Public Comments for 02/09/2024 Appropriations - Health and Human Resources Subcommittee
HB608 - Temporary detention; certified evaluators, report.
We do NOT want privates to be able to complete TDO evaluations! This will destroy all the work we have done to keep people OUT of the hospital. I have worked in a CSB most of my 32 year career.
Strongly oppose!!
I stand opposed to HB608.
Strongly opposed to this. We work diligently to provide services in the least restrictive environment. As a result, we have significantly decreased our TDO rate in our area. If this were to pass for a pilot, undoubtedly other providers would begin to seek the same privileges to TDO individuals. We feel that it would ultimately reverse the work that we have done and this would not be in the best interest of the individuals we serve.
I stand opposed to HB608 for the reasons stated in the other comments of opposition.
Greetings and thank you for considering my comments. I would oppose this legislation that would allow for prescreening evaluations to be completed by private agency personnel even under a pilot program such as what is proposed. One of the foundational components of the TDO process is that the evaluation is completed by an unbiased professional, one that is not connected to the ED that the individual presents in or to the hospital to which they are placed. This provides a protective factor for the individuals that we serve to help ensure that they are evaluated objectively and their best interests are pursued. The CSB is required to see all individuals who present for evaluation and there is a concern that this program could result in hospitals choosing who they see and who they refer to the CSB for evaluation based on payor source. Changing this process would also allow a private entity to have a direct route to the state hospital system in a time where we as CSBs are being encouraged to do everything possible to minimize admissions to those facilities. My belief and I believe as history as shown, there will be an increase in state bed utilization as a result of this in a time where we already are experiencing bed shortages due to high levels of forensic TDOs, staffing shortages, etc. There has also been the statement made that the magistrate is one who determines the TDO and while they may issue that TDO order, that decision is based upon the information provided by the evaluator and recommendations for placement facility. In summary, I do not feel that this is a solution to the bed shortage that we have. Our CSB has been able to add many components of the crisis continuum including a Crisis Receiving Center, 23 hour program, mobile crisis team, care centers in each of our hub areas that are walk-in, one of which is open 24/7 (the others are open 7 days a week, 12 hours per day), Partial Hospitalization Program in each of those locations, expanding our youth CSU by four beds, expanding our adult CSU to 16 beds in the next couple of years, and a host of other services that support individuals in crisis. We have seen our TDO rates drop significantly over the past few years as we have rolled out these services and we continue to see a decline for this current fiscal year. As an alternative to the proposed legislation, I encourage you to explore ways to support programs such as the ones that we have implemented that are proactive in preventing individuals from presenting in the EDs for evaluation and actively work to keep individuals in our communities, in their homes, and with their families and support systems.
Strongly opposed.
Strongly opposed !!!
Strongly oppose
Greetings Health and Human Resources Subcommittee members, As the Executive Director for District 19 Community Services Board (CSB) I am concerned about the impact this bill and a similar senate bill will have on catchment areas across the state. D19 CSB catchment area includes the cities and counties of Colonial Heights, Emporia, Hopewell, Petersburg, Dinwiddie, Greensville, Prince George, Surry, and Sussex, respectively. Currently CSBs/BHAs are designated by the Code of Virginia as the single point of entry into the publicly funded system and this legislation provides a bypass for private hospitals. As currently written, the legislation is silent on whether these facilities will be required to conduct EVERY evaluation or if they will still rely on the CSB system. Ultimately If these bills pass, private hospitals will be able to evaluate only those individuals they want to evaluate and send those whom they do not want in their facilities to state hospitals. This includes the ability to admit to their facilities only those with insurance and send anyone who is uninsured or underinsured to the state hospital. Virginia’s CSB/BHA public safety net has been established to treat all regardless of insurance coverage or ability to pay. This allows for the civil commitment process as established by the Code of Virginia to be accomplished without the prospect of monetary gain but with the individuals rights and due process at the fore. CSBs/BHAs work closely with private hospital systems, law enforcement, local judicial systems, and community stakeholder’s to ensure that Virginia’s most vulnerable citizens have the treatment needed from the initial notification of a crisis, during the civil commitment process, coordination of TDO placement and care while waiting for a bed (private or public), participation in the commitment hearings, and all of the ancillary tasks related to aftercare and liaison services to successfully assist individuals who are subject to this process with transitioning back to the community. In closing, having more individuals complete evaluations will not address the bed crisis issues, ER boarding, or the burden on law enforcement to maintain individuals while they are waiting on a bed. Continued effort to build out Virginia’s Crisis system and diversion to lower levels of care, and prevention efforts at the community level will decrease reliance on emergency treatment for those in of behavioral health services. Please see the attachment for specific examples regarding why this bill should be opposed. Respectfully, Terrelle Stewart, LPC, CPSC Executive Director District 19 Community Services Board
I strongly oppose HB 608. I would like to refer the reader to review the comments in item # 11 of the attached Department of Planning and Budget 2024 Session Fiscal Impact Statement, which are also listed below: "According to DBHDS, prior to legislative changes several decades ago, the practice of non-CSB designated clinicians conducting emergency evaluations was permitted. Multiple criticisms of the commitment process emerged during this time period, including inadequate screening that resulted in numerous TDOs and admissions to state hospitals and a lack of community services and supports to prevent unnecessary hospitalization. At the time, the law mandated examination by an independent physician or a psychologist. Subsequently, a series of studies was conducted by the Institute of Law, Psychiatry and Public Policy (ILPPP) at the University of Virginia in 1988, DBHDS in 1990, and the Joint Legislative Audit and Review Committee (JLARC) in 1994. After the JLARC study, the General Assembly required that in all cases, only an evaluation conducted by a community services board (CSB) could lead to the issuance of a TDO and required the CSB to determine the place of hospitalization. The requirement was designed to ensure consideration of less restrictive interventions and avoid unnecessary TDOs."
Strongly Oppose
Opposition to HB608 Temporary detention; certified evaluators, report. HB608 Financial Impact Statement itself addresses many concerns Fiscal Impact Statement o Pilot for One Provider carries a fiscal impact to the Commonwealth o Indicates that the addition of non-CSB evaluators into the behavioral health care system “adds additional. administrative burden” to ensure that non-CSB evaluators are consistent in evaluation protocols across the civil commitment process o States if enacted, DBHDS anticipates an increase in the # of individuals who are evaluated and admitted to a state hospital, leading to increased census pressures throughout the system. o Addresses the history of who prior legislative changes were made decades ago due to concerns of inadequate screening by non-CSB clinicians resulting “numerous TDOs and admissions to that hospital and a lack of community. services and supports to prevent unnecessary hospitalization.” • This has been evaluated numerous times without such recommendation, including detailed in Study in December 2021: PLEASE READ THE REPORT Report on Item 320.II of the 2021 Appropriations Act Report on Who Should Conduct TDO Evaluations in Virginia https://rga.lis.virginia.gov/Published/2021/RD828/PDF . ALSO, Highlighted PDF Version attached. o This Bill ignores the study and concerns of representatives throughout the system regarding complexities that this. would unwind among other conflicts. • Individuals conducting evaluations as part of this pilot have no incentive to explore less restrictive alternatives above The fact that this pilot will give a private facility the ability to directly access state hospital beds in every part of the state which means although this is a pilot, it has statewide impact on bed access. • The pilot does not guarantee that this private facility will accept ANY TDOs and if it does accept TDOs, they can pick and choose based on insurance status and acuity. • Part of the reason the state made the CSBs the single point of entry in the first place was to ensure that the least restrictive alternative was always the first consideration. • This creates 2 legal tracks for law enforcement and magistrates must navigate and does not address concerns of ensuring that less restrictive alternatives are considered. • Inconsistent with GA investments in STEP-VA, counters recommendations of J-LARC Study only months ago.
While I do support change in the code regarding those who can initiate the TDO process, I cannot support this legislation and am baffled by how a bill benefiting only ONE provider could gain any traction. But I'm sure the bill's sponsors came up with this out of the kindness of their hearts; it would be illegal for a nonprofit to influence legislation in the traditional American way. The GA has had documented for them the inefficiencies of our system for well over a century and these have gone unaddressed. Having an objective 3rd party who advocates for or against what the US Supreme Court has referred to as a serious deprivation of liberty is one of the few things that has been working within our system. Having dealt first hand with the provider in question they have not proven themselves to be competent, compassionate, or unbiased toward any client that would be affected by this bill. Many within this organization have referred to the CSB as incompetent because they choose to disagree with their uninformed and untrained opinions, and I believe this has more to do with degrading the CSB's power rather than helping those in need. So while I do support busting up the monopoly that the public system has over this niche field of mental health treatment, there are better and more creative ways to do so that are consistent with national standards of care and what has shown to work in other states. There are experienced, competent, and licensed private providers of community crisis services that are available now should the GA choose to use them for this purpose.
Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.
Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.
I am the Crisis Dir. for the Hpt-NN CSB. The CODE purposely allows only CSBs to conduct preadmission evals. Despite many formal workgroups & thorough studies, including by DBHDS in Dec.2021, no recommendation to provide private hospitals w/ an exception was made. Instead, concerns related to conflict of interest & complexities such action would result. The authority this private hospital system is requesting, is a challenging & complex process & MUST respect the liberties of each individual, balance the legal & ethical demands w/ the clinical needs, & DOES deprive an individual of their liberties. To accomplish this request of ONE provider, in addition of changes to the code, also requires significant adjustments and/or exceptions in many regulatory standards & local, regional & statewide protocols. Significant adjustments or exceptions would be needed for the orientation, training, oversight, & supervision of Certified Pre-screeners initiated in 2016 by the Deeds Commission which are not practical & according to the Bill’s Financial Impact Statement, at cost to the Commonwealth, based on a ONE provider’s request. The Code addresses financial considerations which is directly contrary allowing an evaluator determining that an individual can be invol. hospitalized, having a financial interest in the outcome. Aside from the obvious concerns, there will be upcoming requests to provide financial incentives to hospitals accepting more TDOs. Approval of this bill or any substitution allowing this to occur: Directly contradicts efforts & GA investments in STEP-VA; is inconsistent with the goals of moving Va. toward a Crisis Now System & Gov. Right Help Right Now; counters recommendations included in the last 2 JLARC studies; allows a provider to refer to the state hospital; & an ability to directly tax locally-funded public resources including LEO, magistrates, justices, public defenders, & CSB. On Tuesday, the provider shared a rationale to assist with “Workforce Shortages” & that a similarly credential clinician would already working with clients would avoid “duplication”. Instead, it complicates roles of other local publicly funded resources by creating 2 legal tracks based on their request & w/o considering impact on the public servants. The CSB has met all performance contract guidelines & delays in individuals accessing care are due to the inability to acquire an accepting bed. The provider’s proposed use of this clinician’s role as stated is working in a dual role, also serving as the unit’s therapist while providing pre-screening duties, is inappropriate & devalues the importance for their convenience. In order to evaluate what may be needed to allow provider to be a certified prescreener, an alternative pathway for an allowance lacks attention to the needs of a prescreener, including respect to the local orientation and knowledge of resources for ALL & threatens safeguards put in place by the Deeds Commission to ensure protections for liberties. Nor could such a pathway place the adequate emphasis on ongoing supervision, oversight & significance of recommendations made in this process. Despite CSB playing such a critical role at all aspects of the BH system, at no time were we approached on consulted on the impact or potential consequences. Clearly, private entities have a role in our system, but not one that allows them to silo while encumbering public resources. this direction would be dangerous & egregious.
The Code of Virginia mandates that pre-screenings be completed only by individuals employed by CSBs and that an entity shall not have financial interest in the evaluation of an individual for psychiatric hospitalization. This bill defies both of these requirements in favor of supporting the request of one provider. This provider has stated that their goal is to support CSBs workforce challenges and move individuals needing care through the system more quickly. However, there was no conversation with us on how CSBs can be supported, and we disagree with these comments. Our CSB staff completed 3,945 pre-screenings last year; lack of access to a pre-screener was not an issue. Please refer to the 2021 DBHDS study on "Who Should Conduct Pre-screenings" for its recommendations and the recent JLARC study that points to the need for private hospitals to admit more people. This shows where the problems lie, including the fact that State hospitals have operated above 100% capacity while many private hospitals operated well-below. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to those hospital beds without bias. Please do not combine these issues—these are separate concerns and a not very veiled attempt by one provider to gain control to the entire behavioral healthcare process. Advancing this bill at the expense of the public is unacceptable to our community and our Commonwealth. We know that the people with the highest need will be served by our public system, while those with less intense needs will be selectively filtered through this private hospital system. Furthermore, our trained staff will be sought after with offers of higher pay. This will give this hospital system even more control in selecting who they serve while utilizing public funds to do so. This action will effectively dismantle our community safety net. We have information from two recent JLARC studies and a 2021 DBHDS study on the pre-screening process that do not indicate a need to do anything different with the pre-screening process. However, the JLARC study does place emphasis on the need for private hospitals to increase their admissions. Giving them more control to our public system compounds the current issues we are trying to overcome with the private hospitals and takes us backwards in our efforts to resolve issues to access. Previous legislators saw the need to keep pre-screening separate from service provision for this very reason. DBHDS’s own impact statement points out issues with this pilot which will also result in increased cost to our public system— again, to support a private provider. When we look at all of this, the only reason we can see that this is being done is that this provider lobbied for it. The guise of supporting our CSB is inaccurate. Advancing this bill by using the term “pilot” should not be downplayed. Pilots are made to be continued. We ask that you look beyond the benefit to a single provider and consider the damage that the passage of this bill will do to our system. This will be followed by one thing after another until our entire system is uprooted. We do not want to take this step back when so much has been done to move us forward.
The Code of Virginia establishes CSBs as the single point of entry into the publicly funded behavioral healthcare system, and mandates that pre-screenings be completed only by individuals employed by CSBs. This provides the opportunity for anyone who presents with a behavioral health crisis to have equal access to prescreening and when needed, follow-up care. Further, the Code of Virginia establishes that parties involved in the completion of the pre-screening shall not have financial interest in the pre-screening process. The Hampton-Newport News CSB serves over 12,000 people annually. We respond to six hospitals and completed 3,945 pre-screenings last year. We have outstanding staff who have propped this system up through all of the challenges, ensuring that people who need services were responded to, working countless hours to search for elusive hospital beds, while some private hospitals picked and chose who to accept at a time when they knew state hospitals were overflowing. CSBs endured the brunt of the anger and frustration from patients, families, and community stakeholders, to be met with this bill that shows that our work is not good enough. Please consider the recommendations of the recent JLARC study that points to the need for private hospitals to admit more people. This provides empirical data that shows where the problems lie. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to them without bias. Advancing the advocacy of one provider at the expense of the public is unacceptable to our community and our Commonwealth. Private hospitals have a place in this system, but this is not it. We know that the people with the highest need will still fall in our care while those that can be directed to other programs within a private hospital system will be chosen to financially support those programs. Furthermore, our trained pre-screener staff will be sought after with offers of higher pay which will impact the ability to keep our pre-screener positions filled. The result will be that the public will be filtered to one location rather than being provided equal access to pre-screening when and where it is needed. This will effectively dismantle our safety net. We believe the intentions of this bill are good, but no one consulted with our CSB on this matter. I assure you, as we have gone down this road in the past, the outcome will not be beneficial for the individuals we serve. Had the goal been the placement of pre-screeners within a psychiatric emergency department, this could have been done in conjunction with our CSB while remaining within the Code of Virginia, rather than by circumventing the established process. The ability of private entities to lobby with legislators for public funds intentionally cuts CSBs out of the conversation and eliminates necessary partnerships. We ask that you look beyond the benefit to one provider and consider the damage that the passage of this bill will do to our system. There is a reason that past legislators saw fit to put these safeguards in place as defined by the Code of Virginia. This action sets a bad precedent that will embolden private entities to continue to seek public funds while advancing motives that are in direct conflict with the Code of Virginia. We do not want to take this step back when so much has been done to move us forward. Thank you for your consideration of this important matter.
Opposition to HB608 Ryan Dudley Hampton-Newport News Community Services Board
HB787 - Administrative Process Act; appeals of case decisions regarding benefits sought.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!
My name is Michaela Lieberman and I’m an attorney and the interim director of Health Justice and Public Benefits at the Legal Aid Justice Center. We support HB 787 because it is an essential step in guaranteeing access to justice for individuals appealing the loss or reduction of their critical benefits like SNAP, TANF, and Medicaid. HB787 amends the Administrative Process Act to allow Circuit Court judges to review legal issues in additional to factual issues in administrative appeals of public benefits cases like SNAP, TANF, and Medicaid. Currently, the APA only allows judges to review how administrative hearing officers ruled on the facts of a case – not on how hearing officers ruled on or applied the law in a case. Here’s why this bill matters: When my client, a 21-year-old survivor of a traumatic brain injury who depended on extensive home-based personal care services to keep him living safely at home, lost more than half of his services after the State arbitrarily reduced them, he appealed the reduction because he faced the grave risk of institutionalization in violation of the Americans with Disabilities Act. Even though my client raised this ADA argument at his Medicaid appeal hearing, the hearing officer assigned to his case ignored it. My client decided not to appeal the hearing officer’s decision to Circuit Court, in part because the APA would have prevented the Circuit Court judge from reviewing the hearing officer's legal analysis (or absence thereof); in its current form, the APA would have only allowed the judge to review whether the hearing officer got the facts right. So the APA- as it’s currently written – gives unelected, unappointed hearing officers the final say on what the law is in SNAP, TANF, and Medicaid cases. HB 787 would change that. It would allow Circuit Court judges to review administrative hearing officers’ legal findings de novo, just as judges can in all other administrative appeal cases that come before them. We urge you to vote yes on HB 787 so Virginians facing reductions in/losses of critical benefits like SNAP, TANF, and Medicaid have access to justice, too.
HB1499 - Virginia Health Workforce Development Authority; powers and duties, definition.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
Strongly Oppose
Hi, Im Lydia Figueroa and I’m a nurse educator. As a nurse educator I’m concerned about faculty not being qualified to provide the education needed to teach nurses the critical thinking skills needed to provide quality patient care. Instead of decreasing educational requirements for nursing faculty, could this bill helped secure funding for graduate schools in nursing. It is important that nursing students to gain the knowledge needed to become safe practitioners from highly qualified faculty members. Exactly how will this bill help the body of nursing education, research and practice. Moreover, I do not believe this is the answer for underrepresentation of remote locations or minority health care. Funding more qualified healthcare facilities in those locations will help with that. My final statement reflects upon the large number of nurse educators who were not aware of this bill in a timely manner. Was there a survey or other opportunities for our input? Where did this come from. Nursing should be more respected. We put in the work for our profession and we need to maintain the integrity. Thank you.
I am extremely concerned about the potential change of education requirements. There are potential ramifications they may not have been considered. Where academic nurse educators made aware of this desired change prior to this point?
As a faculty member teaching in both the graduate and undergraduate nursing education program in an accredited school of nursing, I am writing to provide comments to HB 1499. Over the past year, I have worked collaboratively with representatives from nursing education, practice, and regulation to create an actionable strategic plan to address the unprecedented nursing workforce the Commonwealth is experiencing. Yet, critical steps to address the nursing workforce shortage are visibly absent from the current legislation (HB 1499) being considered. Virginia is projected to experience a shortage of more than 20,000 registered nurses within the next ten years, and some models predict that the national nursing shortage will reach more than half a million nurses by 20301. This shortage compromises the health of all Virginians and the stability of the healthcare system in the Commonwealth. While this proposed legislation attempts to address health care provider shortages, it falls short of addressing the needs of preparing a highly educated nursing workforce to care for the increasingly complex needs of Virginians. Therefore, I ask the committee to consider specific actions to amend this bill and address the nursing workforce crisis. One key action is to allocate funds within the Virginia Health Workforce Innovation Fund to: 1. Build a sustainable and more diverse nursing workforce • Launch a Virginia Nurse Educator Academy for new academic educators, clinical instructors, and preceptors. • Prioritize debt forgiveness opportunities for contracted worktime for nurses and expand wrap around services to support nurses in school. 2. Create innovative models of nursing education and practice • Establish a designated fund to support research and development of innovative models of nursing education and practice such as the Earn While You Learn program. 3. Strengthen the Nursing Education Pathway • Establish joint academic/practice (employer) appointments to enhance nursing faculty in schools or nursing. • Standardize student onboarding processes across the Commonwealth to streamline clinical education and reduce institutional burden. 4. Engage the Nursing Workforce through Collaboration and Partnerships • Establish a Virginia Nursing Workforce Center to administer innovation funds and coordinate efforts to educate, recruit, and retain a professional nursing workforce. 5. Retain the Nursing Workforce • Develop a clearinghouse of best practices/exemplars for nursing recruitment and retention and workforce development. In conclusion, investing in nursing education and practice is the pathway to ensuring a stable healthcare system in the Commonwealth. Thank you for your consideration of these important requests. Respectfully, Theresa Gaffney, PhD, MPA, RN, CNE
As one of Virginia’s healthcare workforce educators and leaders, I am writing to support HB 1499. This bill, if passed, has the potential to significantly impact the healthcare landscape in our state and, specifically, the Rappahannock Region, which suffers from extensive health inequities and health workforce shortages. The legislation aims to develop and implement strategies to recruit and retain underrepresented minority and rural populations to join and remain in Virginia’s healthcare workforce.
I am writing to support HB 1499. Passage of this important workforce development bill could significantly allow us to expand strategies to recruit and retain healthcare professionals of all types. Specifically, it would give us the opportunity to impact underrepresented minority, and in the Southwest Virginia area, rural populations. Thank you for all you do!
HJ41 - Fentanyl crisis; Joint Commission on Health Care to study policy solutions.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
HB218 - Health insurance; health care provider panels, continuity of care.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.