I am writing in support of HB45. Athletic trainers are licensed health professionals with a defined scope of practice in the Commonwealth of Virginia. We work under the direction of a physician. Athletic training has specific CPT codes for billing defined by the AMA. HB 45 has made it through the HIRC in 2021 and not been found to have a negative financial impact. Athletic Trainers should be able to bill a third party payer for for our skilled services delivered to patients under our defined scope of practice under the direction of a physician. As a dually credentialed athletic trainer and physical therapist I see this as a step in the right direction of increasing patient access to care and enhancing professional collaboration. Rose Schmieg DHSc, LAT, ATC, PT Director Division of Athletic Training Shenandoah University

I am writing in opposition to HB45. Athletic Trainers provide valuable services, but Centers for Medicare and Medicaid Services do not recognize ATCs as a provider of therapy services, and I worry that the bill would unintentionally expand ATC services to non-athletic/medically complicated patients which could put ATCs in the position of practicing outside their scope.

Good morning, all! My communication today is with regards to support for HB45 (previously HB59 during the 2020 General Assembly) as I am unfortunately unable to attend in person. While I personally support HB45, I am pleased that, after its own review, the HIRC unanimously voted in support as well. Additionally, with the BOI’s review of the measure, and subsequent ruling of no fiscal impact, it is comforting to know that Athletic Trainer’s within the Commonwealth would be able to care for fellow Commonwealth citizens without adding any additional financial burden. It should give you confidence knowing Athletic Trainers are essential healthcare providers licensed by the Department of Health Professions and regulated under the Board of Medicine. Your support would be for constituents who are Master’s degree educated, nationally certified by the Board of Certification and possess a National Provider Identifier (NPI) number and taxonomy code (Taxonomy Code: 2255A2300X - Specialist/Technologist - Athletic Trainer). The scope of practice for an Athletic Trainer is defined by the code of Virginia and, by code, we provide treatment and rehabilitation of such injuries or conditions related to athletic or recreational activity under the direction of the patient's physician or under the direction of any Doctor of Medicine, osteopathy, chiropractic, podiatry, or dentistry, while using heat, light, sound, cold, electricity, exercise or mechanical or other devices. Within the Current Procedural Terminology (CPT) code book, Athletic Trainers are recognized healthcare providers with their own subset of procedure codes to legally allowed to bill for services in the Physical Medicine and Rehabilitation (PM&R) section, essentially identical to those of Physical Therapy (PT) and Occupational Therapy (OT). A vote of ‘yes’ on HB45 would fall in line with support from the Virginia Orthopaedic Society (VOS) and the fact that Athletic Trainers have appropriate education, state licensure and national certification to be recognized and compensated by third party payors for services legally allowed to perform and bill for. I am appreciative of your service to the Commonwealth and your thoughtful review of HB45. A vote of ‘yes’ on HB45 does not change the scope of athletic training in anyway but simply allows Athletic Trainers the ability to receive appropriate compensation for services legally performed with the Commonwealth. I know I can speak for the Virginia Athletic Trainers’ Association by saying ‘Thank You’ and we would be grateful for your support of HB45.

Comments Document

Good day Delegates, I am writing in support of HB45 which would amend insurance code language to add "licensed Athletic Trainer", and is a measure carried by Del. Ware. I wished to be in person for this, however my work responsibilities dictate otherwise. Our Lobbyist Becky Bowers Lanier who represents the Virginia Athletic Trainers' Association is present and carries our message well. First off, Del. Ware thank you for sponsoring this bill, it has been a great pleasure working with you since we first introduced this measure in the 2020 General Assembly. You are a true peoples politician and on behalf of myself and the entire Virginia Athletic Trainers' Association, we are grateful for your efforts. Historically HB45 was previously filled as HB59 in the 2020 GA. This measure was referred to the Health Insurance Reform Commission (HIRC) where it was reviewed further. The BOI has noted no fiscal impact and otherwise cleared their checks and balances. The HIRC voted unamosiuly in favor of the measure and is a recommendation of theirs that the measure move forward unabated. As you are aware this bill was carried by a Delegate who was in the minority previously, but mustered bi-partisan support in a majority controlled commission. This measure is a bipartisan bill that should move through the committee in favor. Athletic Trainers are Masters level educated, licensed health care providers within the commonwealth that have a delineated scope of practice as set forth by the code of Virginia. We practice under the direction of physician, hold national provider identifier numbers governed by CMS, and are considered healthcare experts in the field of concussion management. We are recognized providers by the American Medical Association in their Current Procedural Terminology (CPT) handbook, have specific athletic training evaluation code numbers, and are legally allowed to bill for services within the physical medicine and rehabilitation section. At present time, however, receiving reimbursement for services from third party payers has proven difficult or even a non-starter. This code amendment will help align the profession of Athletic Training with other providers whom appear in the current language. Our education supports this measure, our state license supports this measure, our national certification supports this measure, and finally the largest compilation of orthopaedic surgeons in Virginia (The Virginia Orthopaedic Society/ VOS) supports this measure. By voting yes on HB45 you are helping cement the profession of Athletic Training within the commonwealth of Virginia as a valuable healthcare provider. The Virginia Athletic Trainers' Association and myself are grateful for your time and consideration on this measure.

TechNet has concerns that the bill enacts requirements regarding free trails not seen in other states. Will reach out with recommended changes that will align the bills with other states' laws.

I support all these bills because raising the wage now will result in closing businesses (especially small and minority owned) and increase prices for customers. I support being able to opt out permanently of problem calls. Thank you for these bills.

The price of energy affects the poor and working man much more than it does any rich politician or or entitled class. The idiocy espoused by the Biden administration and the leftist politicians in America is it is not just laughable, it is anti-American and impacts impacts each one of us in a negative way. Stop the spread of communism in our country. Put America First. Let us together make America Great Again.

Comments Document

To Whom It May Concern, Please see attached letter from the Truck and Engine Manufacturers Association (EMA) on HB143. Thank you, Tia Sutton Sysounthorn tsutton@emamail.org

Comments Document

Please see the attached letter expressing AEM's opposition to HB 143. We request the bill be withdrawn to give us the opportunity to bring all stakeholders to the table to negotiate a compromise that benefits everyone. Thank you.

I support all these bills because raising the wage now will result in closing businesses (especially small and minority owned) and increase prices for customers. I support being able to opt out permanently of problem calls. Thank you for these bills.

Small business is at the breaking points, if they're still alive. Please do not make it harder for them to stay alive as businesses with putting added financial burdens on them. This is especially true for minority businesses. Thank you for your consideration.

I am writing in opposition to HB237. This bill will roll back important consumer protections on Short-Term Limited-Duration (STLD) plans passed by the General Assembly in 2020. These plans are intended to fill short coverage gaps, not provide full-year coverage. They can exclude coverage for prescription drugs, maternity benefits, mental health, substance use disorders, or pre-existing health conditions; deny coverage, deny a renewal, or exclude services because of a pre-existing condition; charge more based on gender or a pre-existing condition; and have daily, annual, or lifetime limits on benefits. Further, they spend less on enrollee benefits, about $.39 per premium dollar, than qualified health plans, which are required to spend $.80-$.85 of every premium dollar on benefits. Numerous studies have shown that STLD plans are often misrepresented to consumers, and many purchase them without knowing their limitations. I urge you to vote no on this bill.

My name is Freddy Mejia with The Commonwealth Institute and the Healthcare for All Virginians Coalition. Investing in behavioral health has been identified as a priority for the legislature. However, I firmly believe that expanding access to short-term limited-duration health plans that often do not provide mental health and substance use disorder services is counterproductive to those efforts. We are concerned that these plans, which lack many consumer protections, will leave more families in Virginia underinsured and at risk of medical debt. We are opposed to this bill and ask you to please vote no on HB237.

The American Cancer Society Cancer Action Network (ACSCAN) opposes HB237. Short-term limited duration (STLD) insurance plans do not provide the kind of comprehensive insurance coverage cancer patients need. These plans were designed only as temporary coverage and are not subject to the same Affordable Care Act (ACA) requirements as other health insurance products on the market. For instance, STLD plans are not required to provide a robust benefit package. As a result, an enrollee who was attracted to the plan’s lower premiums may find – if they are diagnosed with a serious illness like cancer – that the plan does not cover all of their necessary cancer treatments. In these cases, the consumer can be left with catastrophic costs. STLD plans fail to provide the kind of comprehensive coverage an individual would need if they were diagnosed with a serious and unplanned disease such as cancer. STLD plans can (and most do): - Engage in medical underwriting: issuers can deny coverage to people with pre-existing conditions, charge more based on a person’s health status, or refuse to cover services related to an individual’s pre-existing conditions; - Impose lifetime and annual limits on coverage; - Exclude coverage of essential health benefits; - Engage in post-claims underwriting – once a person is enrolled in coverage if they submit claims for an expensive service, the issuer investigates to determine whether the enrollee’s condition was a ‘pre-existing condition’ – and deny coverage for the condition; - End coverage at the policy’s term, even if the policyholder has gotten sick and needs coverage to continue; and - Negatively impact the risk pool and availability and affordability of ACA-compliant plans by syphoning off younger, healthier consumers who will be more likely to purchase cheaper, bare bones plans. For these reasons we urge the committee to leave the STLD restrictions in place and vote down HB37

Comments Document

The Leukemia & Lymphoma Society respectfully submits this written testimony in opposition to HB 237 concerning short-term limited duration plans. LLS's concern is that the proliferation of these plans will leave many patients underinsured.

Short-Term Limited Duration Plans (HB237) Short-term limited duration (STLD) health plans were originally intended to fill a temporary gap in health coverage. This type of plan was not meant to replace traditional long-term health care coverage options. They lack many consumer protections. This is why AARP Virginia supported 2020 legislation to impose limitations on the sale of STLD health plans in Virginia, which HB237 would repeal. Short-term limited duration health plans are not required to cover prescription drugs, mental health and substance use disorders, and pre-existing health conditions. A February 2020 Milliman Research Report found that 58 percent of plans didn’t cover mental health services and 67 percent of plans didn’t cover prescription drug benefits. Unlike ACA compliant plans, STLD plans can charge higher premiums to people based on their gender. They can charge older people far higher premiums than currently allowed by the ACA. Short-term plans also can charge high deductibles and cost-sharing for the benefits they do cover (e.g., a $5,000 deductible for a policy that lasts three or six months). And, the plans can include dollar limits and caps on how much they will pay out for a given service or in total for benefits over the life of the policy, or during the life of the enrollee. The applicable Medical Loss Ratio permits up to 40% of premiums collected to cover administrative costs and profits (vs. only 15% in the individual market.) Additionally, increased marketplace subsidies make this sort of legislation to expand access to these types of plans really unnecessary. Overall, short-term health plans are a bad deal for consumers, and Virginia should not broaden their availability. As such, AARP Virginia asks that you vote “no” on HB237.

The American Lung Association believes everyone should have quality and affordable healthcare coverage. While the federal government has expanded the use of short-term, limited duration insurance plans (known as short-term plans), these plans can deny coverage based on pre-existing conditions like lung disease and do not provide the comprehensive coverage that individuals need to stay healthy. The current COVID-19 pandemic emphasizes the critical nature of access to comprehensive, quality coverage, regardless of pre-existing conditions. The American Lung Association in Virginia urges members to oppose House Bill 237, legislation that would rollback safeguards for consumers purchasing short-term plans in Virginia. Protections for Virginians were passed in 2020 in Senate Bill 404. Repealing these protections will harm patients with asthma, COPD, lung cancer and other lung diseases. Under federal regulations, short-term plans almost always refuse coverage to patients with pre-existing health conditions. Current lung disease patients, like patients with COPD or lung cancer survivors, could be denied coverage because of these health conditions. Individuals who buy a short-term plan and then receive a new lung disease diagnosis in the middle of a plan year could find the coverage for their disease rescinded, leaving them without any coverage options until the open enrollment period for Virginia’s individual marketplace comes around. Short-term plans are not required to provide coverage for basic treatments and services that individuals need – even if they are healthy now. For example, these plans do not have to cover preventive services like lung cancer screening or tobacco cessation treatment, nor do they have to cover essential health benefits like hospitalizations and prescription drug coverage. This will create confusion for consumers trying to purchase comprehensive coverage and could leave patients with massive medical bills or force them to forgo needed treatment if they get sick. Short-term plans also often require consumers to spend enormous sums during the deductible portion of their benefit design, which can quickly eclipse any premium savings consumers may accrue while covered by one of these plans.1 Additionally, short-term plans will likely attract younger and healthier individuals, dividing the individual marketplace risk pool in Virginia. That will result in a spike in premiums for comprehensive plans sold in the marketplace, the only ones that will cover the treatments and services that lung disease patients need. Patients with lung disease should not have to pay higher premiums because they need coverage for a pre-existing condition. Even those consumers who seek a comprehensive ACA plan may be diverted to a Short-term plan through deceptive marketing and misleading websites.1 The American Lung Association in Virginia urges lawmakers to support the safeguards for consumers purchasing short-term plans that were passed in 2020 through Senate Bill 404 and Oppose House Bill 237 which would roll back these protections and harm Virginians. 1 Under-Covered: How “Insurance Like” Products Are Leaving Patients Exposed. 2021 https://www.lung.org/getmedia/5b240c9a-72ec-4217-bc75-d416e6f69f51/undercovered_report.pdf

The National Multiple Sclerosis Society writes to express strong opposition to the removal of limitations on the duration, renewal, and availability of short term limited duration health plans. We respectfully urge the Committee to vote NO on HB 237. The Society has a unique perspective on what people with multiple sclerosis (MS) require to manage their disease and live their best lives. MS is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Virginians impacted by MS should not have to worry whether their health insurance will cover their doctor visits, care for COVID-19, or treatment for complex, chronic conditions like multiple sclerosis. All Virginians deserve health insurance that is comprehensive and includes patient protections, covers an expansive network of providers and plan features, and provides simple and clear information regarding plan costs and coverage. Short term limited duration plans fail to meet these standards, and place people living with MS at great risk for medical debt and high out-of-pocket costs. Given the risk these plans pose to Virginians living with MS, the Society was supportive of efforts in 2020 to place common-sense limitations on STLD plans. We strongly oppose any effort to remove these limitations, as called for in HB 237.

The Virginia Breast Cancer Foundation (VBCF) opposes HB 237, which repeals prohibitions on the duration, renewal and extension, and availability of short-term limited-duration medical plans (STLDPs). These health insurance plans can serve as a stop-gap measure for some consumers, but should be kept “short-term” as currently available. VBCF's concern is that STLDPs are not required to adhere to a vast range of important patient protections and are a poor coverage option for consumers who may encounter a serious diagnosis - such as breast cancer - while holding such limited coverage. Among other things, they can refuse coverage for pre-existing conditions and choose not to cover essential health care services, including cancer screenings. Many individuals with STLDPs who become sick will be unable to afford the care needed to respond to a life-threatening or life-changing diagnosis and will be forced to delay treatment for the months it may take to secure adequate coverage. At VBCF we know that early diagnosis and treatment of breast cancer leads to better outcomes for patients. Limited health plans that do not cover essential health care services such as cancer screenings are not a good choice for many consumers. Expanding the duration, renewal, and extension of STLDPs is moving in the wrong direction for Virginia. We oppose HB 237.

VEA is opposed to HB296 and HB320

I support all these bills because raising the wage now will result in closing businesses (especially small and minority owned) and increase prices for customers. I support being able to opt out permanently of problem calls. Thank you for these bills.

Small business is at the breaking points, if they're still alive. Please do not make it harder for them to stay alive as businesses with putting added financial burdens on them. This is especially true for minority businesses. Thank you for your consideration.

The Roanoke Regional Chamber of Commerce supports HB 309 and thanks the committee for its consideration.

VEA is opposed to HB296 and HB320

I support all these bills because raising the wage now will result in closing businesses (especially small and minority owned) and increase prices for customers. I support being able to opt out permanently of problem calls. Thank you for these bills.

Small business is at the breaking points, if they're still alive. Please do not make it harder for them to stay alive as businesses with putting added financial burdens on them. This is especially true for minority businesses. Thank you for your consideration.

TechNet has concerns that the bill enacts requirements regarding free trails not seen in other states. Will reach out with recommended changes that will align the bills with other states' laws.

I support all these bills because raising the wage now will result in closing businesses (especially small and minority owned) and increase prices for customers. I support being able to opt out permanently of problem calls. Thank you for these bills.