Comments Document

Thank you for the opportunity to provide comments on House Bill 327 sponsored by Delegate Sullivan which directs the State Corporation Commission to apply for an extension of the existing State Innovation Waiver authorizing the Commonwealth to implement a reinsurance program. The American Lung Association supports this bill as an integral way to ensure people have access to health coverage.

My name is Cait Hebert, and I am a fertility nurse at a large fertility practice serving patients across Virginia. Every day, I care for individuals and families who are navigating the emotional, physical, and financial realities of infertility. I sit with patients when they receive devastating news about their fertility. I celebrate with them when treatments work. And too often, I watch hope disappear when cost becomes an insurmountable barrier. No patient should have to walk away from medically necessary care simply because their insurance refuses to recognize infertility as a real medical condition. One of the most difficult conversations I have with patients happens far too often. They come in with diagnostic insurance coverage. We complete their testing, identify the cause of their infertility, and can clearly outline a treatment plan that offers a real chance of success. Then they learn that their insurance does not cover the treatment itself — and the cost is simply out of reach. I’ve watched patients go from relief at finally having answers to devastation when they realize they cannot afford the care that could help them. In most other areas of medicine, when a patient receives a diagnosis, insurance typically covers medically necessary treatment. Infertility is one of the few medical conditions where diagnosis may be covered, but treatment often is not. Patients are left knowing what is wrong and what could help them — yet unable to move forward because of cost alone. Infertility treatment is not optional or elective care for the people I care for. It is medically necessary care for individuals who want the chance to build a family. Without insurance coverage, access depends almost entirely on income, not medical need. That reality leaves too many Virginians behind. House Bill 328 is important because it recognizes fertility care as part of essential health coverage. Updating Virginia’s Essential Health Benefits to include fertility treatment would mean that fewer families are forced to choose between financial stability and the chance to have a child. This bill would not erase the emotional challenges of infertility, but it would remove one of the biggest barriers patients face: affordability. It would give future patients a more equitable path forward and the opportunity to pursue care based on medical need rather than financial circumstance

Comments Document

The Alliance for Fertility Preservation (AFP) appreciates the opportunity to provide comments to the House Labor & Commerce Committee in support of HB 328, which would add important fertility benefits to Virginia’s essential health benefit (EHB) benchmark plan. The AFP is a national 501(c)(3) organization dedicated to expanding information, resources and access for patients facing potential infertility caused by cancer treatments. For several sessions, we have advocated for legislation that would add fertility preservation coverage to the EHB benchmark plan for Virginia residents at risk of medically-indicated (iatrogenic) infertility. Even though patients facing iatrogenic infertility have recognized, effective options for preserving fertility, the high cost is often a barrier. Expenses can range from several hundred dollars for sperm banking to approximately $15,000 for egg or embryo banking. Without insurance coverage, these standard treatments are unaffordable for many patients even though the costs across a population of insureds are extremely low, typically pennies per member per month. Medically necessary fertility preservation has been considered standard of care by leading medical associations for more than twenty years and the House Labor & Commerce Committee has an opportunity to ensure that eligible Virginia residents will also have access to these critical services should they ever need them. It is our hope that the Commonwealth of Virginia will join twenty-one other states, the District of Columbia, the Federal Employees Health Benefit plan and the Veterans Health Administration in enacting fertility preservation benefits. In addition, we are pleased that HB 328 would also add infertility treatment to the EHB benchmark plan. Cancer survivors who preserve their fertility will eventually need access to Assisted Reproductive Technology (ART) procedures, often including in vitro fertilization (IVF), in order to use their genetic materials for family-building. Without insurance coverage the out-of-pocket costs for these treatments can be insurmountable for most Virginians.

Comments Document

On behalf of RESOLVE: The National Infertility Association, we write in strong support of HB 328, which would include infertility treatment services as Essential Health Benefits (EHB) in Virginia’s benchmark plan starting 2029. Each year, RESOLVE supports thousands of Virginians who struggle with the disease of infertility. Many are forced to make heartbreaking financial decisions—refinancing their homes, taking on significant debt, or, most tragically, giving up their dreams of parenthood—because their insurance offers no fertility care coverage. The real cost lies not in covering infertility treatment, but in continuing to exclude it as essential health care. Without insurance coverage, fertility care is financially out of reach for most Virginians. Out-of-pocket costs can total tens of thousands of dollars, making access to care dependent almost entirely on income. For many individuals and families, whether they can build a family should not hinge on their ability to pay out of pocket for medical treatment. Including fertility care in Virginia’s EHB update is a critical step toward recognizing infertility as the disease that it is and ensuring that insurance coverage reflects the needs of today’s families. Many states have already taken steps to modernize their insurance standards to include fertility treatment, and Virginia should not fall behind. We appreciate the thoughtful work that has gone into this proposal and welcome the opportunity to work with the Committee to further refine and strengthen the language as needed. HB 328 represents a meaningful opportunity to expand access to care and reduce barriers for Virginians who are simply trying to build their families. We respectfully urge your support of HB 328 and stand ready to serve as a resource as you consider this important legislation.

Comments Document

Dear Chair Maldonado and Members of House Labor and Commerce Subcommittee #1, On behalf of the Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO), I'm pleased to submit a letter in support of HB 328 (attached). Please don't hesitate to reach out if you have any questions about cancer care; we're happy to be a resource. Best, Sarah Lanford Associate Director of State Advocacy Association for Clinical Oncology (ASCO)

I am Scott Garka, President of 501(c)3 nonprofit Richmond CultureWorks and I am writing to ask for your support of HB353. CultureWorks aims to strengthen arts and culture in the Richmond and Tri-Cities region to drive greater impact in our region. Nonprofit arts and culture represents a $329 million annual economic engine for our region supporting 6700 FTE jobs and generating $80 million in local, state, and Federal tax revenues to support schools, fire, police and other critical services. Yet many of those employed in arts and culture go without health insurance because their small nonprofit employers don't provide it and they cannot afford it themselves. This is rolling the dice for them as one car collision or illness could bankrupt them no matter how careful they are. CultureWorks has looked into creating some kind of benefits consortium to address this issue and are told at every turn that it is not legislatively possible. HB353 seems to open up that possibility so I urge you to vote in favor of the technical change. What the Bill Does HB353 proposes a targeted amendment to §38.2-3431 of the Code of Virginia that would expand the types of nonprofit entities eligible to serve as a "sponsoring association" for a benefits consortium, thereby increasing access to health benefit plans for members of qualifying associations throughout the Commonwealth. • Current Virginia law allows a sponsoring association of a benefits consortium to operate only under §501(c)(5) or §501(c)(6) of the Internal Revenue Code. • HB353 adds §501(c)(3) to the list, allowing charitable nonprofit organizations to serve as sponsoring associations for benefits consortiums. • As a result, nonprofits with charitable missions would be eligible to operate benefits consortiums for their members. Why It Matters 1. Expands Access to Health Benefits Allowing 501(c)(3) organizations into the consortium space could extend group health plan opportunities to thousands of nonprofit employees who often lack access to affordable coverage options. Charitable organizations, particularly small and mid-sized ones, frequently struggle to offer competitive benefits because of limited bargaining power in the insurance market. This impacts their ability to retain their staff and provides essential services to the community. 2. Supports the Nonprofit Workforce Virginia's nonprofit sector is a major employer. Enlarging consortium eligibility could help stabilize recruitment and retention by making it easier for nonprofits to pool risk and reduce premiums. HB353 is a technical change with significant implications for nonprofit workers' access to affordable health benefits. By expanding eligibility to 501(c)(3) organizations, the Commonwealth would enable more nonprofits to band together to provide health coverage, strengthening Virginia's service-providing infrastructure and workforce resilience.

My name is Antoine Williams. I'm Managing Director of AVANTKOFA and former Housing Program Manager for the City of Charlottesville. I support HB 353's intent to expand sponsoring association pathways for health benefit plans. Small nonprofits carry weight that would otherwise fall to the public sector—housing services, workforce development, community health, emergency assistance. But these organizations often can't access the group benefits market that larger employers take for granted. Without market access, they can't offer competitive benefits. Without competitive benefits, they struggle to recruit and retain the talent the work demands. The sector weakens, and communities lose capacity. HB 353 addresses this gap by allowing nonprofits, faith-based organizations, and trade associations to band together as sponsoring associations—creating the market access that individual small operators cannot achieve alone. I encourage the Committee to consider: 1. Clarifying the five-year existence requirement for newly formed associations serving emerging workforce sectors 2. Ensuring accessibility for small nonprofits and faith-based organizations already anchoring Virginia's communities Thank you.

My name is Antoine Williams. I'm the Managing Director of AVANTKOFA and a former Housing Program Manager for the City of Charlottesville. I support HB 353's intent to expand sponsoring association pathways for health benefit plans. In my research on workforce stability, I've identified what I call the "Benefits Trap"—where skilled professionals remain in misaligned positions because decoupling health coverage from employment is financially prohibitive. This is particularly acute for essential workers in housing, public safety, and municipal government. HB 353 creates infrastructure for portable benefits through sponsoring associations. This aligns with broader workforce resilience goals. I encourage the Committee to consider: 1. Clarifying the five-year existence requirement for newly formed associations serving emerging workforce sectors 2. Ensuring accessibility for small nonprofits and faith-based organizations already serving essential workers Thank you.

Thank you for this opportunity. I am the retired CEO of an area agency on aging, and currently on a non-profit hospice board, and chair of the Center for Non-Profit Excellence (CNE) board. I speak from experience when I emphasize the importance of quality and affordable health care plays in recruiting and retaining great staff. This has become even more important as the marketplace affordability is questionable. Being able to allow a charitable nonprofit organization {}501(c)(3) to serve as a sponsoring association for benefits consortium extends group health plan opportunities to thousands of nonprofit employees who often lack access to affordable coverage options. Charitable organizations, particularly small and mid-sized, frequently struggle to offer competititve benefits because of limited bargaining power in the insurance market. This would allow nonprofits to pool risk and reduce premiums. Nonprofits provide necessary services to help the most vulnearable in our communities, as well as being a major employer. This makes good business sense and humanitarian support. This is a technical change with significant implications and yet no cost to the Commonwealth. Please help us support recruiting and retaining quality staff, and provide affordable healthcare to many more who need it, through a clear solution. I appreciate your support, Marta M. Keane

Chair and members of the committee, thank you for the opportunity to speak today. My name is Dr. Mariane Asad Doyle, and I serve as CEO of the Center for Nonprofit Excellence, representing more than 1,000 nonprofits across Virginia. Nonprofits are essential employers in every community — providing healthcare, childcare, housing, food access, and disaster response — yet they face one of the biggest workforce challenges: the rising cost of health insurance. Many small and mid-sized nonprofits simply cannot compete with larger employers, leading to staff turnover, burnout, and service disruption. HB353 is a practical, market-based solution. It allows nonprofits to pool together to access more affordable, stable group health plans — just as chambers of commerce and other membership organizations already do. This bill does not create a new mandate or cost to the state. It simply gives nonprofits a tool to better support their workforce. When nonprofit employees are healthy and retained, communities are stronger and services are more reliable. On behalf of Virginia’s nonprofit sector and the people we serve every day, I urge you to support HB353. Thank you.

I am writing in support of HB353. Nonprofit organizations in Virginia provide critical services to meet the basic needs of Virginians and would be unable to operate without the dedicate of nonprofit professionals. Nonprofit professionals are some of the most talented, authentic, and dedicated individuals in Virginia. Often, a job or a career in the nonprofit space means less pay, fewer benefits, and more uncertainty compared to the private sector, despite the fact that nonprofits are doing the work to keep people alive through a time of increasing difficulty and crisis. Now is the time to act and open avenues for a stronger nonprofit workforce and this bill would create a pathways to better, less expensive health benefit plans for nonprofit professionals.

I currently work in the nonprofit sector serving a community I grew up in and care deeply about. Working in nonprofit does not come with large salaries when compared to corporate or private-sector jobs. Instead, many of us choose this path because of our passion for the mission of the organization and the people we serve. For me, the opportunity to give back to my community and make a meaningful impact outweighs the appeal of a six-figure salary in a role I may not feel as connected to. Access to affordable health-care benefits within the nonprofit sector would be a major incentive for professionals like me to choose — and remain in — nonprofit work. Competitive benefits matter, not because nonprofit employees expect more, but because they allow us to build sustainable careers while continuing to serve others. Without access to viable health insurance options, nonprofits risk losing dedicated, mission-driven staff to higher-paying sectors simply because of basic benefit needs. In my experience, nonprofits prioritize their employees and volunteers by supporting work/life balance. There is flexibility, trust, and an understanding that personal well-being matters. I have not encountered micromanagement or unnecessary barriers to taking time off when it is needed. While I have only been in the nonprofit sector for just under a year, it is a space where I can genuinely see myself building a long-term career — provided that the fundamentals, like health coverage, are attainable. House Bill 353 offers a practical and important solution. It does not create a new state program, require state funding, or mandate participation. Instead, it makes a technical change in Virginia law that would expand eligibility for nonprofit-led health benefits consortiums. This would allow charitable nonprofits to collaborate on affordable coverage options for their staff, strengthening recruitment, retention, and long-term organizational sustainability. Nonprofits are employers just like businesses. They compete for talent, manage payroll, and provide essential services to communities across the Commonwealth — especially in rural and underserved areas where nonprofits are often among the largest employers. Access to group health insurance through trusted, nonprofit-serving consortiums would help stabilize the workforce and ensure continuity of vital services. With rising healthcare costs placing increasing strain on nonprofit budgets and contributing to staff turnover, House Bill 353 is needed now. It recognizes the reality of nonprofit employment and provides a flexible tool to help nonprofits remain competitive, without imposing new mandates. I strongly urge support for House Bill 353 and appreciate the opportunity to share my perspective as someone committed to nonprofit work and community service in Virginia

This bill matters because it expands access to health benefits. Allowing 501(c)(3) organizations into the consortium space could extend group health plan opportunities to thousands of nonprofit employees who often lack access to affordable coverage options. Charitable organizations, particularly small and mid-sized ones, frequently struggle to offer competitive benefits because of limited bargaining power in the insurance market. This impacts their ability to retain their staff and provides essential services to the community. This bill also supports the nonprofit workforce her in Virginia. Virginia's nonprofit sector is a major employer. Enlarging consortium eligibility could help stabilize recruitment and retention by making it easier for nonprofits to pool risk and reduce premiums

Good afternoon, I am writing in strong support of HB 353 and to urge its passage. I work in nonprofit operations in an HR role, where recruiting and retaining qualified staff is increasingly difficult, not because of lack of mission commitment, but because many charitable nonprofits simply cannot offer affordable, competitive health benefits. For small and mid-sized 501(c)(3) organizations, limited bargaining power in the insurance market often results in higher premiums, fewer plan options, or no viable coverage at all. HB 353 addresses this challenge through a practical, targeted amendment to Virginia law. By allowing 501(c)(3) organizations to serve as sponsoring associations for benefits consortiums, the bill would enable charitable nonprofits to pool risk, leverage collective purchasing power, and expand access to group health plans for nonprofit workers across the Commonwealth. This change is especially important for organizations that provide essential services, often under state contracts or grant funding that does not adequately account for rising benefit costs. When nonprofits are unable to offer sustainable health coverage, the consequences are real: higher staff turnover, difficulty filling vacant positions, and increased strain on the very systems that serve Virginia’s most vulnerable populations. HB 353 is not a mandate or an expansion of government programs. It is a technical correction that modernizes the Code of Virginia to reflect the realities of today’s nonprofit workforce. By including charitable nonprofits alongside existing eligible associations, the General Assembly would be supporting workforce stability, operational sustainability, and continuity of services in communities statewide. In short, this bill strengthens nonprofits’ ability to care for the people who care for Virginia. I respectfully ask you to support HB 353. Thank you for your consideration and for your commitment to Virginia’s nonprofit sector. Katherine King

Please, please support our struggle to support health care - especially during this difficult time! Thank You.

Please vote YES for HB353. I am in support of the HB353 for small businesses, nonprofit organizations, and other entities that will benefit small group plans. With the challenges many are facing with the rising costs of healthcare, there should be affordable healthcare group insurances, products, and program resources to serve this population. Thank you,

In regions like Southside Virginia, nonprofits are often among the largest employers and essential service providers—especially in rural and underserved communities. Organizations like the Dan River Nonprofit Network support hundreds of nonprofits delivering critical services—from healthcare and workforce development to food security and education. HB353 would help these organizations compete for talent, retain experienced staff, and continue delivering these vital services by making affordable group health insurance more accessible. Many small and mid-sized nonprofits struggle to offer competitive health benefits because of rising costs and limited bargaining power. HB353 allows nonprofits to join group-facilitated health plans, creating economies of scale and more affordable options for employees who provide essential community services. Affordable, competitive health insurance is directly tied to recruitment, retention, workforce stability, and organizational sustainability. HB353 supports the people delivering critical services in every region of the Commonwealth. This bill builds on existing, trusted infrastructure. Sector capacity-building organizations—like the one I work for and organizations we partner with—already serve as trusted conveners and partners for nonprofits. Allowing these organizations to facilitate group health insurance aligns with the original intent of the law and leverages proven networks—without creating new state programs. Why is this needed now? Honestly, it has been needed for over a decade. When the Dan River Nonprofit Network formed in 2013, our community identified healthcare costs as a major barrier—for both nonprofit employees and organizations trying to recruit and retain talent. Over the years, we’ve tried to provide short-term solutions, like facilitating discounted health agreements with local FQHCs, but these “band-aid” approaches can’t solve the systemic problem. Rising healthcare costs continue to strain budgets and drive staff turnover. HB353 offers a practical, timely tool to help nonprofits remain competitive and continue serving our communities.

As the founder and executive director of Babybuns For Life Network, Inc., a Virginia-based nonprofit serving families with babies in neonatal intensive care units (NICUs), I strongly support HB 353. Babybuns For Life Network is currently a volunteer-led organization with no paid staff and no employer-sponsored health or life insurance benefits for board members. While this structure has allowed us to maximize limited resources and directly serve families in crisis, it also presents challenges as we plan for long-term sustainability, growth, and organizational stability. As our nonprofit continues to expand its reach and impact, the ability to eventually recruit and retain qualified staff will be critical. Access to affordable, consortium-based health benefits would be a key factor in making future paid positions feasible and responsible. HB 353 creates an important pathway for small and emerging nonprofits like ours to plan ahead and build capacity without being priced out of offering benefits. Through our partnership with the Center for Nonprofit Excellence (CNE), Babybuns For Life Network has benefited from collaborative support, strategic planning, and responsible stewardship of funds. HB 353 aligns with the cooperative model that CNE promotes—allowing nonprofits to leverage shared resources to strengthen operations while remaining mission-focused. Supporting HB 353 is an investment in the future of Virginia’s nonprofit sector. Even volunteer-driven organizations need policies that support sustainable growth and workforce development. This bill would help ensure that when nonprofits are ready to take the next step, access to affordable health coverage is not a barrier. I respectfully urge legislators to support HB 353 and consider its long-term impact on nonprofits serving vulnerable populations across the Commonwealth.

I am writing to encourage your support of HB 353 to expand the types of nonprofit entities eligible to serve as a sponsoring association for a benefits consortium. As a longtime nonprofit employee and director, I've seen firsthand how difficult it is for small 501(c)(3) organizations to provide health insurance coverage to employees. In this difficult time where government cutbacks have led to drastic cuts in essential human services, nonprofits have become the backbone of our social support system. To do their work nonprofits need to keep talented employees, but if they can't offer healthcare benefits they often lose talented candidates to large employers and corporations. For four years, I served as an executive director for a nonprofit that ran a sober-living home for women. During that time, I saw how difficult it was to serve women in need of safe, supported living without providing healthcare benefits to our employees. It simply wasn't tenable to purchase insurance for an organization with 3 staff members and employees simply can't afford the high prices on the insurance marketplaces without assistance, so good job candidates often opted to work for larger employers. I hope you will support this legislation and help ease the burden that unaffordable and unattainable health insurance is placing on our essential nonprofit organizations -- and show your support for individuals who want to do meaningful work to help their communities, especially as the government is opting out of doing that work itself.

As organizations dedicated to caring for others, we are increasingly constrained by the astronomical cost of health care, which makes it difficult to provide even basic coverage for our own staff. This undermines our ability to live our missions and uphold core values of respect, dignity, health, and well-being. No organization serving the public good should be forced to choose between sustaining its work and ensuring access to essential health care for the people who make that work possible. We urge your support for this bill so that mission-driven organizations can offer meaningful health coverage, strengthen their workforce, and continue serving our communities with integrity and care.

As a member of the governing board of three non-profit organizations, and as an employee of another non-profit organization, I am painfully aware of the difficulty of providing health insurance coverage to such organizations' employees. The passage of HB 353 would allow such organizations to partner with each other and compete in the insurance marketplace. Particularly in a time when federal subsidy support for ACA plans has been compromised, this is a common sense, market based piece of legislation to allow our employees to be cared for as we care for our communities. Please support this needed legislation

By expanding eligibility to 501(c)(3) organizations, the Commonwealth would enable more nonprofits to band together to provide health coverage, strengthening Virginia's service-providing infrastructure and workforce resilience. Thank you.

Dear Members of the Committee, Thank you for the opportunity to submit written public comment on HB 353, a bill that would expand eligibility for nonprofit organizations to form health benefits consortiums in Virginia. I write in strong support of this legislation. HB 353 proposes a targeted amendment to §38.2‑3431 of the Code of Virginia, adding 501(c)(3) charitable organizations to the types of nonprofits permitted to serve as a “sponsoring association” for a benefits consortium. Under current law, only 501(c)(5) and 501(c)(6) organizations may do so. Expanding eligibility to include 501(c)(3) organizations would open the door for thousands of nonprofit workers to gain access to more affordable and competitive health coverage options. Many nonprofits - especially small and mid‑sized organizations - struggle to offer robust health benefits because they lack bargaining power in the insurance market. Allowing charitable organizations to participate in benefits consortiums would enable them to pool risk, reduce premiums, and strengthen their ability to recruit and retain staff, ultimately stabilizing the nonprofit workforce that provides critical services in communities across the Commonwealth. This is a technical change, but one with significant real‑world impact. By expanding consortium eligibility, the General Assembly would empower more nonprofits to offer health coverage and ensure that those who dedicate their careers to serving Virginia’s communities have access to the benefits they need and deserve. For these reasons, I respectfully urge you to support HB 353. Thank you for your consideration and for your commitment to the wellbeing of Virginia’s nonprofit workforce. Sincerely, ~Mark Deutsch

Nickel and diming people’s healthcare is dangerous. It gets in the way of real people receiving the care and medicine that they need to live their lives. As a Type 1 diabetic, I don't want a company’s profit motive standing in the way of care I need, care I still have to pay for. Our legislators should pass laws that guarantee people are able to get the care that they need, when they need it, without a for-profit entity standing between them and their care. Pass these bills.

Health insurance carriers further limiting in network services is ridiculous. I support this bill and doctors choosing the best services for their patients.

Allowing health insurance to deny referrals from in-network carriers is an overreach, and should be left in the hands of the actual medical professionals.

It’s bad enough that insurers restrict patients and providers to in-network labs and testing facilities to begin with. It is even worse when they put restrictions on their restrictions and force all testing to go through centralized national laboratories when local labs can process results more quickly. These processing delays can have harmful and even fatal consequences, and serve no purpose other than consolidating corporate profit. Please support this legislation and give doctors and patients the freedom to choose the in-network services that are best for them.

Only if the Subcommittee has questions.

Comments Document

VSAP's technical comments are in the attached letter.

None of this helps affordability or the regular consumer.

My husband and I are residents at Cedarfield CCRC in Henrico County. I am writing in support of VaCCRA's efforts in the VA General Assembly (HB476, SB358) which would improve CCRC resident/management communications by requiring that the CEO and board member from management be present and participate in at least two of the four quarterly meetings with residents currently required by law instead of sending a "designated representative." We have a significant investment in our community, and want it to not only survive but also thrive. We believe that more quality high-level communication and dialogue is vital to a healthy community, and we want to hear directly from our community Executive Directors at least twice a year.

I write in support of HB476. Good communication between CEO's, board members and residents of CRCCs is essential. Having resident representation on the governing board not only ensures transparency, it also creates trust and a good relationship between management and residents. Such representation benefits management in that is kept informed about day -to- day quality of care received, delivery of services by staff, emerging resident concerns, etc. and provides input for creating policy and decision-making. Likewise, regular information sessions between CEO's, boards and residents keeps residents informed about a facility's financial health and stability, pending board decisions, staffing changes, etc. shows residents that they are stakeholders and have a voice in this important enterprise. Having resident represented on the CRCC board is important and serves both management and residents. Regular information session between CEO's and residents ensures clear communication and reduces resident anxiety and rumor.

I am a resident of Cedarfield. I find it puzzling as to why our parent company, Pinnacle, does not meet with the residents of this community. We are the “customers” and could give them vital feedback and information that would help them in so many ways. After all, they are not seniors! What could be more important for a business than knowing their customer? At the least,, Quarterly meetings with residents are essential! I urge the passing of this bill

My name is Kay Sommers, and I have been a resident at Cedarfield in Henrico for the past two years. I feel that the CEO and at least one board member of Pinnacle, which is Cedarfield’s management organization, need to be more cooperative with the Cedarfield residents who wish to have opportunities for good two-way communications. Cedarfield residents have paid a significant entrance fee and continue to pay a significant monthly maintenance fee. With those kinds of investments, it makes perfect sense that the residents are entitled to a few participatory meetings with the organization that manages the facility. Please support HB476 that will stipulate more meaningful meetings with residents.

I am a resident of Cedarfield Continuing Care Community, located in Henrico County. i am president of VaCCRA at Cedarfield (average of 220 members), one of the many continuing care communities in Virginia that are also member of the Virginia Continuing Care Residents Association ("VaCCRA"). Cedarfield is a wonderful place to live. Its residents and staff work diligently to make Cedarfield better and better. Communication from Pinnacle Living and its Cedarfield designees, that manage Cedarfield and importantly its finances, have to be improved, however. The passage of HB 476 will solve some of the communication problems. The Virginia Senate just passed (1/30) a similar bill SB358. While I strongly support the passage of HB476, I would also support SB358 as a substitute. Both bills require stronger and more reliable communication between Virginia's CCRC's, its thousands of residents and Pinnacle/Cedarfield. Cedarfield residents are highly educated and accomplished citizens, who are also highly invested financially in Pinnacle/Cedarfield. Cedarfield residents deserve free and accurate discussion of issues that relate to Cedarfield, including "income, expenditures, and financial matters as they apply to the facility and proposed changes in policies, programs, facilities, and services." See, Section 38.2-4910.B. Pinnacle/Cedarfield's management has not always been in compliance with the enacted Section 38.2-4910.B. Its "town hall" monthly meetings have mostly not allowed "free discussion," Cedarfield residents most often have not been allowed to ask questions from the floor. Cedarfield residents were allowed after the adjourned meeting to find an appropriate staff member and ask questions. These staff members, after the meeting, "hung out" against our meeting room walls, waiting for a resident to address a question to him. Obviously the full body of residents, during the convened meeting, missed out on all the open discussion, which would, in part, draw more questions from residents. This failure of Pinnacle/Cedarfield to recognize that free discussion is required is systemic of its general failure to communicate with its residents. Speakers are often not prepared; their reports spotty, of little significance and of little interest. Cedarfield's residents are not generally happy with these failed communication efforts. Pinnacle's CEO has not spoken at any monthly Town Hall meetings this last fiscal year. There is no substitute for the CEO conducting a thorough and free discussion with Cedarfield residents. (Board Members never interact with residents, as dictated by Pinnacle's CEO.) All the CEO's knowledge cannot and is not understandably transferred to Cedarfield's executive director and other staff members. One example, during this last fiscal year, of a failed attempt to present financial matters to Cedarfield, involved two seasoned, Pinnacle/Cedarfield business office/financial directors. They had no power points, and no written handouts were made available to the residents at the meeting period. Their presentation consisted of reading off complex combinations and numbers and dollar amounts. Their oral report was presented in rat-a-tat fashion, which was impossible to follow. Communication is a goal of HB476. It requires adequate and open communication between Pinnacle/Cedarfield management and Cedarfield residents. All of Virginia's many CCRCs will be served.

My name is Charlie Finley, and my wife and I have lived for six years at Lakewood, a Continuing Care Residents Community (CCRC) in Henrico County. Typically, the entry fee for a CCRC can range up to $500,000 and more, depending on the size of the selected apartment. The monthly rental fees my wife and I pay are now more than $7000. According to the contracts we must sign, we do not own anything. There are some 51 CCRCs in Virginia. As individual members of VaCCRA (Virginia Continuing Care Residents Association) our concern is the increasing number of CCRCs suffering financial stress, mismanagement, or even going bankrupt, potentially leaving the residents “high and dry." A recent one, Aldersgate, outside of Charlotte, NC enjoyed very favorable publicity for three years in the Charlotte Observer, and received awards for its outstanding management. Then it went bankrupt. To this day we do not know how, or if, the residents were treated financially, but their "nest eggs” were potentially in jeopardy. Another sterling example of mismanagement is Friendship House with 885 units, just outside of Chicago. There are more examples, at least indicating the need for residents to be on the board of directors (not included in HB476). HB476 would provide some partial protection to prevent the residents being caught by surprise. House Bill 476 calls for the CEO and at least one board member to visit in person and be open to all residents at the CCRC under their management at least twice a year and be very open and transparent about their facility’s financials, days' operating income, and net worth, etc. If the CEOs and boards in Virginia are already fulfilling this minimal obligation, they have no reason to oppose HB476. Most of us at Lakewood believe this is not too much to ask. You will hear all kinds of arguments indicating this degree of transparency is not needed, that we residents are not qualified to evaluate or understand this financial information, and that we just need to trust the “management.” I would point out that many of our residents have run their own businesses, been appointed by governors, transition teams and task forces, etc. and are quite savvy. Let the 16 CCRC bankruptcies since 2020 speak for themselves. Another partial remedy to the seclusion of understandable financial reports by managements is the recently published book by AARP, Disrupting the Status Quo of Senior Living. No legislation is proposed by the author, rather an adjustment in attitude . . . to view residents as members of a community instead of only numbers of just renters or clients. It is also a clarion call to have residents serving, with voting rights, on the boards of directors (hopefully in the future). We thank each one of you for favorably considering this very modest bill, HB476. You will help some of the 900,000 of us nationwide rest a bit easier. We cannot see where there is any cost to the Commonwealth for the passage of HB476. Sincerely, Charlie Finley 1900 Lauderdale Drive Lakewood, CH 202 Richmond, VA 23238 804-521-9611 charfinley@mindspring.com

Re: HB476 (Watts) relating to quarterly meeting requirements of Continuing Care Providers Madam Chairman and members of the House Commerce and Labor Subcommittee #1; I am a resident of Lakewood, a CCRC (continuing care retirement community) in Henrico County(a LifeSpire community.) I am a member of Virginia Continuing Care Residents Association (VaCCRA), a statewide educational and advocacy organization with a mission to promote, protect, empower and better the lives of residents of CCRCs in the Commonwealth of Virginia. Please favorably consider HB476, which simply requires trustees and management to take a few hours of time per year to interact directly with residents who have expended a considerable sum in entrance fees (downpayment) and monthly service fees (rent) to live in Virginia CCRCs. Thank you for your consideration, M. Heltzer 1960 Lauserdale Drive; Apt. 101 Henrico, VA 23238

HOUSE BILL NO. 476 I strongly support passage of a strengthened version of House Bill 476. ALL quarterly meetings should be open to ALL residents, not just two meetings. At least one board member, and the CEO or other high-level official of the provider, should be required to participate in at least two quarterly meetings that are open to all residents (participation in all open meetings would be better). Residents should be entitled to at least one voting member with rights of full participation on the board of any provider operating in Virginia. If residents of CCRCs are not given reasonable and sufficient representation and participation rights in their communities, the CCRC providers should be required to offer full or substantial (90%) refunds of buy-in costs throughout the life of the contract at no additional cost to residents. CCRC contracts are contracts of adhesion, or standardized take-it-or-leave-it contracts, representing potentially unfair and/or oppressive relationships between one party with vastly superior bargaining power and a much weaker consumer party with no real power to negotiate. They should be much more closely regulated, as are similar contracts, such as insurance or public utility services (CCRCs are becoming more like classic public utilities every day, and will continue to do so as our population ages). House Bill 476, even strengthened as suggested above, would be only a modest step in the right direction of proper regulation of this increasingly essential service business; but, in the spirit of "better than nothing," the bill should be passed. Contracts of adhesion are generally, but not always, valid and enforceable. They may not be enforced if deemed unconscionably unfair, or extremely one-sided or oppressive to the weaker party. Improvements in CCRC regulation such as House Bill 476 can help to mitigate the imbalance in current CCRC contracts of adhesion, and so the bill should be strengthened and passed.

As a resident of a CCRC, I support this legislation and strongly urge it be strengthened to ensure that residents have a meaningful voice in how their CCRC is managed and positioned for the future. Unlike the typical relationship between a business and its customers, a very significant power differential exists between residents and CCRC senior management/Board of Directors. Once residents "buy in" to a CCRC, they become captive customers and investors (unless they are willing to lose what may be their life savings by moving out of the community, since entrance fees are largely non-refundable). Some CCRC providers now seem to be using the current long wait-lists for moving in to their communities (fueled by the baby boomer demographic wave) to further exacerbate this power imbalance, basically telling current residents who ask for more transparent and regular dialogue with leaders of the organization to leave if they don't like the way things are being done "because our CCRC can easily find a new resident to take your place." Given this unusual business model, why are CCRCs so loosely monitored and regulated compared to other contractual relationships and investments? (See comments on this legislation from Mr. Kanter of Arlington.) While some CCRCs value and benefit from resident engagement and ongoing dialogue between the Board of Directors/senior management and residents, some do not. Thus, it is important that the proposed legislation be strengthened to require (a) a meaningful resident presence on the Board of Directors, including voting rights; and (b) quarterly meetings between the senior management AND at least several members of the Board of Directors AND all interested residents.

I support passage of this bill HB476. I live in a CCRC. As a resident I cannot communicate directly with the CCRC board. Residents of a CCRC provide the financial base for its operation, we are the investors. As investors residents must be able to meet and participate in board meetings.

I write in support of the Watts bill regarding the requirement that CEO and/or Board level management to speak with all CCRC residents at least twice yearly about matters that are important to their lives and resources. We are citizens of the community that they have been hired to manage. We have no vote in selection of this management. I would love to agree with LeadingAge VA that new regulations are not needed, but unfortunately, we all know that business too often looks to its own needs rather than to the common good. Look at polluting businesses as a current example. This regulation is onerous only to those managements that do not currently operate with respect for their residents. I am lucky enough to live at Goodwin House Bailey's Crossroads where the CEO meets with all interested residents monthly in a public forum -- with no agenda, simply to answer our questions. We have two meetings a year with the CEO and the chair of the Board of Trustees. Our CFO meets quarterly with our resident Finance Committee and annually with all residents. Our current management does not need the regulation. But our next CEO or Board Chair or CFO may. Clearly, the management of many -perhaps most- of the Virginia CCRCs DO need this. They do not meet with their residents, and appear not to consider that they are only half of the community, that the other half can be ignored. At least one ED posts a sign on the door that reads "Staff Only." I wish I could agree that regulation of independent living communities does not need regulation, but you only have to talk to CCRC residents all around Virginia to know that is not the case. Upper management too often fails to respect those who pay the bills. Thank you Vivian Watts for understanding that and for listening to us.

Re: HB476 (Watts) relating to quarterly meeting requirements of Continuing Care Providers Madam Chairman and members of the House Commerce and Labor Subcommittee #1; I am a resident of Lakewood, a CCRC (continuing care retirement community) in Henrico County(a LifeSpire community.) I am a member of Virginia Continuing Care Residents Association (VaCCRA), a statewide educational and advocacy organization with a mission to promote, protect, empower and better the lives of residents of CCRCs in the Commonwealth of Virginia. Please favorably consider HB476, which simply requires trustees and management to take a few hours of time per year to interact directly with residents who have expended a considerable sum in entrance fees (downpayment) and monthly service fees (rent) to live in Virginia CCRCs. Thank you for your consideration, Glen Scott 1900 Lauderdale Dr. A-215 Henrico, VA 23238

I am a 12-year resident of a CCRC and token resident representation (non-voting) on the Board of Trustees was granted in the past, only to be rescinded. I urge the committee to favorably support HB476 with an amendment to require that one resident should be allowed to attend all meetings as a voting member (not as a guest attendee as the bill currently states).

As residents of a CCRC, my wife and I wish to see this bill amended to require that one resident should be allowed to attend all meetings as a voting member (not as a guest attendee as the bill currently states.)

I am a soon-to-be retired Physician Scientist, formerly Professor of Internal Medicine at UC-Davis, and long-time developers of pharmaceutical agents. My wife and I have lived in a CCRC based in Central Virginia for 5+ years and find ourselves in the same situation as many who have commented before: i.e. Our Board of Trustees are making significant decisions, which can dramatically affect residents' lives, without allowing for residents to have any meaningful input other than through the CEO, which functionally excludes any direct resident voice in these decisions This is really unacceptable, after all, as residents of CCRC’s are the ones who provide the financial resources to operate them. I urge the Committee to acknowledge the value of House Bill HB476 to improve CCRC resident’s voice in decisions that greatly affect their lives by passing it.

I am a retired registered nurse and a resident of a CCRC in Charlottesville. Having served on a nonprofit board in the past where our training was very clear that it was essential to interact meaningfully with the stakeholders in order for our evaluation of the CEO’s performance to be valid, I was shocked to learn that it was the CEO who serves as the Board representative and there is a virtual wall between Board members and Residents (stakeholders) who financially support the CCRC. I urge the committee to act favorably on House Bill HB476.

I am a retired Associate Professor of Internal Medicine and Geriatrics, a board member of the Virginia and the National Continuing Care Residents Associations, and the secretary of the Government Relations Committee. CCRCs are not provided the protections and oversight afforded to nursing homes and assisted living. In CCRCs, we depend on management's (administration's) willingness to work with us, share information, and include us in their planning. Most of us didn't realize the magnitude of the chasm between management and residents when we signed admission contracts. We assumed that the leadership would be honest and open with us. My CCRC invested in a home health company that failed, resulting in a loss of over $20 million since 2018. They have never discussed it with us, their residents. We do, after all, turn over our life savings with the promise of responsible care, communication, and power-sharing. We view ourselves as the stakeholders. Instead, they assume we have given them our money to manage, all without telling us. Most of us have enjoyed successful careers and mature employment. We have the background to be competent partners in a shared enterprise. Our community of independent living residents still views communications as inadequate. There is a real need for a board member to come face-to-face with the broader community of residents.

Comments Document

Evelyn “Penny” Jez, Ph.D. Re: HB476 Madam Chair and Members of the Sub-Committee: My name is Penny Jez. I have been President of the Virginia Continuing Care Residents Association (known as VaCCRA) for five years. I also serve on the Board of Directors of The National Continuing Care Residents Association (Known as NACCRA). I have been a resident of Covenant Woods, a CCRC in Mechanicsville, for 11 years. VaCCRA is an education and advocacy membership association with nearly 25 years of service supporting more than 3,000 Virginians living in Continuing Care Retirement Communities (CCRCs). I will speak today in support of HB 476 (Watts). CCRCs are retirement communities that include three levels of care: independent living in apartments; assisted living; and nursing home care. Choosing a CCRC enables a retiree to move to higher levels of care in the same community as their health declines. Residents make a substantial financial investment of life savings to enter these facilities and pay a hefty monthly fee to retain residency. When CCRC legislation was created in the 1980s, the General Assembly wisely spelled out five residents’ rights in the Code (38.2.-4910.B). Those rights stipulated that the board of directors, its designated representative, or other such governing body hold quarterly meetings with residents or representatives elected by residents for the purpose of free discussion of issues related to the facility, including income, expenditures, and facility matters as they apply to the facility and proposed changes in policies, programs, facilities and services. Most recently, however, our members have reported increasingly alarming instances of noncompliance with contracts and violations of Residents’ Rights as specified in the Code. For example, residents in Virginia’s CCRCs have reported that facilities have failed to hold quarterly meetings with residents, have prevented residents from distributing information regarding residents’ rights to self-organization,and have failed to assign an appropriate officer--a CEO or CFO-- to address residents' concerns about the financial status of their CCRCs in these quarterly meetings. As such, residents' concerns remain unanswered in an appropriate public forum. Since 2020, 16 CCRCs have filed for bankruptcy among the nation’s nearly 2,000 CCRCs. No matter the percentage of loss to the entire number, the real loss is to residents who have paid their life savings into these CCRCs. The difficulties residents face in recovering their lost assets are textbook cases now in elder law among colleges and universities. House Bill 476 would address the need for improved communication between residents and management in Virgina’s CCRCs. VaCCRA strongly supports this legislation. Thank you for the privilege of your time.

I reside at a CCRC in Charlottesville. My situation is similar to others who have commented on this bill. While we do have a Board of Trustees, the system in place has all meaningful communications from residents to the Board running through the CEO. Our Town Halls, (6 per year on average), have the CEO , as the representative of the Board of Trustees , in attendance. There is no opportunity for residents to meet with the Trustees concerning governance issues. The Trustees make significant decisions which can dramatically affect the residents' lives. They make the decisions without allowing for residents' meaningful input other than through the CEO.. In effect, the independent living residents have no one who can be a meaningful advocate for the people who provide the financial resources to operate this CCRC. I don't expect that my input would necessarily change some decisions, but the concerns of the residents should at least have a venue for being heard. The proposed changes to 38.2-4910 will address this concern. I would urge the committee to act favorably on House Bill HB476.

Madam Chair and members of the Labor and Commerce Sub Committee #1: My name is Barbara Rose. I have been a resident of a Continuing Care Retirement Community (CCRC) in Henrico County for 8 ½ years. I am also a member of the Virginia Continuing Care Residents Association (VaCCRA), an education and advocacy group for residents of CCRCs. I am writing to ask for your support of HB476 . This is an important issue to the elderly in the nearly 50 CCRCs in Virginia. CCRCs offer independent living, assisted living and health care services for a large sum of money, somewhat in the nature of long-term health insurance. I learned of resident concerns about inadequate communication and reporting on important matters (e.g. strategic plans and financial information) when no Board member or CEO participates in the quarterly meetings from both residents at my CCRC and working on a VaCCRA survey . What was happening? Instead of a Board member, a “designated representative” was appointed as allowed by the existing law, often the Executive Director of the facility. This person is (i)not part of the Board, (ii) has incomplete knowledge of the Board’s planning and financial information so residents’ questions went unanswered and (iii) as an employee of the Board a conflict of interests may arise. HB476 addresses these resident concerns by: 1. Requiring that the CEO and a Board member (or other governor body) participate in two of the quarterly meetings per year 2. Requiring that at least two of the required quarterly meetings must be open to all residents 3. Result (CEO and Board member participate): the CEO and Board member attending gain first-hand knowledge of residents’ concerns, and also can learn about staff and the condition of the facility 4. Result (meet with all residents): Having the two meetings open to all residents builds trust and provides an efficient way to get important information to all residents and stop rumors Again, I ask your favorable support of the modest proposal in HB476. It is a win-win for all parties with the opportunity for direct communications flowing from key leadership to residents and from residents to key leadership. Sincerely, Barbara Rose 2300 Cedarfield Pkwy, Apt. 451 Henrico, VA 23233 jandbrose@comcast.net

I am Martha Cole Glenn, Vice President of the Virginia Continuing Care Residents Association (VaCCRA), the only statewide association representing seniors who live in continuing care communities. After a career in Washington on Capitol Hill and as a lobbyist in Washington I returned to Richmond and live at Cedarfield, a CCRC in Henrico County. I appreciate the opportunity to comment on HB476 and am among those who know how hard you work because I was once a Legislative Assistant. As confirmed by a survey conducted by VaCCRA's Government Relations Committee many of the members of VaCCRA who are CCRC residents continue to be frustrated by the "communications " gap between their CEOs and board members and the residents they manage. The best example of good communications is in Goodwin Living where the residents are represented on the board and the CEO holds monthly "fireside chats"with residents. But residents of other facilities do not enjoy this kind if relationship. Not only are they often not represented on boards, as a group they have little or no opportunity to converse with top management and are not even allowed see the bylaws! Current law requires that the "board of directors, its designated representative or other such governing body" shall hold quarterly meetings with residents. THE PROBLEM IS THE WORDS 'DESIGNATED REPRESENTATIVE. " This role is often filled by the executive director who, while competent and well-intentioned, often does not have the body of knowledge to respond to some financial and strategic planning questions. Yes, there are resident committees that have meetings with top management. But we dont' think it is too much to ask that the CEO and a board member take a few hours to participate in TWO OF THE FOUR required meetings a year! There are no transparency or confidentiality issues here -- only time. That is all that HB476 requires -- two meetings with residents who are paying as much as a million dollars to have a Life Care contract to live in a CCRC. I urge you to support HB476 and report it to the full committee. Thank you

My name is Joan Lewis and I support HB 476. I live at Goodwin House Bailey’s Crossroads, a CCRC owned by Goodwin Living (GL)). I am lucky to live here as our CEO Rob Liebreich believes “we are all in this together”. He refers to senior leadership, the board and all residents. How is this transparent communication demonstrated by Goodwin Living? Rob comes with the Chair of our GL Board to present semi-annual meetings to all residents. Our Resident Council Chair submits questions in advance which they answer as part of their presentation. At the end, they answer questions from residents. In addition, at the invitation of a Resident Council Chair, Rob comes each month for an unscripted Fireside Chat with residents in our Fireside Restaurant. Our GL Treasurer comes once a year to present the new budget to residents and answer questions. Why is this important? Residents are well educated and have had important jobs. We pay a substantial amount to live at a CCRC. We want to make sure our funds are used wisely. Thus we need to understand the CEO and Board’s planning and financial information. We are the best marketers for new people to come to live in our communities. We create numerous activities. A resident had the idea for our Foundation to pay for immigrant team members’ expensive citizenship application fees. Resident funds to our Foundation have paid for over 200 immigrants and their immediate family member to become citizens. We understand it is important for our leaders to spend money to update and expand our communities. It is in our interest to make our communities more viable.

My name is Herschel Kanter. I am now living in condo but was until recently a resident of a CCRC with a lifecare contract. The amendment to the code contained in HB476 is a small step toward improving communication by CCRC Boards & management with residents and should be supported. But the problem of CCRC oversight in Virginia is much deeper. Leading Age the industry association calls residents customers as if we’re buying hamburgers. Other terms used in the industry are consumers and clients. Maybe instead we should be considered investors since residents have invested substantial sums, for some their life savings. I had been planning to the say something about the particular problems at the CCRC where I was resident but I’ve decided not too because that you would give the impression that the problem was with the management of one CCRC. But CCRC oversight in Virginia is lax, as provided by the Virginia code and maybe it will take a bankruptcy similar to the nationwide Erickson bankruptcy in 2008 or the more recent insolvency of Aldersgate in North Carolina to move Legislators and the SCC’s Bureau of Insurance to see a problem. Residents and the state have a right to know that the reserves are adequate to be sure that CCRC lifetime promises can be kept. In return for their large initial payments residents have a right to be represented in some form on governing bodies. The CCRC contract is a like buying a residence, but without property rights for residents, like a general investment in the CCRC without fiduciary responsibility to individual residents for their investment, like a lease but without tenant rights, like long term care insurance but without actuarial certification, and with aspects of a health facility even in independent living without any oversight of that aspect of the CCRC. The Bureau of Insurance is explicit that it does not get involved in contract disputes, but all an independent living resident has is a contract. All other forms of business in the Virginia code that specialize in dealing with older citizens housing, health or investments carry out the law through detailed regulations under the Administrative Code. These include real estate agents, landlords, HOAs, Condos, hospitals, urgent care facilities, assisted living facilities, nursing homes, investment advisors and more. For some unexplained reason CCRCs do not require licensing or detailed oversight. No statewide Board exists to look into problems of CCRCs. I guess we have to wait for a bankruptcy that leaves some residents out on the street. Again please support the modest proposal in HB 476.

I am a Virginia resident and co-founder of a Virginia-based, state-registered investment advisory firm serving middle-class professionals in their 30s and 40s. Virginia-based registered investment advisers are currently at a competitive disadvantage due to outdated advertising and testimonial restrictions that no longer reflect federal standards or modern consumer behavior. In 2022, the U.S. Securities and Exchange Commission modernized its advertising and marketing rules for investment advisers. These updated rules allow SEC-registered advisers, under clear guardrails, to solicit and display client reviews, including online reviews such as Google Reviews, and to use client testimonials on their websites. These changes were designed to increase transparency, improve consumer access to information, and reflect how individuals evaluate professional services today. However, Virginia’s State Corporation Commission has not yet adopted these modernized rules for state-registered investment advisers. As a result: *Large advisory firms (such as Morgan Stanley and Merrill Lynch), which are SEC-registered due to managing over $100 million in assets, are permitted to solicit Google Reviews and publish client testimonials. *Washington, DC–based advisory firms, which follow the SEC Marketing Rule, are permitted to do the same. *Virginia-based small and mid-sized advisory firms are prohibited from engaging in these common and widely accepted business practices. This discrepancy creates an uneven playing field that disproportionately harms small, independent Virginia firms, many of which serve middle-class and professional households, while benefiting large national firms and neighboring jurisdictions. Nearly half of U.S. states have already adopted these rules for state-registered advisers without evidence of increased consumer harm. HB 479 would simply allow Virginia to align with the federal standard already in effect elsewhere. It would: *Promote fair competition between Virginia firms and their DC-based and SEC-registered peers, *Support small businesses operating in the Commonwealth, *Improve transparency by allowing consumers to see authentic client feedback, *Maintain strong investor protections through established regulatory safeguards. HB 479 would allow Virginia businesses to operate under the same modern rules that apply to competitors across the Potomac and to large national firms. For these reasons, I respectfully urge support for HB 479.

Allowing registered investment advisory firms in Virginia to publicly post client reviews and testimonials would strengthen investor protection by increasing transparency rather than suppressing useful information. The SEC’s updated Marketing Rule already permits testimonials subject to strict anti-fraud safeguards, including disclosure requirements and prohibitions against misleading statements. This framework demonstrates that investor protection and testimonials are not mutually exclusive, and that regulating how reviews are presented is more effective than banning them outright. Aligning Virginia’s rules with this approach would protect investors while ensuring communications occur within a supervised, enforceable regulatory structure. Public client reviews materially improve investor decision-making. Investment advisory relationships are highly personal , and traditional disclosures such as Form ADV, while important, do not convey service quality, communication style, or client experience in a way most retail investors can easily evaluate. Testimonials provide real-world context that helps prospective clients assess fit, set realistic expectations, and compare advisory services more meaningfully. Preventing advisors from sharing this information leaves investors to rely on informal or unregulated sources that may be less accurate or complete. Permitting testimonials would also promote competitive fairness among advisory firms, particularly benefiting smaller and independent RIAs that lack national brand recognition. Large financial institutions already enjoy significant marketing advantages, while smaller firms often depend on reputation and client satisfaction to compete. A blanket prohibition on testimonials disproportionately disadvantages these firms, limiting competition and consumer choice. Allowing testimonials on equal terms creates a more level playing field and encourages higher service standards across the industry.

I support HB 479 because it updates Virginia’s investment adviser advertising rules to reflect the SEC’s disclosure-based marketing regulation that has been in place nationally since 2021. Allowing well-regulated, clearly disclosed client testimonials helps consumers make more informed decisions while preserving strong investor protections. Virginia’s current prohibition creates confusion for consumers and puts Virginia-regulated advisory firms at a competitive disadvantage compared to nationally registered firms, even though most consumers don’t distinguish between the two. Aligning state rules with the national SEC framework levels the playing field, strengthens consumer protection, and supports the competitiveness of Virginia-based small businesses. This is a clear win-win for Virginia consumers and Virginia advisory firms.

My name is Brian Thorp, and I am writing in strong support of HB 479, which would modernize Virginia’s investment adviser advertising rules by permitting the use of client testimonials and endorsements under a disclosure-based framework aligned with the SEC’s Investment Adviser Marketing Rule. HB 479 is a necessary and overdue update that benefits Virginia consumers, promotes fair competition, and aligns state law with the regulatory framework that has governed SEC-registered advisers since May 2021. Since the SEC Marketing Rule took effect, consumers have benefited from greater transparency and access to real client experiences when evaluating financial advisors. Testimonials, when paired with clear and prominent disclosures, help consumers make more informed decisions while preserving strong investor protections. The SEC framework requires disclosures regarding the source of testimonials, whether compensation was provided, and any material conflicts of interest, while prohibiting misleading, promissory, or non-factual statements. Virginia’s continued prohibition on testimonials for state-registered investment advisers creates an uneven and confusing marketplace. Most consumers do not distinguish between state- and federally registered advisers, yet current law allows one group to collect and share client feedback online while prohibiting the other from doing so. This disparity disadvantages Virginia-registered advisers and distorts consumer perception. The practical consequences are real. For example: 1. Consumers may incorrectly assume advisers without client reviews published online are less experienced or less trustworthy 2. National firms with SEC registration gain an unfair marketing advantage over Virginia-based small businesses 3. Independent advisers face pressure to affiliate with larger firms solely to remain competitive 4. Entrepreneurship and consumer choice are reduced within the Commonwealth HB 479 addresses these issues directly by replacing an outdated prohibition with a modern, disclosure-driven approach that mirrors federal standards and the direction taken by the majority of US states. For transparency, I am the founder of Wealthtender, a company that operates a website to help consumers find and hire trusted financial advisors, including an online review platform designed for compliance with the SEC Marketing Rule. Since 2021, advisers operating under compliant testimonial frameworks have collected thousands of client reviews that help consumers better understand the value and impact of professional financial advice. The feedback shared by clients is overwhelmingly thoughtful, specific, and meaningful, precisely the kind of information consumers seek when choosing a trusted professional. HB 479 strengthens consumer protection, supports Virginia small businesses, and brings state law in line with modern regulatory realities. I urge legislators to advance and pass this bill. Respectfully, Brian Thorp Founder and CEO, Wealthtender

Good afternoon, my name is Bruce Silverman. I am from Goochland County, Virginia. I am a retired physician specializing in Nephrology. I am speaking in support of HB 481. As we discuss and debate the rules for prior authorization, let’s be clear. Prior authorization has never been demonstrated to save health care dollars or protect patients from unsafe procedures or medications despite what the insurance industry would have you believe. Actually, we now have 40 years of evidence to the contrary. In the congressionally commissioned report by MedPac, the Medicare Payment Advisory Commission, documents that Medicare Advantage plans which rely heavily on prior authorization to control cost are now costing the Federal government $84 Billion more per year than Traditional Medicare. That is 22% more per individual. Traditional Medicare rarely uses prior authorization. At least up until this year. In addition, the AMA has documented that prior authorization is the number one cause of moral injury to physicians in practice today. They site that they are spending on average 14 hours per week on prior authorization that they find demoralizing and demeaning. This is especially true when you consider our education encompasses between 11 and 15 years. Many physicians have documented that delayed or denied care due to prior authorization has caused their patients injury or death. Not having a board-certified peer to provide analysis of prior authorization continues to put our patients and physicians at risk. Are you at present willing to risk the lives of your constituents to an unproven algorithm established by profiteering insurance companies that are already under criminal investigation for their egregious practices by the Federal government and others or do you trust your physician to do the best established and safe medical practice for you and your loved ones. Thank you.

Comments Document

Please see attached PDF.

This bill is a good step at protecting patients. With the growth of AI, I'm concerned health insurance carriers will exponentially prioritize denials (their profit) at the expense of human lives.

Nickel and diming people’s healthcare is dangerous. It gets in the way of real people receiving the care and medicine that they need to live their lives. As a Type 1 diabetic, I don't want a company’s profit motive standing in the way of care I need, care I still have to pay for. Our legislators should pass laws that guarantee people are able to get the care that they need, when they need it, without a for-profit entity standing between them and their care. Pass these bills.

The growth of AI usage for coverage denial means that people can get denied care without a human even looking at it. Requiring a doctor's confirmation is common-sense for managing the care that people need.

Prior authorization denials are becoming a public health crisis- particularly for Medicare Advantage beneficiaries. Studies have found that nearly one in five prior authorization requests are initially denied. In many cases, the hassle of prior authorization leads patients to give up seeking treatment, leading to worsening outcomes for many patients. The stress of fighting insurers has an impact on physicians as well - many of whom suffer moral injury as a result of repeated denials of treatment they know their patients need. This problem is only getting worse now that insurers are using AI algorithms to make prior authorization decisions. This legislation is a small but important step in the right direction. Requiring that all denials be reviewed by a human physician is basic common sense, and I hope all members of this subcommittee will vote in favor of this bill.

Comments Document

Dear Chair Maldonado and Members of House Labor and Commerce Subcommittee #1, On behalf of the Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO), I'm pleased to submit a letter in support of HB 481 (attached). Please don't hesitate to reach out if you have any questions about cancer care; we're happy to be a resource. Best, Sarah Lanford Associate Director of State Advocacy Association for Clinical Oncology (ASCO)

As President of the Coastal Virginia Medical Society, I respectfully oppose passage of the Prescription Drug Affordability Board legislation (HB483) today as it is being heard in the House Labor and Commerce Subcommittee #1. While it sounds good on the surface, using the word "Affordability" in the title, PDAPs have never saved any money, but rather end up costing hundreds of thousands of dollars per year. Patient costs will increase by over 30%. The "fixes"of this bill over last year's bill are minimal window dressing and will not result in any improvement. The fundamental problem is that the bill is structured incorrectly. The consequences will be decreased supply of life saving drugs and increased cost to the recipient. Please refer this bill to the Joint Commission on Health Care to study it more carefully and fix it so that it does what it is actually intended to do. Thank you.

I'm Greg Josephs and I'm in Ashburn. I want to thank Delegate Delaney for including an exemption for rare disease medications in this bill. Advocates like her and Senator Deeds hear our concerns and address them in this bill. After fighting and managing this disease (Myasthenia Gravis) for 23 years, this exemption is vital to ensuring patients like me have access to the lifesaving meds and therapies we need. Godspeed! Go

Comments Document

The Value of Care Coalition, a network of patient, provider and caregiver organizations, urges opposition to HB 483, primarily for two reasons: First, it's unlikely that savings, if any exist, will reach patients in a meaningful way. Insurers have indicated that if UPLs are implemented, patient costs will rise – not decrease – and that any savings to payers would likely be consumed by new compliance and administrative burdens. Second, substantial evidence suggests that access could be diminished. Surveys of pharmacists, doctors and health plans all point to this likely, and concerning, outcome. The bill relies heavily on Medicare’s maximum fair price, but studies have shown that drugs subjected to the MFP have seen patient out of pocket costs rise by 32% on average last year, with health plans increasing deductibles and shifting drugs to higher cost-sharing tiers. Finally, Virginia voters are hesitant about PDABs and upper payment limits as well. A recent survey by the Coalition shows support dropping dramatically when informed about concerns from important entities in the health care delivery system that directly shape the patient experience, like pharmacists, doctors and health plans. A full comment is attached. We kindly ask that you consider these concerns, and oppose HB 483. Thank you - Derek Flowers, Value of Care Coalition

Comments Document

The Diabetes Patient Advocacy Coalition (DPAC) appreciates the opportunity to express its concerns regarding HB 483. DPAC is an alliance of people with diabetes, caregivers, patient advocates, health professionals, and others working together to support public policy initiatives to improve the lives of Americans living with and at risk for diabetes and its complications. As an organization run by and for people with diabetes, DPAC seeks to ensure quality of and access to care, medications and devices for our community. We appreciate the Committee’s interest in addressing the prescription drug affordability crisis for Virginians; however, we believe that creating a Prescription Drug Affordability Board (PDAB) in the state is not the most direct way to address patient cost concerns. Even years after implementation, states that have established PDABs have not produced direct cost relief for patients, and their primary cost-control mechanism, Upper Payment Limits (UPLs), is misguided. UPLs or similar affordability actions will likely disrupt the rebate contracts between manufacturers and the PBMs who control plan formularies. PBMs have a well-established practice of preferring higher priced drugs that come with a higher rebate for preferential formulary placement. A UPL that results in lowering the rebate received by the PBM may result in that drug being excluded from the formulary or being placed on a higher copayment tier to dissuade the patient from using that medication. Either of those easily anticipated moves by the PBM will restrict patient access and raise patient cost despite the opposite intention. Another common PBM practice is to place restrictive prior authorization requirements on drugs that they want to steer patients away from, which they likely would do in reaction to UPLs. Prior authorizations are proven delay tactics and are detrimental to the management of chronic diseases like diabetes. This is especially frustrating to patients who have been taking the medication for many months or even years and now must get re-approved to continue their successful therapy. As an organization dedicated to protecting patient access and affordability, we respectfully urge the Committee to take steps that would immediately lower patients’ out-of-pocket costs by passing PBM reform measures. There is strong evidence supporting rebate pass-through policies that require insurers and PBMs to pass negotiated savings directly to patients at the point-of-sale. West Virginia, Indiana, and Arkansas passed such legislation in 2021, 2023 and 2024, respectively. Following implementation, rate filings for plans in Indiana and Arkansas saw no increase in premiums attributable to these policy reforms. In addition, delinking PBM compensation from drug list prices will limit future increases in list price, as it will remove incentives to inflate list prices and provide higher rebates to PBMs. It will ensure that patients benefit from the lowered list prices. A recent analysis on drug costs showed that delinking compensation from the list price of a drug could lower overall drug spending by about 15%. These approaches offer evidence-based pathways to improve affordability while minimizing the risk of unintended access disruptions that may be caused by setting up a UPL through a PDAB. Advancing these strategies should be central to the state’s efforts to protect patient access and affordability. Thank you for your commitment to Virginia patients.

I am here to speak on behalf of the PDAB. I am a physician Assistant who became a full time care giver of two aging parents and son whom I adopted with cerebral palsy. With one in four Virginians having to make the decision on whether or not to take their medications as prescribed due to the cost of medications and trying to pay for rent and everyday life needs. The choice of taking the medications needed to live and paying for shelter and food shouldn't be a constant choice Virginians should have to make to survival. Especially when we can have drug companies charge more reasonable rates for the medications that Virginian need.

Comments Document

The Biotechnology Innovation Organization (BIO) respectfully opposes SB271/HB483, which would create a Prescription Drug Affordability Board tasked with reviewing prescription drug costs and setting upper payment limits for specified prescription drugs. Government price controls like those proposed by this bill are an especially drastic action with unpredictable consequences. While the intent of this bill is to lower drug prices, we fear SB271/HB483 will fail to bring down costs for consumers or institutions and instead disincentivize development of new therapeutic breakthroughs. This bill will not lower prescription drug costs for patients because it does not address outof-pocket costs. Patients pay a given price when they visit a pharmacy based on what their health insurer determines—it is for this reason why two patients will pay a different price for the same drug. Out-of-pocket costs have been rising for patients as a result of decisions made by health insurers. SB271/HB483 does not address the price patients pay out-ofpocket and will therefore not directly impact patient affordability for prescription medications. This bill also provides no clear path for lowering prescription drug costs for public or private payers or the healthcare system overall. The price control scheme in HB 1724 is designed around the premise that prescription drug costs have ballooned out of control or are increasing at an unsustainable rate. Yet according to the latest OECD Data for 2023, pharmaceutical spending in the U.S. accounted for 12.4% of national health expendituresless than Canada (14.9%), Japan (17.6%), Germany (13.7%), France (12.9%), and over a dozen other OECD nations.1 And net prices for branded medicines continue to grow slower than inflation; in 2024, net price growth was 0.1% while the annual average CPI growth was 2.9%.2 Unfortunately, artificial price controls only serve to disincentivize biopharmaceutical companies from developing new, more effective therapies. Economists have estimated that government price controls can have a significant, damaging effect on the development pipeline. For example, one study found that an artificial 50% decrease in prices could reduce the number of drugs in the development pipeline by as much as 24%,3 while another study found investment in new Phase I research would fall by nearly 60%,4 decreasing the hopes of patients who are seeking new cures and treatments. Price controls will dampen investment and would not allow companies to adequately establish prices that will provide a return on investment. The average biopharmaceutical costs $2.6 billion to bring from research and development to market.5 They sacrifice millions of dollars, often for decades before ever turning a profit, if at all. In fact, 92% of publicly traded therapeutic biotechnology companies, and 97% of private firms, operate with no profit.6 Out of thousands of compounds only one will receive approval. For drugs that are advanced to phase I clinical trial, there is a 90% failure rate.7

Comments Document

As President of the Virginia Association of Hematologists and Oncologists (VAHO), I am writing to respectfully oppose SB271 and HB483, legislation that would create a Prescription Drug Affordability Board in Virginia. Since our founding in 1990, VAHO has represented Virginia’s largest community of oncologists and multidisciplinary cancer care providers, all dedicated to improving patient outcomes across the Commonwealth. We share your goal of making prescription medications more affordable. However, we have significant concerns that establishing a Prescription Drug Affordability Board, and authorizing the use of Upper Payment Limits, could unintentionally restrict access to critical cancer treatments for Virginia patients. Many oncology drugs are high-cost, highly specialized therapies with limited, if any, generic or therapeutic alternatives. When reimbursement is capped below the real-world cost of acquisition and delivery, providers may be unable to obtain or sustainably offer these therapies, and patients can face delays, disruptions in care, or loss of access to the most appropriate treatment. Cancer is not a condition where patients can wait while supply chains and coverage decisions adjust. Treatment delays can have real consequences, and even short interruptions can undermine outcomes. Measures that function as price controls risk shifting the burden of affordability onto patients and the physicians and clinics caring for them, particularly in community oncology settings where most Virginians receive treatment. To provide additional context, we would welcome the opportunity to share VAHO’s position statement on Prescription Drug Affordability Boards (https://drive.google.com/file/d/1utZjFR53XEgCZNLPytMshKCr8QXVCYff/view) and to discuss our concerns in more detail. We are also eager to work with you on practical approaches that improve affordability without jeopardizing timely access to medically necessary, life-saving cancer therapies. Thank you for your consideration, and for your continued work on behalf of Virginia patients and families.

Comments Document

The EACH/PIC Coalition urges subcommittee members to oppose H.B. 483 legislation to create a Prescription Drug Affordability Board or delay the upper payment limit authority until adverse impacts on patients have been studied and considered by the Assembly.

Comments Document

Submission Summary – Opposition to HB483 (Prescription Drug Affordability Board) Patients Rising respectfully submits this comment in opposition to House Bill 483, which would establish a Prescription Drug Affordability Board (PDAB) in Virginia. While HB483 is framed as an affordability measure, its structure does not guarantee lower out-of-pocket costs for patients and creates meaningful risks to access—particularly for working Virginians and those who rely on community pharmacies. At its core, HB483 relies on Upper Payment Limits (UPLs) that cap reimbursement, not manufacturer pricing. Pharmacies purchase medications from wholesalers up front and are reimbursed after the fact by health plans, PBMs, or government payers. Because manufacturers are not compelled to accept UPLs, the financial pressure created by this policy falls on pharmacies and, ultimately, patients. Pharmacies may be reimbursed below acquisition cost plus dispensing fees, which can lead to reduced participation, limited inventory, or non-medical switching. Patients may face narrower access without any guaranteed reduction in copays, coinsurance, or deductibles. HB483 also fails to reach most working Virginians. The bill explicitly recognizes that self-funded employer plans governed by ERISA are outside state authority and may comply only if they voluntarily opt in. Because a majority of Virginians receive coverage through these plans, PDAB decisions would apply to only a limited segment of the market, undermining claims that the bill will broadly reduce prescription drug costs. While HB483 includes reporting requirements regarding how savings are used, it does not mandate that savings be passed directly to patients at the pharmacy counter. The bill does not require reductions in cost sharing and does not address rebate-driven pricing practices or PBM spread pricing—key drivers of what patients actually pay. The bill also permits tying reimbursement to Medicare’s Inflation Reduction Act Maximum Fair Price. However, the real-world access impacts of IRA-negotiated drugs are still emerging. Early indications suggest that plans may shift formulary placement toward non-IRA drugs with more favorable reimbursement structures rather than improve patient affordability. Even with IRA in place, access disruptions, formulary instability, and non-medical switching remain real concerns. Experience in other states reinforces these concerns. PDABs have not demonstrated patient savings. Maryland’s PDAB has not lowered the cost of a single drug after more than five years. New Hampshire has shut its PDAB down, Ohio’s remains dormant, and Colorado’s first UPL is currently mired in litigation. Affordability policy should be judged by a simple standard: does it reliably lower what patients pay without compromising access to care? HB483 fails that test. It shifts financial risk onto pharmacies and patients, excludes a large share of working Virginians due to ERISA preemption, and lacks enforceable protections to ensure real patient savings. For these reasons, Patients Rising urges the House Labor & Commerce Subcommittee to reject HB483 and pursue patient-centered reforms that deliver real, immediate, and guaranteed affordability while preserving access to needed medications.

Comments Document

I am the executive director of the Rare Access Action Project, and we submitted complete comments over the weekend in opposition to the bill. Let’s be clear, a UPL has been found unworkable in other states. Why? Because the Upper Payment Limit in this bill only sets a limit on what plans can pay for a therapy. It does not set the acquisition cost of the medicine which can be higher than a UPL. Plans have already said in study after study that they will limit use. Pharmacists won’t be able to stock it. And PBMs will switch from it. Again, this data has been shared in our RAAP paper that has been submitted to the committee. And patients are already seeing in CO non-therapeutic restrictions and access challenges with the first UPL product, which by the way, also used MFP to set the UPL. Further, use of MFP, which is designed for Medicare, much like the best price for Medicaid, or FSS, or 340(b) pricing, is intended for those programs only. For a PDAB, those numbers are merely a surrogate plug in for a UPL, and all the problems associated with a UPL tag along for the ride. While we thank the patrons for seeking protections for rare patients, please remember only 5 percent of rare diseases and conditions have an FDA approved therapy. This means that a vast majority of rare patients rely on medicines and therapies that can and will be subject to review by a PDAB. So, a rare disease exemption exempts rare disease prescription drugs but not rare disease patients. Before requiring patients to navigate a new bureaucracy, we ask that the bill be referred to a study committee where that committee can examine the issues, can explore the potential for access disruption, and can shed light on impact for all patients in the Commonwealth. Thank you.

Comments Document

To the Chair and members of the Committee, SAARA of Virginia is in full support of HB483 and SB 271. Prescriptions can’t be effective if they can’t be afforded. Our organization is in support of efforts that intentionally create oversight through the creation Prescription Drug Affordability Board to aid in lowering cost of prescriptions. Respectfully submitted by Anika Richburg, Executive Director, SAARA of Virginia

Comments Document

While HDA understands the goals of this legislation, we would like to respectfully raise for your awareness the concern that applying a state-level price ceiling does not adequately account for how prescription drugs are bought and paid for in the U.S. Rather, placing a cap on in-state purchases but not out- of-state purchases would ultimately limit the ability of pharmacies, clinics or other points of care to recoup costs for administering or dispensing these products, which could result in sites of care in Virginia being unable to stock these medications. For example, while Maximum Fair Price represents the most that Medicare will pay for a drug, it does not change the national “list price” of drugs sold in the U.S. Rather, Medicare reductions in price is a federal effort that will involve several complex steps that can not be replicated at the state level. The attached letter outlines in more detail the destabilizing impact that HB 483 could have on the pharmaceutical supply chain and patient access to critical medications in Virginia. Thank you.

Comments Document

The Coalition of State Rheumatology Organizations (CSRO) would like to express concerns regarding HB 483, which would create a Prescription Drug Affordability Board that is empowered to apply the Medicare maximum fair price to physician reimbursements for provider administered medications. CSRO serves the practicing rheumatologist and is comprised of over 40 state and regional professional rheumatology societies nationwide whose mission is to advocate for excellence in the field of rheumatology, ensuring access to the highest quality of care for the management of rheumatologic and musculoskeletal disease. This legislation would establish a Prescription Drug Affordability Board that would have the ability to not only review the cost of prescription drugs, but establish upper payment limits. This legislation would set the upper payment limit for selected drugs at the Medicare maximum fair price for medications administered to patients throughout Virginia. This would in turn cap physician reimbursement for selected provider administered medications. We fear this proposal may actually limit patient access and drive up the cost of physician administered medications instead of making them more affordable for patients, while simultaneously causing significant financial strain on physician practices throughout Virginia. Please see comments attached.

Comments Document

Attached please find a letter of opposition to HB483 from the HIV+Hepatitis Policy Institute.

Comments Document

People living with rare diseases face extremely limited treatment options, as only 5% of rare conditions have an FDA-approved therapy. By excluding any "drug or biologic that is designated for a rare disease or condition,” you will ensure access to medication for patients living with a rare disease, who have no treatment alternatives. We appreciate the consideration of the unique circumstances of rare disease patients and therapies in this legislation. We urge the Committee to maintain the following section in the legislation: The Board shall not be required to identify every prescription drug product that meets the criteria of this subsection. The Board shall not include in such list of identified prescription drug products (i) any brand-name prescription drug or biologic that is designated for a rare disease or condition under 21 U.S.C. § 360bb and for which the only approved indication is for one or more rare diseases or conditions or (ii) any biological product that is derived from human blood or plasma. The Board shall determine whether to conduct an affordability review for each identified prescription drug product pursuant to the provisions of subsections C, D, and E”

Comments Document

(See attached letter)

Comments Document

Dear Chair Maldonado and Members of the House Labor and Commerce Subcommittee #1, On behalf of the Association for Clinical Oncology, I'm sharing a letter outlining concerns with the upper payment limit language in HB 483, which could jeopardize access to necessary care for Virginians with cancer. Please don't hesitate to reach out if you have questions with cancer care; we're happy to be a resource. Best, Sarah Lanford Associate Director of State Advocacy Association for Clinical Oncology (ASCO)