Comments Document

January 23, 2023 The Honorable Kathy Byron, Chair House Commerce and Energy Committee 900 E Main St Richmond, VA 23219 Dear Chair Byron and Members of the House Commerce and Energy Committee,  The Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO) are pleased to support HB 1471, which requires health insurance carriers to establish and maintain an electronic prior authorization process. VAHO is a professional organization whose mission is to help foster the highest quality of cancer care in the state of Virginia. VAHO members are a community of oncologists, nurse practitioners, physician assistants and other allied health professionals deeply involved in care of our cancer patients. ASCO is a national organization representing physicians who care for people with cancer. With nearly 45,000 members, our core mission is to ensure that cancer patients have meaningful access to high quality, equitable cancer care. VAHO and ASCO are committed to supporting policies that reduce cost while preserving quality of cancer care; however, it is critical that such policies be developed and implemented in a way that does not undermine patient access. Payer utilization management approaches like prior authorization are of particular concern because they represent greater likelihood of raising barriers to appropriate care for individuals with cancer. Time-consuming, labor-intensive prior authorization processes add significantly to burdens already facing physicians and patients. While many prior authorizations may be initiated electronically via individual payer portals, subsequent interactions and requests for additional information are frequently conducted via fax or phone, leading to delayed communication, slower response times, and delays in patient care. A 2021 study from the Council for Affordable Quality Healthcare (CAQH) found that only 26% of prior authorization requests are handled fully electronically, while 35% were fully manual (submitted by phone, fax, e-mail, or mail). Although barriers imposed by prior authorization will not be resolved solely by implementing an electronic process, electronic prior authorization has the potential to improve transparency and efficiency and reduce physician burden, and we urge the Committee to pass this bill. For a more detailed understanding of our policy recommendations on this issue, we invite you to read the ASCO Position Statement: Prior Authorization. If you have any questions about prior authorization, please do not hesitate to contact Sarah Lanford at Sarah.Lanford@asco.org. Sincerely,  Richard Ingram, MD President Virginia Association of Hematologists and Oncologists Lori J. Pierce, MD, FASTRO, FASCO President Association for Clinical Oncology

The National Multiple Sclerosis Society supports HB 1640, to increase the affordability of Medigap plans for Virginians under 65 eligible for Medicare due to disability, including Virginians with multiple sclerosis (MS). MS is an unpredictable disease of the central nervous system, impacting an estimated 1 million Americans. Currently, there is no cure, though significant progress is being made to achieve Society’s vision of a world free of MS. Symptoms vary from person to person and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. Early diagnosis and treatment are critical to minimize disability. Most people are diagnosed with MS between the ages of 20 and 50, in their prime working years. Some people with MS may become eligible for Medicare initially due to disability rather than age, and many may seek supplemental Medigap insurance in order to afford out of pocket costs. While the Society was proud to support SB 250 in the 2020 legislative session to expand Medigap policies to Virginians under 65, for people with high-cost chronic conditions like MS, many of these plans can be prohibitively costly. For people on a fixed income, including those who rely on Social Security Disability Insurance or Supplemental Security Income, it can be difficult or even impossible to afford health care cost-sharing, because their income has to stretch to cover other living expenses. Access to a Medigap plan with an affordable premium could ease some of the burden of cost-sharing for this population. For these reasons, the Society urges a favorable report of HB 1640, which would prohibit insurers from charging individuals who become eligible for Medicare by reason of disability and who are under 65 premium rates for any Medicare supplemental policy that exceeds the premium rates charged to those 65 or older. Thank you for your consideration. If you have questions regarding the Society’s position, please contact Shannon Wood, Director of Advocacy and Policy at shannon.wood@nmss.org.

Dear Chair Webert and Members of the Subcommittee: On behalf of the thousands of people we serve in Virginia, including the 20,942 Virginians currently living with kidney failure, I respectfully request your support for House Bill 1640, which would allow End Stage Renal Disease (ESRD) patients under 65 who are enrolled in Medicare to be eligible to purchase Medigap plans. This bill will provide a one-time, 6-month guarantee issue open enrollment period for eligible Virginians who are already enrolled in Medicare Part B and provide premium protections that ensure plans are affordable for those who need coverage. The American Kidney Fund (AKF), based in Rockville, Maryland is the nation’s leading nonprofit organization working on behalf of the 37 million Americans living with kidney disease, and the millions more at risk, with an unmatched scope of programs that support people wherever they are in their fight against kidney disease, from prevention through transplant. With programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy, no kidney organization impacts more lives than AKF. As you may already know, most people with end-stage renal disease (ESRD) become eligible for Medicare, and most of them choose to enroll in the program as their primary health insurance coverage. However, for many of these patients, private supplemental Medigap insurance is needed to afford their cost-deductibles and co-pays, since Medicare covers only 80 percent of the costs of medical care with no cap on out-of-pocket (OOP) expenses. ESRD patients have complex health care needs and face high out-of-pocket costs: OOP costs for ESRD patients on Medicare can be as high as $18,000/year. Unfortunately, not all Medicare beneficiaries have access to supplemental coverage because in 20 states, including Virginia, insurers are not required to offer Medigap to ESRD patients under the age of 65. Nearly 50 percent of dialysis patients in Virginia are under 65.[1] Further, without a Medicare Supplement plan many patients are ineligible for a transplant because they are considered “under-insured.” Since a kidney transplant is the best treatment for those with ESRD, it is not an understatement to say that this legislation could be a lifesaver. A transplant also could lead a patient to return to a normal life, gaining back all the hours previously spent in dialysis, allowing them to return to work and private insurance plans. We are grateful to policymakers in the Commonwealth of Virginia for previously implementing policies to ensure that other disability communities under 65 have access to Medigap plans. HB 1640 will ensure that this vulnerable population of around 3400 ESRD patients are eligible to purchase plans and not practically denied coverage by providing the premium protection that will make plans affordable. Presently, premiums for Medigap plans issued to qualified under 65 subscribers can cost up to 300% more than premiums paid by those age 65. This legislation will not only save lives, but also will make it easier for patients to cope with the serious financial challenges that come with being diagnosed with ESRD. Thank you for your time and for your consideration of this important legislation. For all these reasons I respectfully ask for your support for HB 1640. Sincerely, Jon Hoffman American Kidney Fund Senior Director, State Policy and Advocacy

Comments Document

Dear Chair Webert and Members of the House Commerce and Energy Subcommittee; On behalf of Virginians living with ALS, we respectfully request your support for House Bill 1640, which requires insurers issuing Medicare supplemental policies, typically known as Medigap, in the state to offer these policies at an affordable rate to all patients who are eligible for Medicare by reason of disability, including patients with amyotrophic lateral sclerosis (ALS) regardless of age. As you may already know, most people with ALS become eligible for Medicare Part A and B regardless of age the month their Social Security disability benefits start. Most patients choose to enroll in Medicare as their primary health insurance coverage. Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Part B covers outpatient care, durable medical equipment, ambulance services and mental health. However, for many of these patients, private supplemental Medigap insurance is needed to afford their deductibles and co-pays, as Medicare Part B covers 80 percent of medical care with no cap on out-of-pocket (OOP) expenses. Medigap plans may cover some of the costs that fee-for-service Medicare does not cover such as copayments, coinsurance, and deductibles. ALS patients have complex health care needs and face high out-of-pocket costs. The average annual OOP costs for ALS patients on Medicare can be as much as $82,500[1][2]. This can present significant financial difficulties for ALS patients and their families, sometimes leading to heart-wrenching decisions such as whether to seek certain types of care or face bankruptcy. Federal law does not require private insurance companies to sell Medigap plans to people under age 65. Most people who develop ALS are diagnosed between the ages of 40 and 70 with the average age being 55 at the time of diagnosis. The lack of federal protection for Medicare eligible patients under 65 has resulted in an uneven patchwork of state laws on this issue. Under the legislation (SB250) that Virginia enacted in 2020, Medigap insurers in the state have to offer at least one plan on a guaranteed-issue basis to Virginians who become eligible for Medicare prior to the age of 65 due to a disability. However, currently insurers are not required to offer Medigap to ALS patients under the age of 65 at the same rate as those that are 65 and over. People with ALS are paying nearly 250% more for their premiums than those 65 and over.[3] If passed, HB 1640 would fix this. We believe that expanding Medigap coverage to Virginians with ALS under the age of 65 at an affordable price is an important and concrete way elected officials can support those with this life-altering, expensive, and devastating terminal disease. Thank you for your time and for your consideration of this important legislation. For all these reasons we respectfully ask for your support for House Bill 1640. Sincerely, Lindsay Gill Managing Director, Advocacy The ALS Association lindsay.gill@als.org

Comments Document

Chair Webert and Members of the Committee, thank you for the opportunity to provide testimony in support of HB 1815, which relates to the coverage of medically necessary breast imaging. My name is Leah Barber and I am the SE Regional Manager of State Policy & Advocacy with Susan G. Komen®. Widespread access to preventive screening mammography is available to millions of women as a result of the Affordable Care Act (ACA). Unfortunately, most individuals at a higher risk of breast cancer or those requiring follow-up imaging due to an abnormal mammogram result face hundreds to thousands of dollars in patient cost sharing for this required imaging – all before they are even potentially diagnosed with breast cancer. Mammography is only the initial step in the early detection process and is not able to alone diagnose cancer. Early detection of breast cancer is not possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. An estimated 16 percent of women screened with modern digital mammography will require follow-up imaging. Additionally, screening delays and cancellations during the COVID-19 pandemic have raised concerns about associated increases in “missed’ and late-stage cancer diagnoses and mortality. Although we don’t know the full impact of the pandemic, emerging data in the two years since the pandemic has reinforced these concerns. The potentially “missed” cancers could be larger and more advanced once ultimately detected, often requiring the use of diagnostic imaging. As committed partners in the fight against breast cancer, we know how deeply important it is for all cancer patients to have fair and equitable access to the breast imaging that may save their lives. As such, we support HB 1815 and urge you to pass this critical legislation. Thank you, Leah Barber (We have attached our full, written testimony)

Comments Document

The Leukemia & Lymphoma Society (LLS) submits the following testimony to the Committee on Commerce and Energy Subcommittee 2 in opposition to HB 2201 regarding premium rate adjustments for Association Health Plans. We agree that it is critical to ensure that affordable health insurance coverage is available to every Virginian who needs it, but we remain concerned that association health plans – or AHPs – are not the right solution. House Bill 2201 would open the door for an AHP to charge higher premiums to individual employers based on the health spending of their employees. In other words, despite forming an association to pool and share risk across all members, this would allow AHPs to effectively punish member-employers and their workers for using their insurance - thus increasing health insurance costs for patients who truly need treatment. Put simply, this bill will let association health plans charge sick people more just for being sick. We share concerns over the affordability of health coverage, and we are eager to work together to find ways to ensure that patients and consumers can afford the best possible plans for themselves and their families – plans that provide the right coverage at the right time, and where affordability considers not only premiums but also out-of-pocket costs. However, this change would serve to further price out vulnerable Virginians who need health services the most.

ChildSavers is a 98-year-old nonprofit providing trauma-informed mental health services for children in Virginia. Current provider credentialing practices have a significant impact on our ability to address Virginia’s youth mental health crisis. This bill would clarify those processes and will result in increased access to mental health services for children in the Commonwealth.