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 support this bill and urge the committee to do so as well. Medical downcoding is a disingenuous practice by insurers that is harming doctors and patients. HB484 will help protect patients and reduce extra administrative fighting from medical providers.

Dear Delegates, My name is Dr. John McAllister, and I am an ophthalmologist and president of the largest physician-owned ophthalmology practice in northern Virginia. We serve tens of thousands of Virginian eye patients. I also currently serve as the president of the Virginia Society of Eye Physicians and Surgeons and sit on the board of the Northern Virginia Academy of Ophthalmology. I am writing to express my full support for House Bill 490 (Hope), which is currently before Labor & Commerce Subcommittee #1. This is a frequent scenario we see regularly: a patient on a fixed income with glaucoma--a potentially blinding disease that requires twice daily administration of eyedrop medication in lower eye pressure. Their arthritis makes it difficult to get the drops in and they use more than one drop sometimes. After 23 days, they run out of this vision-saving medication. They go to get a refill, but it is denied by their insurance because they are requesting this medication too early. They have to wait another week and don't get their vision-saving medication during this time, or they call us. To prevent gaps in care, our staff and physicians almost always get involved, and we send a new prescription, resetting the time line. This wastes the patient's time, our time and resources, and threatens proper vision-saving care. Enter: HB 490. This bill addresses this practical and common problem in eye care: patients running out of prescribed eye drops before their refill date. When this happens, patients are often forced to choose between going without necessary medication or paying the full out‑of‑pocket cost for a replacement bottle. This issue disproportionately affects older adults and patients with conditions such as Parkinson’s disease, tremors, or a prior stroke. Many of these patients have insurance plans regulated by the Commonwealth. Even when used exactly as directed, it is common for drops to miss the eye or for more medication than intended to be dispensed. Bottle design — including size, rigidity, and flow‑control tips — can further contribute to unintentional overuse. HB 490 offers a reasonable, targeted solution that ensures continuity of care and reduces unnecessary administrative burden for both patients and physicians. It allows us to focus on delivering appropriate medical care rather than navigating avoidable coverage gaps. A budgetary projection was made, estimating an impact, but it does not take into account the reality that almost all of these prescriptions are being re-sent by the physicians already. There should be virtually no financial impact, because these bottles are being dispensed early, but only after a new prescription is written. This bill protects patients, it makes proper care more convenient for them, and it allows us as physicians and our staff to spend more time actually caring for patients, rather than jumping through arbitrary hoops to get our patients the proper care they need and deserve. I respectfully ask for your support of HB 490. Thank you for your time and consideration. I would be glad to serve as a resource if you have any questions. Sincerely, John T. McAllister, M.D. President, Northern Virginia Ophthalmology Associates 6565 Arlington Blvd #250 Falls Church, VA 22042 703-534-3900 (o) 703-536-3729 (f) www.nvoaeyes.com

The document attached is a letter of support for HB625 from members of the State Access to Innovative Medicines (SAIM) Coalition.

On behalf of the Association for Clinical Oncology (ASCO), I submit the attached one-pager highlighting the financial challenges patients with cancer experience. We thank the Subcommittee for your work to address the financial barriers to cancer care.

On behalf of the Association for Clinical Oncology (ASCO), I'm pleased to submit a letter in support of HB 625. Please don't hesitate to reach out if you have questions about cancer care; we're happy to be a resource.

Please, vote for this bill. The average Virginian spends about $1,500-$2,000 in prescription drug costs and some surveys have shown that 1 in 4 Virginian's skipped taking their meds due to prescription drug costs. As oral chemo because an increasing option for treating cancer patients in remission, the bill will help keep necessary medicine accessible for those in need. Again, please vote for this bill.

On behalf of the Association for Clinical Oncology (ASCO), I'm pleased to submit a letter in support of HB 631, which would protect Virginia Medicaid patients from harmful pharmacy benefit manager (PBM) practices. Please don't hesitate to reach out if you have questions about cancer care; we're happy to be a resource.

Attachment included urges support for HB-1007 from Ann Jones, Esq. and Donna Rostant, Esq., who regularly represent children who are beneficiaries of the Virginia Birth-Related Neurological Injury Compensation Program.

Chair and members of the committee thank you for the opportunity to speak. My name is Sturgis Kidder, I am the father of Andrew P. Kidder who is a beneficiary of the Virginia Birth-Related Neurological Injury Compensation Program and I am here to support House Bill 1007. HB 1007 strengthens the Program by clarifying and modernizing how it operates, while preserving its original purpose: delivering timely, appropriate medically necessary care to Andrew and the other children in the Program who rely on it every day. For myself and other families in the Program, clarity and consistency are not abstract policy goals but they directly affect whether care continues uninterrupted. I want to emphasize that beneficiaries of the Program are not seeking expansion or special treatment. We are seeking certainty that the Program will function as intended, that decisions will be made transparently, and that medically necessary care will not be delayed or jeopardized by ambiguity in the law. Thank you for your time and I urge you to support HB1007.

My wife and I are Virginia constituents, and our daughter Mary Anastasya is enrolled in the Virginia Birth-Related Neurological Injury Compensation Program. The program's functioning is critical to our family, so we're asking you to support HB 1007. This bill would update an existing statute to make the program operate in the way it's intended: to benefit the families of the babies in Virginia who suffer neurological injuries at birth. The bill has several benefits to families and the Commonwealth. It formalizes existing administrative benefits, adds predictability, and reduces litigation risk without expanding the Program’s mission. Improves governance by setting fiduciary standards, requiring surety bonds, and mandating regular, accessible Board meetings. Provides families with clearer rules, quicker processes, and enforceable timelines for expense reimbursement. Gives families greater certainty and lowers the risk of legal disputes. Ensures families have a voice in oversight through Board representation. Gives families meaningful remedies when benefits are unreasonably delayed. These changes will cost Virginia taxpayers $0, as the program is funded by contributions from medical providers. I respectfully ask that you support HB1007 and help protect the families who rely on this Program. Thank you for your time and consideration. Sincerely, John Schultz

Chair Maldonado and Committee Members, I am 63 years old and have lived with Type 2 diabetes for more than 26 years. I have also run peer support groups for women living with diabetes for more than 8 years. While I am grateful that Virginia has adopted a $50 monthly cap on insulin, I fully support this bill that would reduce the aggregate cap to $35 even for those who take multiple types of insulin. Many people take both a long-acting insulin and a short-acting (meal-time) insulin. I have heard horror stories about people who have rationed their insulin because they can't afford it and ended up in the emergency room with diabetic ketoacidosis (DKA), a life-threatening condition. I believe 24 states currently have a cap of less than $50. I also support limiting the aggregate cap on diabetes equipment and supplies to $35/month. As someone with Type 2, I have had to pay out-of-pocket for the best tool I've ever used in managing my diabetes - a continuous glucose monitor (CGM). CGMs are not covered by most insurance plans for people who have Type 2 unless they take insulin or, in some cases, multiple types of insulin. At one point, I was paying more than $2,000 for a 90-day supply of ONE of my meds, but thankfully, a generic is now available. I urge you to pass this bill to help lower the cost burden on the more than 800,000 Virginians who live with diabetes.

On behalf of the American Diabetes Association and the over 816,000 adult Virginians diagnosed with diabetes, and children in the Commonwealth living with diabetes - please accept the attached letter in support of HB 1214 - which improves access to life-saving insulin and the critically necessary diabetes equipment and supplies that help support effective diabetes management by those impacted. Thank you, Monica Billger State Government Affairs Director American Diabetes Association

Please accept the attached testimony from the R Street Institute in opposition to HB 1228.

Dr. Rich Ingram, representing the Virginia Association of Hematologists and Oncologists. Good afternoon, my name is Rich Ingram, and I am a full-time medical oncologist and have been practicing in Winchester, Virginia for the past 23 years When treatment is delayed because of insurance mandated white bagging, it is not abstract concept or a talking point—it is a real patient sitting in front of me, waiting. This legislation restores common sense flexibility by allowing patients and physicians to decide how critical medications are delivered, without unnecessary barriers. I respectfully ask for your support of this bill and on behalf of the patients my team collectively serves I would like to thank Delegate Ward for bringing this important issue forward on their behalf Richard Ingram, MD, FASCO Shenandoah Oncology, PC 400 Campus Blvd., Ste. 100 Winchester, VA 22601 Phone: 540-662-1108 extension 214 Fax: 540-773-7788 Mobile: 540-974-7845 richard.ingram@usoncology.com

On behalf of the Association for Clinical Oncology (ASCO), I'm pleased to submit a letter in support of HB 1390. Please don't hesitate to reach out if you have questions about cancer care; we're happy to be a resource.