories is costly, there are far fewer individuals who require this level of support from their wheelchair than who require a manual wheelchair. 2. We based our average of $5,800 to determine our average cost of a custom wheelchair on 2 years worth of data provided to use by one of the largest DME providers in the state. They provided us with total reimbursement for custom wheelchairs for over 300 pieces of equipment for 2 years and $5,800 was the average for an individual piece of equipment. We believe this is a more accurate reflection of what the average cost of a custom wheelchair will be as it reflects what was actually ordered and reimbursed for over a 2 year time period for individuals with TBI, SCI and CVA which reflect a large portion of the individuals that this bill intends to assist. This would lower the total fiscal impact statement by bringing the average cost from $15,000 to $5,800 per unit. 3. Our budget amendments also break the initial total cost into 2 separate years to catch up the back log of individuals that we believe to be eligible to receive a custom wheelchair. Which would divide the fiscal impact provided by DMAS in half lowering the overall fiscal impact. 4. After the first 2 years, individuals are only eligible for new equipment every 5 years. So once all of the current folks are caught up the fiscal impact would be a fraction annually of the first 2 years. We believe that our numbers provided to get to our budget amendment dollars request are accurate and would like to request that this information be brought to the attention of DMAS and the members of this committee for consideration. Thank you all for your service to our great Commonwealth of Virginia. We hope you support HB241 and associated budget amendments to help our friends with disabilities residing in nursing homes throughout our communities gain access to independent mobility.

Chairman Fariss, distinguished delegates… I appreciate the opportunity to request your support for House Bill 241 and its accompanying budget item. My name is Richard Bagby. I serve as the Director of the United Spinal Association and am representing a group of dedicated volunteers comprised of clinicians, effected Virginians with disabilities, and other compassionate stakeholders. This bill will close a critical gap in coverage for Virginians with disabilities who receive Medicaid and reside in nursing homes by giving them access to wheelchairs prescribed by their doctors which they would otherwise be able to get if they lived in the community. Increasing their health and quality of life. Additionally, it will save the Virginia taxpayer a substantial amount of money. First and foremost, the Fiscal Impact Statement forecast is grossly inflated beyond the ask of the budget item. For example it relies on an average cost of a wheelchair to be $15,000. We strongly believe that the ask reflected in the budget item is far more accurate based on the commonwealth’s largest durable medical equipment provider’s data, which shows the average cost of the relevant equipment to be $5,500. I suspect the impact statement mistakenly cites the amount billed as opposed to actual reimbursement amounts. Further, the impact statement forecasts the initial ask to be ongoing year over year until at least 2029. The reality is that our ask of $3.8 million divided over the next two years will clear the backlog of eligible Virginians currently living in nursing facilities. Beyond 2024, the budget would decrease exponentially as new beneficiaries per year would only amount to the number of new admissions, likely less than 300 people, as opposed to the 1,500 from the current ask. Finally, what is not addressed in the fiscal impact statement is the cost savings associated with this bill. Studies overwhelmingly show that properly fitted wheelchairs and cushions significantly decrease the likelihood of pressure sores and other secondary complications. The incident rate of pressure injuries in nursing facilities is 44%....each pressure injury costs DMAS on average $86,500. House Bill 241’s ask of $3.8 million over the next 2 years will take a significant bite out of the $200 million plus dollars DMAS currently has budgeted for treating pressure wounds…while also giving Virginians with disabilities a chance at realizing independence again. Thank you for your consideration of his incredibly important bill.

I am in support of H.B. 241. Everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility.

As a wheelchair user, I support HB 241. Medical equipment- such as a prescribed/recommended wheelchair- is vital to human autonomy, independence, and overall health.

Save tax payers money by providing the necessary equipment in nursing facilities! Save patients from having residual health problems by giving them wheel chairs and other necessary equipment!

I have worked in the physical rehabilitation field for over 30 years and know how critical it is for individuals to have access to appropriate equipment to maintain a level of independence and quality of life . Decisions on funding of equipment needs for an individual has a direct impact on their long term outcomes . Access to appropriate equipment impacts physical health , mental health , quality of life , and level of independence . Appropriate equipment is a necessity wether living at home or in a facility .Please support HB241 to ensure equitable funding of equipment to meet the individual needs regardless of someone's living disposition . Finding a wheelchair that meets the needs of a patient and denying them access based on their disposition is detrimental to physical and mental well being . Adjustment to loss of mobility and physical functioning is challenging enough, but not providing the appropriate equipment to best meet the patients needs , level of independence , and mobility is detrimental.

Virginia Medicaid recipients who live in nursing facilities are denied wheelchairs prescribed by their doctors, solely because they live in nursing facilities. If they had the means/support to return home after an injury Medicaid would pay for their wheelchairs. If this legislation passes, it would cost Virginians about $3.8million…but would save the taxpayers 10’s of millions of dollars ATLEAST. While also giving people the chance to get: out of bed/out of the nursing facility/back to their homes/back to work/back to life.

As a retired physical therapist I repeatedly saw the inequity for Medicaid recipients forced to live in a nursing home for medically necessary supplies/ devices. There is no rationalization for denying the need for wheelchair payment when prescribed by the attending physician. How is the same chair an approved device at home but not approved in a more limited environment ( less assistance )? If anything, the nursing facilities are understaffed and not able to address the daily needs of residents. The wheelchair makes them more independent leading to fewer associated illnesses. Approval for payment should be a no brainer, please correct this injustice .

This bill should be passed. Providing these wheelchairs will have multiple positive effects. Having the ability to be mobile will decrease incidence of depression, provide a sense of independence and decrease medical care. With the use of the wheelchair you may even see some patients able to transition home. I urge all to vote for this bill

I support H.B. 241

As a medical professional I have seen many patients go without the medical equipment necessary to improve independence only because of where they live i.e. a nursing home. Please consider this when voting for this bill. How would you feel if your mother developed bed sores that require hospitalization and contractures that prevent her from getting around only because her Medicaid policy would not pay for a wheelchair that would allow her the ability to get out of bed. No one should be denied the ability to navigate their living environment just because of where they live.. If Medicaid can pay for it at home why not a nursing home???

I am in support of H.B. 241. Everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility.

I have worked with patients who require specialized equipment for over 18 years. I have seen many unfortunate trends in insurance coverage resulting in a significant reduction of daily independence versus a persons ability to be independent when provided with the right equipment. There are many young people (early 20s) who have suffered from a traumatic injury and are permanently disabled who are residing in nursing homes due to a lack of consistent caregiver support and lack of needed specialized durable medical equipment. If they were able to achieve a level of independence with therapy and empowered by the right equipment, they would be able live a life of independence and productivity. The current law wastes MANY taxpayer dollars. The recommended bill would resolve this issue What’s the issue?: Virginia Medicaid recipients who live in nursing facilities are denied wheelchairs prescribed by their doctors, solely because they live in nursing facilities. If they had the means/support to return home after an injury Medicaid would pay for their wheelchairs. How would this legislation save taxpayer dollars?: Good question! Since the folks we’re talking about cannot access appropriate equipment, they are relegated to lie in bed or use equipment that is not appropriate. This leads to secondary complications like bed sores…which Medicaid pays for…to the tune of hundreds of millions of dollars per year! If this legislation passes, it would cost Virginians about $3.8million…but would save the taxpayers 10’s of millions of dollars ATLEAST. While also giving people the chance to get: out of bed/out of the nursing facility/back to their homes/back to work/back to life. Therefore, I urge you to support this bill to reduce unnecessary skilled nursing facility stays, reduce wasted dollars, and empower many Virginians to live productive lives.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As a person with a disability and dependent on a motorized wheelchair, I was astounded to learn the people who live in nursing facilities in Virginia cannot receive medically necessary equipment prescribed by a physician in a rehab setting. I have visited people in nursing homes and, without my wife and my community, I would have to live in a nursing home also. Hi am often one bad situation away from living in a nursing home. Without access to a suitable motorized wheelchair and other durable medical equipment I would be bedbound or would be waiting for someone on staff to push me from place to place in a standard wheelchair. When I have durable medical equipment I can get around independently once someone gets me up and then my wheelchair. I can even get out and about in my community. This does so much for my psyche! When it is well maintained my chairs and motors and batteries will last five, seven, or 10 years. It is an investment that, all in all, pays off in my independence and overall health. I support this legislation and the efforts to provide funding for people in nursing facilities who depend upon durable medical equipment to meet their unique needs.

I have been a paraplegic for nine years and use a wheelchair full time for mobility. My wheelchair has been made specifically for me to maximize my quality of life and minimize the likelihood of developing pressure sores, which can involve lengthy hospital stays for treatment and observation. Currently, Virginia's Medicaid program does not cover wheelchairs for people who have a similar condition to me but who's situation requires that they stay in a skilled nursing facility. Without the use of a properly fitting wheelchair, medical problems related to skin breakdown are far more likely to occur which is ultimately several times more expensive to treat than a wheelchair would have been in the first place. Please vote yes on HB241 to improve the quality of life for disabled Virginians and ultimately save the Commonwealth money on Medicaid disbursements for preventable pressure sore treatments.

I support H.B.241 because I believe Virginians living with disabilities should have the same access to prescribed equipment no matter whether they live in a nursing facility or the community. Precision fitting is so important to the long term health of an individual, it would seem there should be no distinction based on residence. From a financial standpoint, well-fitted equipment potentially saves money by lowering the chances of issues such as pressure sores, improving cardiovascular function through improved mobility, and other factors that could affect costly secondary treatments.

I’m Kent Keyser. I vote in Arlington County. I am an advocate with the United Spinal Association for equal access to health care for people with disabilities. Delegates, thank you for your public service. I hope you will support Delegate Adams’ bill, HB 241, to amend the Virginia’s Medicaid budget to cover customized power and manual wheelchairs which are medically necessary and are prescribed by a physician to meet the daily needs of residents of skilled nursing and long term care facilities. Not only do these customized wheelchairs prevent medical complications, like bed sores, aka Pressure Injuries, which can cost over $150,000, studies overwhelmingly agree that these customized wheelchairs, prescribed by physicians, improve the physical health, mental health, and overall independence of people living with disabilities. Let me give you an example. These customized wheelchairs include components that are known as complex rehabilitative and seating technologies. For people like me who have a spinal cord injury, or for others with traumatic brain injuries or strokes, these medically prescribed components allow us to be able to use a wheelchair. Let me explain. I still need someone to help me in and out of bed, mornings and nights. But because my spinal cord injury limits my trunk control, my ability to hold myself back in my wheelchair, I have a complex rehab component on my wheelchair that allows me to tilt back so I can function independently all day. Without that tilt function, long ago, I would have rotted away by being bedridden. Instead for fourteen years that tilt function and the customized cushion I sit on have helped keep me healthy – fourteen years and no pressure wounds – fourteen years and no spinal cord injury related hospital readmissions. Fourteen years of earning a living and fourteen years of paying Virginia taxes. Please vote to close this critical gap. Every Virginian prescribed medically necessary equipment should have equal access to the technologies available to meet their health and safety needs regardless of where they live in Virginia.

Subcommittee members, I am contacting you today to encourage you to support HB 241 regarding power wheelchairs in nursing homes. This subject has become important to me because my own son is recovering from a spinal cord injury suffered July ’20 which resulted in quadriplegia. Fortunately, he has good insurance through his wife and we have been able to care for him at home, though it has taken a team of us 24/7. But this has all left me with insights which compel me to advocate for others who find themselves in similar circumstances as my son but without his considerable resources. It is my understanding that Medicaid does not currently provide power chairs for nursing home residents, even for those whose extreme physical limitations leave them vulnerable to pressure ulcers (bedsores). For these patients, bedsores are not just a simple nuisance; they can quickly lead to expensive hospitalizations in the ICU, and sometimes ultimately even death due to sepsis. The most important strategy to help PREVENT bedsores is changing a patient’s position at least once every two hours. Unfortunately, a patient who is paralyzed due to stroke, spinal cord injury, etc. cannot do this for themselves. Therefore, it is up to the busy nursing home staff to be sure that position changes are done, eating up much of the care-givers’ time. Power chairs have the ability to recline, which enables the patient to shift their weight themselves without having to rely on a staff member to do it for them. Making power chairs available to these severely disabled patients could literally help make the difference between life and death for them. The loss of life due to sepsis resulting from pressure ulcers is tragic, especially since in many cases it can be avoided. This tragedy is aggravated by the fact that the cost of the basic powerchairs which could be supplied to these patients is far less than the overall cost for wound care and hospitalization. It might also increase efficiency in nursing homes, as less staff-time would be required for such frequent re-positioning during the day. I firmly believe that having a power chair available was a game-changer for my son. Although a bedsore was beginning to form after a month of being bed-ridden in the ICU at VCU Medical Center (under the very best of care), he has not suffered one since. Getting up out of bed and into a chair was important; being able to recline very frequently in order to shift his position was key. On a personal note, having the ability to move from one room to the next without depending on anyone else is priceless. As a voter, I appreciate a commonsense approach to keeping Medicare costs and expenditures down. In my opinion, preventative measures make more sense than expensive wound-care and hospitalizations. Approval of power chairs for those nursing home residents most in need of them is the smart thing to do. The improved quality of life afforded to these patients by the independence provided by those power chairs makes it the right thing to do. Please consider supporting this bill. Sincerely, Lesa Collins Ph 434-665-4105

We support the bill.

As a nursing home resident in Arlington, not having access to a custom fitted CRT Wheelchair has been a barrier in my ability to re-engage with my life and my community post injury. It effects my independence, the quality of my life and what I can or cannot do. It can make a difference between whether I am bedridden or able to engage outside of the walls of the nursing home and live more independently. As a quadriplegic, I received my first motorized wheelchair As a gift through a charitable organization, but it was not fitted to me. Consequently, it caused pressure sores that kept me primarily bedridden during the first two critical years post injury. If I had been mobile, I would I have had more opportunity to gain strength and develop more independent skills through the use of the chair. Instead, I was essentially warehoused as a bedridden nursing home resident, with virtually no mobility and zero independence. Later, my high school graduating class generously donated money to help me purchase a used motorized Wheelchair and have it fitted to me. Unfortunately, properly seating and fitting me to the chair to me was easier said than done. It took approximately 18 months before the chair was comfortable and more usable by me. This involved paying out-of-pocket for dozens of appointments and countless hours of labor by Wheelchair technicians. The modifications and adjustments are ongoing and I have a $1900+ invoice for custom padding as recent as two weeks ago. I want the same right to necessary, appropriate and fitted equipment as my fellow Virginia Medicaid neighbor living across the street in an apartment.

This issue is important to me because I am an Occupational Therapists that has dedicated my career to working with people with disabilities for the past 20 years. I have seen first-hand how not having access to appropriate medical equipment for seating and mobility has resulted in significant medical complications, functional declines, and devastating psychological concerns. When a person has access to their medically appropriate seating and mobility device, they have improved functional capacity, independent mobility, proper stability and support, reduced pain, reduced need for caregiver assistance, reduced risk of pressure injuries, and an improved quality of life. Everybody has the right to have functional mobility, it is a basic human right! Not only does providing our nursing home residents with the custom equipment they need to be functional, safe, and more independent, but it has a huge impact on the financial and caregiver strain that facilities experience. It’s pretty simple, what would you want your loved one to have access to?

Comments Document

A year and a half ago I had an accident that changed my life forever. I was mountain biking at Bell Isle here in Richmond when I crashed. I couldn't move and had difficulty breathing because the crash severely damaged the spinal cord in my neck. Five days later I woke up with a tube in my stomach, another one in my throat, and no sensation below my shoulders. I was unable to eat, speak, move, or breathe on my own. I laid in bed like this for 1 month and my only source of physical activity was having a foam wedge alternate from being under my left and right side every 4 hours. When I left the ICU I went to an inpatient rehab facility that specialized in spinal cord injuries. They noticed a small white dot above my tailbone that looked like a pimple. Later that week I received a power chair that allowed me to travel around the facility and tilt back every 20 minutes. By tilting back I relieved pressure off of that white dot. It completely healed the following week. I cannot begin to express how important that power chair was to every aspect of my health. It did relieve pressure off of my tailbone, but I honestly couldn't feel that part of my body. What I did feel what is the overwhelming sense of Joy to independently travel around the facility. I was motivated to see what other parts of my life I could get back. When you have a condition like mine you need to count your blessings. I try not to look back and think about how my life could be different, but when I do I remain thankful. I'm thankful that I had good insurance. I'm thankful that I went to a specialized facility. I'm thankful that the experts around me took the extra precaution the treat that white dot as the beginning of a pressure sore and not a pimple. I could be one out of 10 people in a hospital right now that has a pressure wound. I could be taking up space in a hospital bed for a month and a half, the average length of time to heal a pressure wound. I could be in nursing facility, without a power chair, still rotating every four hours on a foam wedge. Approximately 4% of the Medicaid budget is spent treating pressure wounds. The average cost of a power chair is $5500 and the average cost of a pressure wound is over $86,000. A person on Medicaid is able to receive a power chair UNLESS they go to a nursing facility. HB 241 simply removes this exception. Vote yes on HB 241. It's not just right for the budget, it's right for the people.

Approximately 15,000 Virginians who are Medicaid beneficiaries reside in nursing facilities across the state. About 10% of these people live with disabilities which require specialized wheelchairs for their mobility, independence and to prevent secondary medical complications like bed sores. These wheelchairs provide people living with disabilities access to independent functional mobility, and access to social, recreational and community activities, they also prevent pain and suffering from these secondary medical complications. By providing people with disabilities living in nursing facilities specialized wheelchairs, this legislation will promote their optimal health and well-being and also will create a cost savings in prevention of costly medical complications that occur when people do not have access to medically necessary equipment. As a wheelchair user living with quadriplegia, this issue is important to me because everyone deserves the right to have their health and mobility. People with mobility impairments like mine should not be confined to a bed or improper mobility aides. This causes an unnecessary and depressing lack of independence, drastically reducing quality of life. More importantly, it leads to many health complications which bring about costly surgeries and in some cases even death. I hope you'll consider passing this bill and its corresponding budget amendment Item 304#40h. Thank you, Josh Sloan

I am writing to voice my support for bill HB241. I work in the Complex Rehab industry, helping to provide wheelchairs as a licensed Assistive Technology Professional. I work with individuals day in and day out who have had a tough situation take their life and turn it upside down and cause them to require the need of a power wheelchair. Whether it is because of an accident that has caused physical trauma to the spinal cord or because of a neurodegenerative disease like ALS or MS, when the ability to walk is taken from someone it is always life changing and devastating. Imagine you are no longer able to independently get yourself from one spot to the next without the aid of a wheelchair and for a lot of these individuals you require assistance to do simple things like eating, toileting, and dressing. For many people in these situations their wheelchairs are the key to the little bit of independence they have left. What is frustrating in the state of Virginia is if your situation requires you to go to a skilled nursing facility, your ability to get the mobility equipment that you need is taken from you. This is unfair. This is unjust. This absolutely needs to change so that for people in these situations they have the ability to live their life to the fullest extent possible with the same technology available to everyone else.

Providing people with appropriate equipment will help them maintain their health, quality of life, and safety. People with sensation deficits will obtain skin breakdown when sitting on inappropriate cushions this will cause health issues such as infection leading to hospitalization and possibly sepsis or osteomyelitis. When people have wheelchairs they are unable to maneuver their overall health both physical and mental health decline. These chairs can also cause poor posture placing them at risk for scoliosis, shoulder pain, and inability to maintain balance to perform their activities of daily living independently. Why should people in facilities not have the quality of life compared to those who are in the community. If you allow them to have the proper equipment they will have more opportunity to be independent with their activities of daily living, be more independent with leisure activities, social interaction and an improved quality of life.

My name is Dr. Megan Murphey and I am the Assistive Technology Specialist at a large free standing inpatient rehabilitation hospital. I spend my days helping people recover from devastating injuries such as traumatic brain injuries and spinal cord injuries, as well as medical issues like stroke and Multiple Sclerosis. I also help prescribe custom wheelchairs for individuals with disabilities. When someone is admitted to our facility they work hard to regain their independence and return to their home, families, work and community. Unfortunately, not every patient has the support system or resources to return to their home when they discharge, and are forced to transition into skilled nursing or long term care facilities. Because of the current statute they are now also unable to have access to the prescribed wheelchair. This wheelchair is vital to their ability to get out of bed, to look out the window, to go the bathroom to use the toilet or to brush their teeth at the sink. Lack of access to this equipment not only takes their only source of independence and ability to perform necessary daily tasks but also can lead to bed sores from lack of mobility. Bed sores cause pain and suffering and can lead to infection and death. Bedsores are also significantly more expensive to treat than what the cost of providing a custom wheelchair is. Not only will this legislation improve the quality of life for Virginian’s with disabilities living in nursing facilities but will provide a way to prevent costly medical issues and save the health care system money. It should not matter where people with disabilities live, if they need a medically necessary wheelchair they should have access to one. Please pass this legislation and associated budget amendments so I never have to tell another patient they cannot have the wheelchair we worked so hard together to perfect.

Comments Document

Thank-You for the opportunity to send this written correspondence. I am a Clinical Nurse Specialist (CNS) who recognizes the need for eliminating a practice agreement with a physician for CNSs that do not practice with prescriptive authority. Many CNSs are employed in academics, research or are consultants to healthcare systems. These areas of employment are examples of employment that do not necessarily require prescriptive authority or a practice agreement with a physician to practice as a licensed Clinical Nurse Specialists. The ability to practice within the full capacity of a licensed CNS in Virginia will be negatively impacted if a practice agreement is required for ALL CNSs. This negative impact is related to the ability of a licensed, educated, and experienced CNSs to practice to their fullest capacity of expertise with a requirement of collaboration of a physician and the availability of physicians to Advanced Practice Registered Nurse ratios. Please see the attached talking points for HB285. Respectfully, Sarah Taylor, MSN, MHR, AGCNS-BC, CEN Virginia Association of Clinical Nurse Specialist, Legislative Chair

I support all of these bills to increase coverage for children, to train care providers in the pernicious influence of cultural bias and systematic racism that can skew our medical decisions (without us even realizing it). I worked as a hospital RN, and then a Nurse Practitioner for 23 years. Nurse practitioners have the education and professional certification requirements to work collaboratively. We do not need practice agreements or supervision by a medical doctor to work within the law and limits of our profession. I do not agree with any measures to limit the dissemination of birth control to women who seek help in limiting conception. I do not know the details of Mr LaRock’s bill, but I have followed his history of preference for the State to control women in their choices for their contraception and well-being within their life limitations. I believe doing all we can to educate girls and women to be their own decision makers, and equal to men spiritually, mentally, and legally will reduce the incidence of unwanted and too early pregnancy better than any heavy-handed scare tactics.

We support the bill.

I work in a group home for youth who are in foster care and also diversion programs from the Department of Juvenile Justice. Once a young person turns 18, they are released with little to no support. Even in re-entry, housing is not an option or priority for a young person because there are no hotels/motels that will allow a person under the age of 21 to stay temporarily. There are few transitional options for young people and we know from studies and data that having the least amount of resources leads to criminal activity, behavioral health issues, often times, substance use disorder and introduction into the adult carceral systems. Youth gun violence has increased because we have more young people being forced to live on their own without support from parents and other community members. They are being robbed of their potential because they are often thrust into adult situations the moment the clock strikes 12am on their 18th birthday. We have to do more to embrace our young people and provide housing for them during this pivotal transitional period in their lives. I would love to see this bill passed and more support be made available for young people leaving foster care and the juvenile justice system.

Voices for Virginia's Children is in support of this bill. Virginia continues to rank 49th in the country for youth in foster care aging out without a permanent connection. For these reasons, we urge your support of the bill.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

I respectfully urge you to SUPPORT HB 915. This bill is essential to prevent unelected bureaucrats from establishing the school mandated immunizations in Virginia. This establishes an additional safeguard from regulatory capture/corruption. Thank you.

Please support HB 1245 that allows nurse practitioners practice autonomy after 2 years of practice in the state of Virginia. Over half of the US states, DC and the Veterans Administration allow NPs some level of practice autonomy. Why is the state of Virginia behind? If this year’s legislation is not passed, Virginia will be the only state that requires NPs to practice for five years before being eligible for autonomous practice. There have not been any negative impacts on patient safety since HB 793 and HB 1737 were passed, which have temporarily allowed NPs to practice with increased autonomy. As a matter of fact, states with restricted NP practice are more likely to have geographic health care disparities, higher chronic disease, primary care shortages, higher costs, and lower standings on national health rankings. Having nurse practitioners providing care actually allows increased supply, and does not compromise safety. Currently, we are amidst a healthcare crisis and staffing shortage. The Bureau of Labor Statistics data shows that the U.S. lost 17,500 health care employees in September 2021 and projects more than 50% employment growth for NPs by 2029, meaning NPs needing a practice agreement may have difficulty finding a collaborating physician, limiting access to health care services. If HB 1245 does not pass, there will be limited access to care for patients in Virginia. During this especially challenging time in healthcare, we need to DECREASE rather than increase the strain on healthcare providers and our healthcare system. This bill will encourage new graduate nurse practitioners to practice in Virginia, rather than leaving the state to practice elsewhere. Please support HB 1245.

I called my doctors office last week for an appointment and was told the earliest appointment was at the end of March. I received a call from a friend stating that a nurse practitioner who was in private practice could see me at the end of the week. Nurse practitioners (NP) have been a staple in society bridging the gap of access to care for decades. During the unprecedented global pandemic nurse practitioners have been instrumental in providing safe, competent quality care, lifting the burden for physicians who specialize in more complex care. And they did it without the supervision of medical doctors. I urge you to make the two-year collaborative practice period permanent for nurse practitioners, instead of reverting to the original five year requirement that was in place prior to the COVID-19 pandemic. There is a plethora of evidence to support the quality and safety of autonomous nurse practitioner practice, including data collected in the Commonwealth over the past two years. Pass HB1245; the people in the Commonwealth should not suffer due to lack of access to health care when there are qualified nurse practitioners available to meet their needs.

Comments Document

Please see the attachment: The Virginia Association of Colleges of Nursing requests your support of HB1245 sponsored by Delegate Dawn Adams.

I oppose 1245. Over the last 41 years I have worked with medical students, resident physicians in training, physician assistant students and nurse practitioner students including their faculty as a teacher for University of Virginia, Virginia Commonwealth University, Virginia Tech Carilion School of Medicine, Virginia College of Osteopathic Medicine and Radford University Carilion. I am opposed to HB 1245 for following reasons: 1. Quality of their NP training is markedly limited compared to physician and physician assistant training. Less rigorous, less detailed, limited hands-on experience. NP faculty I have worked with are dedicated but are not as knowledgeable on practice of medicine. 2. Their faculty that I have worked with are not the cream of the crop in their practice of medicine. The national association for NP programs accreditation requirements are less stringent compared to the physicians’ Accreditation Council of Graduate Medical Education (ACGME) 3. Over the years I have received number of complaints regarding their care from patients as a director and medical director of several programs at Carilion Clinic and Centra Health. Missed diagnoses, errors in prescribing, misinterpreting lab results. Thank you for your time in considering this testimony. If you have any questions, I will be glad to answer. Roger A. Hofford, M.D. FAAFP, CPE Clinical Professor of Family Medicine, Virginia Commonwealth University & Virginia College of Osteopathic Medicine Associate Professor of Family Medicine, Virginia Tech Carilion School of Medicine

Good morning members of the committee. I am submitting my testimony in support of HB1245. My name is Margaret Constante, I graduated from VCU’s family nurse practitioner (NP) program in 2004. Aside from my pre-requisite education, my nursing specific education to receive my associate, bachelor, master degrees, and NP license alone consisted of nine years. Upon graduation, there was a hunger for knowledge and passion to help patients and their families as well as society as a whole. Nurses have always been trained to look for the needs and to improve on the health of the whole. Since its inception, nurses have always made huge sacrifices in times of crisis. As NPs we are prepared to practice independently. The law, however has confined us to depend on someone else to decide what knowledge we can use and how we use it. In my first practice I worked under supervision with a well know group of physicians that I highly respect. I learned a lot from each of them. In the first three months I shadowed my physicians; we saw everything. My knowledge base continued to expand in that time. I had purpose. After three months, I was on my own however, confined. I was only allowed to see less than a handful of things that walked through the door, and although I had prescriptive authority, that too was limited. Although I kept up with education, conferences, obtained certifications, researched, and spoke in conferences, I felt I was losing great amounts of knowledge. By being under supervision, then later collaboration, and even later as a doctoral prepared NP, my allowed practice did not change much. Frustrated with feeling confined and quite bored, I felt the need to move on. Having my autonomous NP license has afforded me the ability to move out of a restrictive model. Within one year of working autonomously, I have learned more than I did in my many years of having restricted practice. Other than expanding my knowledge, autonomous practice has afforded me the ability to work in an environment where no physicians want to work (because of reimbursement and insurance carriers) seeing patients who really need care who would otherwise had to wait to be seen in a hospital system, with a waiting period of over six months. I have seen cancers walk through the door that are bigger than someone’s fist, caught cancers that if a patient had waited any longer would’ve costed them their lives. I have regained the knowledge I have learned many years ago and then some. As an autonomous NP, my education has prepared me to always collaborate with providers and non providers of many disciplines and I will always continue to do so just as any physician would, that is the nature of being a provider. The difference is that I do not have a physician restricting my capacity to learn, assimilate, and to provide quality patient care. I have come to love my patients, my new community, my primary care providers in the area as well as colleagues specialist. My patient population has limited resources, transportation, and feel as though they want to be treated in the communities where they are comfortable. Looking back having had multiple years of experience within being granted autonomous practice within the five-year window is that you can clearly see the diminishing returns on that overly long transition from education to practice. Had I been able to practice more autonomously earlier my knowledge base could’ve been stronger earlier. Please support HB1245.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

In the past 4 years I worked as a faculty with a Radford nurse practitioner training program in Roanoke at Carilion Roanoke Community Hospital. The program director of the program had not practiced seeing patients12 years prior to directing the program. Practice and teaching requires experienced teachers. I spent a lot of time retraining and correcting several of their faculty, correcting mistakes. Lack of knowledge was glaring at times. I received a number of complaints from patients regarding their care at my facility and other facilities regarding missed diagnoses or wrong dosing or wrong medication for patient's diagnosis.

I support all of these bills to increase coverage for children, to train care providers in the pernicious influence of cultural bias and systematic racism that can skew our medical decisions (without us even realizing it). I worked as a hospital RN, and then a Nurse Practitioner for 23 years. Nurse practitioners have the education and professional certification requirements to work collaboratively. We do not need practice agreements or supervision by a medical doctor to work within the law and limits of our profession. I do not agree with any measures to limit the dissemination of birth control to women who seek help in limiting conception. I do not know the details of Mr LaRock’s bill, but I have followed his history of preference for the State to control women in their choices for their contraception and well-being within their life limitations. I believe doing all we can to educate girls and women to be their own decision makers, and equal to men spiritually, mentally, and legally will reduce the incidence of unwanted and too early pregnancy better than any heavy-handed scare tactics.