The Virginia Association of Personal Care Providers support HB 1831, which will allow for the more efficient and effective delivery of personal care services by allowing nurse supervisory visits to take place via telephone communication. We have learned through the COVID-19 pandemic that telehealth and telephone communication can safely be used in the provision of care. HB 1831 will allow providers to more efficiently provide supervision of home care attendants and will allow them to be more readily available to address any question, concern or issue that may arise. This bill will allow for more supervision to occur.

I am for nurse practitioner to be able to practice without a doctor being there

Addressing topics for perspective is a form of growth.

Part of the flexibility allowed during the COVID public health emergency was the use of telephonic supervisory visits. This bill will make permanent that change that allows a licensed nurse to conduct telephonic supervisory visits. These visits are for the sole purpose of evaluating the performance of duties and tasks in a care plan by trained health care workers. Supervisory visits are not nursing assessment visits nor are they intended to evaluate the individual receiving care. Individuals receiving assistance with activities of daily living are not under medical supervision for these services. This change will allow licensed home care agencies to continue their operations in an efficient manner and better utilize licensed health care professionals. I ask that you please support this legislation.

I endorse the subcommittee's recommendation to support this bill. Currently, people with serious mental health problems, often self-medicated by substance abuse, who finds themselves facing criminal charges, also find themselves in limbo waiting for the more thorough mental health assessment. This delays services and healing for the person who is ill and adds to incarceration expenses. A one-time boost to staffing in order to catch up can then be maintained with benefit for all. Thank you for considering this.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1874. The VACBP supports efforts to identify and provide services to individuals committed to local correction facilities in a timely manner. We also strongly support the ability for private-sector providers to partner with correction facilities to help meet the behavioral health needs of those in their facilities. Thanks to Del. Coyner for introducing this legislation. The VACBP also supports HB 2092, which will ensure all providing direct patient services, including those contracting with a provider and those employed by a temp agency used by a provider. Thanks to Del. Willett for introducing this bill.

I am for nurse practitioner to be able to practice without a doctor being there

Addressing topics for perspective is a form of growth.

Mr. Chairman and Members of the Committee., I oppose “civil immunity for health care professionals serving as members of or consultants to entities that function primarily to review, evaluate, or make recommendations related to health care services to include health care professionals serving as members of or consultants to entities that function primarily to address issues related to career fatigue and wellness in health care professionals licensed, registered, or certified by the Boards of Medicine, Nursing, or Pharmacy, or in students enrolled in a school of medicine, osteopathic medicine, nursing, or pharmacy located in the Commonwealth. “ Aren’t these the same people that own the facilities?

I am for nurse practitioner to be able to practice without a doctor being there

Black women babies are 9x more likely to die during the during pregnancy and first 12 months of birth. No one knows why or has implemented systems to research. This is a very important bill. No reason black women are dealing with issues of maternal mortality and infant mortality rates that are extremely higher than other races.

The day I had been waiting so patiently for will never come. I can’t stop thinking had I requested more work or ultrasounds to be done, my baby girl would still be here. I beat myself daily and don’t know if this pain and void will ever leave. It was a Saturday, I noticed my baby not moving as much, I contacted my doula, she instructed it’s better to be safe than sorry, so I went to the ER. Initially they had trouble finding a heartbeat but they did and my baby’s heart was doing fine. They kept me on the monitor for about 30 minutes and said everything is fine and I’m free to go. I contacted my doula to express that movement still wasn’t like normal and is there anything else they normally do. She said you can ask if they will do an ultrasound to ensure everything fine or if they have another test that can provide more clarity for my nerves. Dr. Instructed I’m just overthinking and baby has a strong heartbeat so it’s no need. I said okay I have a doctors appointment on Monday anyway I can have them check. Fast forward Monday is hear and I’m at my OB for a checkup she goes to find a heartbeat and just like that it’s never comes. I’m terrified crying yelling and loss for words when I’m told there is no heartbeat and we need to run tests to see if there is anything at all. Nope nothing can be done. I’m 36 weeks and my baby girl is no longer hear. For weeks I’m reviewing everything over again and I’m looking at the autopsy report no reason is given. No one knows what happened. I go through phases of blaming myself to blaming my husband. I’m healthy, wealthy, college educated, and I made all of my prenatal appointments but my baby is still not hear. I can’t even be happy for my friends who are expecting because my baby is no longer here without an explanation I will never see her wiggle her toes and even gaze into her eyes. 26, African American, and afraid to get pregnant again. Please support this bill. Chelsea Stewart Richmond, Virginia

Establish a review team to study and improve outcomes for fetal and infant mortality (currently exists, but needs dedicated funds and structures to operate effectively) Virginia Needs to Review and Study Fetal and Infant Mortality The U.S. has one of the best healthcare systems in the world—and yet our fetal and infant mortality rate is unacceptably high. Within the U.S., Virginia ranks 21st, which demonstrates the need to study and improve in this area in the Commonwealth. Black women are 9 times more likely to lose a pregnancy than white women. It is imperative that this division along racial lines also be addressed. In order to do that, we must understand the factors that put women of color at substantially greater risk of losing a pregnancy. A Fetal and Infant Mortality Review (“FIMR”) Team would use an integrated, multidisciplinary, community-based approach to study all of the elements and circumstances that contribute to fetal and infant mortality. FIMR includes action-oriented processes to improve services, systems, and resources for women, infants, and families. These improvements are crucial if we are to address these problems. For all of the above reasons, I strongly support HB 1950.

My name is Rebecca Gotwalt and my [Senator/Delegate] is Chap Petersen/Karrie Delaney. Currently the Commonwealth is undeserved in many areas of reproductive healthcare. When I was young I was shamed and threatened by a Giles County Health employee for requesting a check up and birth control. After that failure, I fell pregnant and had to come up with what seemed an impossible amount of money and travel more than 120 miles round trip to obtain my abortion. If something as simple as birth control and abortion are so difficult to obtain, what chance do Virginians have who want to complete a healthy pregnancy? Maternal, fetal and infant mortality must be addressed – with an emphasis on the health of Black and brown families that have death rates up to nine times that of their white counterparts. Please support HB 1950 and move Virginia forward in our quest to provide quality reproductive healthcare for all.

I am for nurse practitioner to be able to practice without a doctor being there

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1976. The ability to attract and retain a quality workforce to provide behavioral health services in Virginia is among the most significant challenges our members face. Last June, our association launched OneVACBP, an initiative focused on fighting racism and promoting diversity, equity and inclusion. We applaud Del. Willett for introducing this bill to ensure the Authority is engaged in developing strategies to increase diversity in our healthcare workforce and to examine demographic data on race and ethnicity in training programs and licensure to support this goal. I'd also like to take this opportunity to remind the members that it is critical that workforce needs in the behavioral health industry be recognized and included in the focus of the Virginia Health Workforce Development Authority. Thanks to Del. Willett for introducing this legislation. The VACBP also supports HB 2070. While private-sector behavioral health agencies provide 80% of the Medicaid behavioral health services in Virginia, private providers play virtually no role in STEP-VA. As the CSBs continue their work to achieve the STEP-VA milestones, we encourage consideration of how private-sector providers in Virginia can support their efforts. The VACBP strongly supports any action this body may take to encourage partnership between the CSBs and private providers and for this reason, we ask that you vote yes on HB 2070.

I am for nurse practitioner to be able to practice without a doctor being there

HB1915- Children are the future. Teachers care for our future and should be paid in a way that reflects the sentiment that we care for the future of our country. HB1987- This should be allowed for mental health especially. Many mental health in-person appointments are missed because someone’s mental illness keeps them from leaving the house or the person doesn’t have childcare at the time where they need to make the appointment. Telehealth will help with accessibility.

The Virginia Poverty Law Center strongly supports HB 1987 which extends and clarifies Medicaid telehealth services and remote monitoring of many health conditions. During this horrible COVID-19 pandemic, Virginia (and the U.S.) has gained new appreciation for the value of tele-medicine. Both providers and patients have benefited from easier access to medical care and improved monitoring of chronic conditions. The Medicaid program has fully participated in authorizing more telehealth during the pandemic. HB 1987 builds upon this experience and maintains valuable telehealth services to Medicaid enrollees. I have two concerns about the FIS for HB 1987. The estimated costs to DMAS appear inflated because (1) the FIS seems to count all telehealth services as ADDITIONAL services, rather than replacements for appointments and services that would normally occur; and (2) the FIS doesn't consider any cost benefits or reduced hospital/ED services which are very likely to result from better access and monitoring through telehealth. Thank you for supporting HB 1987. Jill Hanken, VPLC Health Attorney

We support this bill. Extending the use of telhealth in Virginia will benefit those with chronic conditions that live in our underserved communities. It can also reduce hospitalizations and other health care costs by helping to control conditions such as diabetes, high blood pressure, etc.

Chairman Sickles, members of the Subcommittee, good morning. I am Dr Karen Rheuban, Director of the UVA Center for Telehealth and board chair of the Virginia Telehealth Network. Thank for the opportunity to speak to HB1987, which directs the Department of Medical Assistance Services to cover remote patient monitoring services for priority, high risk, high cost patients and conditions. Remote patient monitoring programs improve patient outcomes, and lower the cost of care. I would respectfully like to address the fiscal impact statement prepared by the Department of Planning and Budget. UVA began our remote monitoring program in 2014. Based on our prior data, and the first 6 months of FY 21, we anticipate monitoring approximately 6200 high risk patients this year. For those monitored patients with the conditions identified in this bill, we project a reduction of 25,034 hospital bed days. These reductions result from hospital admissions and readmissions avoided and shortened length of stay. With an average total cost per bed day of $2015 for low case mix index patients, we conservatively project cost savings across all payers of $50,443,510 in FY21. In addition, our data demonstrated a reduction in emergency department visits for our monitored patients by 14%. One additional note for consideration as it relates to the costs of remote patient monitoring: many patients only require 30 days of monitoring, others only 3 months, rather than as projected, all patients for a full year. Medicare has covered remote patient monitoring for a broad range of conditions since 2018. We urge the committee to consider this additional information, particularly regarding cost savings to the Medicaid program, when considering the true fiscal impact of HB1987. Thank you.

My name is Stephen Grammer, from Roanoke. I encourage you to pass HB1987 and HB2124. HB1987 would allow people who without transportation easier access to being able to communicate with their primary doctors. This also would be cost-effective, due to the fact that people will not have to get ambulances going to hospitals over non-emergency situations. HB2124 would allow people with disabilities to get treatment for COVID. We are on a very low-budget, and can not afford to pay out of pocket for treatment. Again, I encourage you to support HB2124 and HB1987. Thank you for your time and consideration.

January 20, 2021 Chair Mark Sickles Health Welfare and Institutions Committee Virginia General Assembly 1000 Bank St Richmond, VA 23219 RE: HB 1987--Physical Office Location Amendment to Conduct Telehealth Chair Sickles and Member of the Committee, On behalf of Hims & Hers, a direct-to-consumer digital health company, we urge you to preserve access to healthcare treatment for thousands of Virginians by removing language recently added to HB 1987 that would require a physical office or relationship with a practice” in order to conduct telehealth in the Commonwealth. This onerous and unnecessary language will have a chilling effect on direct-to-consumer health platforms like Hims that are providing care to thousands of Virginia residents during a global pandemic but do not have a physical location. Especially during the COVID-19 pandemic, it is critical that we encourage, not curtail telehealth usage, and reduce nonessential, face-to-face encounters between patients and healthcare workers while maintaining the highest quality of care. At Hims & Hers, we connect patients to licensed healthcare providers for medical consultations and treatment across all 50 states. Our platform is powered by virtual care, without an in-person visit, which is a care delivery model that has been embraced by state legislatures, hospitals, healthcare providers and patients across the country. Since our launch in 2017, we’ve powered more than two million digital healthcare visits across a variety of conditions, ranging from sexual health to psychiatric health. In response to the pandemic, Hims & Hers has incorporated access to additional telemedicine offerings, including primary care services, mental health support groups, and access to at-home COVID-19 testing kits. We believe providers should always be held to the highest standard of care regardless of the mode of delivery, and that is why providers on our platform are licensed, highly-credentialed, and held to evidence-based clinical standards. Our executive team and board of directors are composed of some of the most experienced minds in healthcare, like Dr. Toby Cosgrove, former CEO and current Executive Advisor of the renowned Cleveland Clinic, and Dr. Patrick Carroll, our Chief Medical Officer (CMO), the former CMO of Walgreens. We recognize that telehealth is not an appropriate mode of care delivery for all conditions, and that is why we rely on licensed providers to make those determinations and refer patients to the appropriate healthcare systems and platforms. However, the current proposed physical location requirement in HB 1987 would effectively ban Hims and other direct-to-consumer digital health platforms from providing care in the Commonwealth. This is especially troubling for those in underserved areas, where telehealth is a lifeline for receiving quality care. We hope that you will remove this language from the bill, and ensure that quality care is preserved for thousands of Virginia residents. Sincerely, April Mims VP of Public Policy Hims & Hers, Inc cc: Vice Chair Rasoul, Committee Members, and Clerk Rushawna Senior

To the Members of the Committee: On behalf of the Virginia Community Healthcare Association and the 155 community health center sites across the Commonwealth that serve over 355,000 Virginians in medically underserved communities, we ask for support for House Bill 1987. Remote Monitoring Services would be invaluable in monitoring the health conditions of some patients, particularly those recently released from a hospital setting. In North Carolina, a pilot program conduced several years ago in a community health center led to significantly reduced A1C numbers in diabetic patients. For cardiac patients, one can cerrtainly see the benefit of having remote monitoring at home after having stents, or having a heart attack. On the last paragraph on audio only services – this has been an important part of delivery of services in medically underserved areas that have limited access to internet broadband services. In some parts of the Commonwealth, video is not available due to limited bandwidth. Although not mentioned in the bill, I would ask the committee to remember that when a health provider does provide services by audio only, they bring to bear their full knowledge. Reimbursement for audio only services should be at a full and regular rate, not a discounted rate, as the services of the provider requires their full abilities. Thank you, Rick Shinn - Director of Government Affairs Virginia Community Healthcare Association

VACo supports this legislation in keeping with our long-standing position in favor of the use of telemedicine to provide long-distance clinical care, patient and professional education, and public health, as well as support for flexibility in the delivery of these services.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I want to express our support for HB1987. The ability to provide and be reimbursed for behavioral health services delivered via telehealth and telephone has been absolutely critical to our members as they have worked to meet the needs of Virginia's most vulnerable residents. We applaud DMAS, DBHDS and DMAS for their quick action to develop the regulatory framework within which services could be provided early in the pandemic and in close coordination with providers. We support efforts to continue to allow use and reimbursement for telehealth and telephonic delivery of services where appropriate throughout the duration of the current public health crisis and beyond it. Thanks to Del. Adams for introducing this bill and for her commitment to identifying how telehealth can continue to be leveraged to increase access to quality healthcare services for all Virginia residents. The VACBP also supports HB2197, which would create a workgroup to evaluate and provide recommendations for the permanent use of virtual supports and assistive technology for the ID/DD population in Virginia. We believe that such an effort that is collaborative and inclusive will yield valuable insight that can guide future policy in this space. Thanks to Del. Runion for introducing this bill.

Teladoc Health would like to register our concerns with amendments to House Bill 1987. Recognized as the world leader in virtual care, Teladoc Health directly delivers millions of medical visits across 175 countries each year through the Teladoc Health Medical Group and enables millions of patient and provider touchpoints for thousands of hospitals, health systems and physician practices globally. Specifically, we strongly oppose the amendment to Section 54.1-3303 B. As written, the bill would require that a Virginia-licensed health care provider practicing using telemedicine and prescribing Schedule II–V controlled substances also have a physical office practice in the Commonwealth or an immediately contiguous jurisdiction. This provision has no clinical basis and is an arbitrary restriction to Virginia-licensed practitioners who treat patients using remote technology. The clinical guidelines for telehealth and telemedicine are anchored in standard of care, and the Commonwealth should maintain such standards and continue to tie state policy to federal restrictions on prescribing controlled substances. A requirement for a physical practice in Virginia or an immediately contiguous jurisdiction is an artifact of “old thinking” and would gut the ability of telehealth to deliver access to affordable quality health care. This bill fails to acknowledge the capacities of technological innovations in medicine. Today there is no other state with such an antiquated requirement in statute or regulation. Federal law (Ryan Haight Online Consumer Protection Act of 2008) already imposes rules around the prescription of controlled substances (Schedules II–V). This is simply bad public policy and ill-advised. Simply stated, the standard of care should dictate whether or not a prior physical examination of the patient is required prior to diagnosis and treatment of the patient, including prescribing Schedule II–V controlled substances. After the establishment of the valid professional relationship and treatment in accordance with the standard of care, geographic restrictions on follow-on care are arbitrary. We are very appreciative of the hard work that has gone into this legislation and respectfully request the sub-committee reject the proposed amendment. Thank you for your consideration. We are happy to answer any questions.

On behalf of the ATA and the 400 organizations we represent, I am writing to express concerns about an amendment made to HB 1987 in §54.1-3303 (B). In its revised form, HB 1987 would create unnecessary and impractical barriers to the establishment of telehealth services across Virginia, limiting practitioners’ ability to prescribe vital medications to their patients throughout the state based on arbitrary geographic restrictions. Currently, the bill would place geographic restrictions that determine the practitioners who can provide prescriptions to their patients, the language reading: “To prescribe a Schedule II through V controlled substance utilizing telemedicine, prescribers must maintain and practice or maintain a relationship with a practitioner at a physical office practice in the Commonwealth or in an immediately contiguous jurisdiction in order to unsure availability for an in-person examination when required by the standard of care.” In mandating the existence of a physical presence for practitioners to prescribe Schedule II through V controlled substances, the language establishes an arbitrary geographical barrier that would limit Virginians’ access to the prescriptions they need to lead healthy lives. When applied to real-world scenarios, the requirement proposed in this amendment is not practical in protecting Virginians’ safety or ensuring their access to accessible and high-quality care. If this bill were passed with the amended language, a Virginia citizen located in Alexandria could legally receive a prescription from a provider in Memphis, Tennessee (as Tennessee shares a border with Virginia), 881 miles away. However, a practitioner in Philadelphia, Pennsylvania, just 146 miles away from that same citizen, could not prescribe this patient’s medication simply because Pennsylvania does not border Virginia. Moreover, this language is not needed because if an in-person examination is needed to meet the standard of care for prescribing, then the practitioner would already be violating the standard by using telehealth technology to do so - regardless of whether they have a physical office or a relationship with a practitioner in Virginia or a “contiguous jurisdiction.” Simply put, there is no overlap between when a practitioner can use telehealth to prescribe medication and when an in-person exam is needed to prescribe, making this proposed amendment unneeded. Finally, the language also is likely in violation of the 10th Amendment. While the 10th Amendment gives broad discretion to states to regulate the health, welfare, and safety of its citizens, it still cannot “arbitrarily” or “capriciously” violate the Commerce Clause when doing so. The requirements imposed by this bill certainly would legally violate the Commerce Clause by limiting an out-of-state practitioners’ ability to practice medicine in Virginia despite the fact that they are licensed to practice there. The ATA applauds other aspects of HB 1987 which guarantee that nothing shall preclude coverage of telehealth services by insurers, including those services which involve remote patient monitoring. However, the ATA strongly objects to the amended language, and we believe that passing House Bill 1987 in its current form would be a step backward for patients and practitioners in the Commonwealth. We urge you and all of your colleagues to strike the amended language in §54.1-3303 (B) before considering the approval of this bill.

It is essential to address the demand for healthcare in a practical way - and these proposals are safe, evidence based, and needed. HB1987: Reimbursement for remote patient monitoring is proven to improve quality of care, lower readmissions, and lower travel and treatment costs. Remote patient monitoring is an essential benefit that allows patients to leave the hospital and get the same quality of care at home. For high risk pregnancies, it can cost as little as $26 a day to provide this service with higher convenience, better care, and keeps a hospital bed open for someone else who might need it more. Compare that to a $5,000 a day stay in the hospital with lower convenience, higher costs, and lower satisfaction. The Governor wisely removed reimbursement barriers to providers to offer this service to those suffering COVID-19 with great results. Virginians deserve access to this benefit and remote patient monitoring needs to be reimbursed immediately. HB1737: Nurse practitioners have safely served their communities with 2 years experience during the pandemic, and states across the country already allow for them to practice with the scope of practice with less restrictions that we have in Virginia. We need frontline healthcare workers practicing to their full capability and this reform achieves that safely. HB1747 / hb1817 : Enabling providers s to practice to their full capability is essential. Nurse practitioners deserve the opportunity be certified and practice according to their skills and education. This common-sense reform helps front line care providers to be more efficient and useful in serving in care deserts. In the same way, we should better leverage physician assistants in the field who could do more but are restricted by regulatory barriers. HB1769: Virginia law, unfortunately, puts walls between patients who are seeking care from licensed providers beyond our state lines. The commonwealth of Virginia does not care if a patient gets in the car and travels to another state to get treatment from an outstanding provider, but if a Virginia gets on the information highway, it can lead to criminal charges who is merely offering care to a Virginian in need of it. When the law was written, a phone was tethered to the kitchen wall. Today, our phones are supercomputers that can provide detailed healthcare information to a doctor in real-time. Our laws are still looking backwards in healthcare - not forward. Patient behavior is seeking better care with more convenience. This bill removes barriers between patients and providers across the country.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

Representing many groups of the EMS community I have heard horror stories from providers who have responded to calls for patients whom the providers have no idea what the problem is. There is a need to know what the problem or illness is prior to arriving or even leaving their headquarters in order to get the PPE on and be ready. We appreciate Del. Aird for submitting this bill in order to assist the EMS providers across the state.

Managed care organizations are contracting with third party audit organizations to recoup payments made to home care providers. Often times, these third-party organizations are aggressive, are paid based on the amount of reimbursement recovered and apply arbitrary standards inconsistent with both Medicaid and Medicare guidelines. House Bill 2022 (2021) introduced by Delegate Chris Head would require plans operating in Virginia to develop clear and transparent audit processes. Any changes made to provider requirements must be communicated in writing to all home care, home health or hospice providers 90 days prior to their effective date. Home care and hospice agencies shall have access to clear and consistent training on the audit expectation and process prior to implementation. These audit processes would consist of an opportunity for home care and hospice agencies to work collaboratively and correct any technical errors identified, provided the plan of care was followed and patient care was delivered. Managed care organizations shall not contract with a third-party audit organization that are paid on a contingency basis. All appeals processes shall be conducted by an organization that is not a subdivision of either the managed care organization or the third-party audit organization. This bill would restore a fair and equitable audit process.

I am for nurse practitioner to be able to practice without a doctor being there

Spoken

McShin supports this bill.

We strongly support HB 2070 that gives Community Services Boards' the ability to increase the availability and quality of services through public/private partnerships to all Virginians with behavioral health challenges and substance use disorders.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1976. The ability to attract and retain a quality workforce to provide behavioral health services in Virginia is among the most significant challenges our members face. Last June, our association launched OneVACBP, an initiative focused on fighting racism and promoting diversity, equity and inclusion. We applaud Del. Willett for introducing this bill to ensure the Authority is engaged in developing strategies to increase diversity in our healthcare workforce and to examine demographic data on race and ethnicity in training programs and licensure to support this goal. I'd also like to take this opportunity to remind the members that it is critical that workforce needs in the behavioral health industry be recognized and included in the focus of the Virginia Health Workforce Development Authority. Thanks to Del. Willett for introducing this legislation. The VACBP also supports HB 2070. While private-sector behavioral health agencies provide 80% of the Medicaid behavioral health services in Virginia, private providers play virtually no role in STEP-VA. As the CSBs continue their work to achieve the STEP-VA milestones, we encourage consideration of how private-sector providers in Virginia can support their efforts. The VACBP strongly supports any action this body may take to encourage partnership between the CSBs and private providers and for this reason, we ask that you vote yes on HB 2070.

The Department of Behavioral Health and Developmental Services strongly supports this agency bill to extend background check and central registry requirements to contracted staff providing direct care services, oftentimes alone, to individuals receiving DBHDS licensed services.

In favor of programs to better facilitate the development and progress of my community.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1874. The VACBP supports efforts to identify and provide services to individuals committed to local correction facilities in a timely manner. We also strongly support the ability for private-sector providers to partner with correction facilities to help meet the behavioral health needs of those in their facilities. Thanks to Del. Coyner for introducing this legislation. The VACBP also supports HB 2092, which will ensure all providing direct patient services, including those contracting with a provider and those employed by a temp agency used by a provider. Thanks to Del. Willett for introducing this bill.

We will support the bill as introduced; DBHDS worked with us to address the greatest of our concerns and reduced the potentially devastating impact on the providers of developmental disability services to a manageable level. Especially in these difficult times, providers have used staffing agencies to supplement already depleted staffing when self-isolation/quarantine was required. And as vacancies become more difficult to fill especially with increasing competition driven by the minimum wage increases, staffing agencies will be critical. We would, however, discourage providers who use contract staff for “direct care” roles to be cautious about the potential misclassification of employees. We also note that the provisions added to §37.2-416 (private providers) and §37.2-506 (CSBs & BHA) were not added to §37.2-314 (DBHDS operated facilities)

We will support the bill as introduced; DBHDS worked with us to address the greatest of our concerns and reduced the potentially devastating impact on the providers of developmental disability services to a manageable level. Especially in these difficult times, providers have used staffing agencies to supplement already depleted staffing when self-isolation/quarantine was required. And as vacancies become more difficult to fill especially with increasing competition driven by the minimum wage increases, staffing agencies will be critical. We would, however, discourage providers who use contract staff for “direct care” roles to be cautious about the potential misclassification of employees. We also note that the provisions added to §37.2-416 (private providers) and §37.2-506 (CSBs & BHA) were not added to §37.2-314 (DBHDS operated facilities)

The Virginia Nurses Association strongly supports HB2111 and appreciates the inclusion of nursing in the membership of the task force. We look forward to continuing this important work.

In favor of programs to better facilitate the development and progress of my community.

Voices for Virginia's Children, on behalf of the Racial Truth & Reconciliation VA coalition with over 400 members, is supportive of HB2111. In 2019, Virginia Mercury reported that Black women in VA were 3 times more likely to die after giving birth than a white woman, a disparity Gov. Northam made a goal to eliminate by 2025. In order to do so, we must identify and evaluate disparities in existence in order to combat them through equitable policy responses. COVID-19 has especially highlighted the disparities that contribute to poor health outcomes and further impact marginalized communities. This policy is a step in the right direction in improving maternal health and birth outcomes. Thank you, Del. Herring for championing this bill.

Good morning. I am George Barry Hamann, a funeral director here in Delegate Mugler’s district in Poquoson, Virginia and I am in full support of this bill. In March, because most of the PPE supplies were diverted to hospitals and recognized first responders, funeral homes were unable to receive the equally necessary PPE’s to support our service to our communities. It took literally months to receive even one box of gloves and even now we are just receiving some of the back ordered supplies that we attempted to purchase in March and April. I ask that you support this bill to ensure that funeral homes can receive the PPEs during a pandemic to fulfill our essential role of caring for those who were lost during this difficult time. Funeral homes and their staff are uniquely and unquestionably an essential part of any loss that our communities face. Thank you Delegate Mugler for introducing this bill on our behalf. Thank you all for your time and consideration. 

Why are we paying for illegal people here when we need to take care of African American, Hispanic and Asian Americans concerns FIRST? Some of our own need food.

As a lead Community organizer for the latinx population in Richmond Va I have seen that many people did not go to the hospital with COVID-19 or with symptoms of the pandemic because just thinking about the bills that these people could face, they put their lives in danger and that of others, it is not fair that because they do not have legal status they cannot access to a health care. I ask please consider this bill, there are thousands of people who would benefit

As a family physician in Richmond, VA, I am acutely aware of devastating and disruptive consequences of COVID-19 on our communities. Access to testing, treatment, and vaccination, is essential to get us functional as soon as possible. With an illness that has disproportionately affected our Black and Brown community members, we must level the access to care and provide free testing, treament, and vaccination, regardless of insurance or immigration status. This is the only way that we, together, can move forward. Thank you.

The Jewish Community Relations Council of Greater Washington (JCRC) submits this testimony in support of HB 2124, because the public health crisis we are facing is a clear emergency, and ensuring widespread testing for, treatment of, and vaccination against COVID-19 is a necessity for individuals and the community at large. Access to COVID-19 related treatment and services will improve individual health outcomes, as well as curb the spread of this virus throughout the Commonwealth and beyond. Enabling all individuals to get treatment – both preventative and therapeutic – ultimately will reduce the burdens on our medical facilities and on society. JCRC is honored to present this testimony on behalf of over 100 local synagogues, schools and institutions, including a network of agencies that provide excellent cost-effective social services to the community at-large on a non-sectarian basis. We are guided by Jewish law, history and tradition, which insists that we assist in the caretaking of all immigrants.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

My name is Stephen Grammer, from Roanoke. I encourage you to pass HB1987 and HB2124. HB1987 would allow people who without transportation easier access to being able to communicate with their primary doctors. This also would be cost-effective, due to the fact that people will not have to get ambulances going to hospitals over non-emergency situations. HB2124 would allow people with disabilities to get treatment for COVID. We are on a very low-budget, and can not afford to pay out of pocket for treatment. Again, I encourage you to support HB2124 and HB1987. Thank you for your time and consideration.

Hello Mr. Chair and members of the committee. I am Zowee Aquino, Community Health Manager at NAKASEC VA. During the special session, the General Assembly made a monumental fix that gave legal permanent residents greater access to Medicaid in Virginia. I worked with Asian American youth and impacted families to support this effort, and was so glad to be part of this legislative victory. In this session, as COVID-19 continues to decimate working class communities, we have another opportunity to support access to health care for immigrants in HB 2124. I speak with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion. They think COVID-19 vaccination is only for citizens, and won’t sign up for the vaccine. In some cases, they don’t even get tested - they instead stay at home, isolate, and deal with it themselves - because they think it is their only option. This is one of their stories: My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now. People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread. Thank you Mr. Chairman and members of the committee.

I am Zowee Aquino, Community Health Manager at NAKASEC VA. I work with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion around COVID-19 treatment and services: They think COVID-19 vaccination is only for citizens, and won't sign up for the vaccine. Sometimes, they don’t get tested - they instead stay at home, isolate, and deal with it themselves. This is one of their stories: "My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now." People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

Thank you for the opportunity to provide comments on HB 2124 by Delegate Lopez. The American Lung Association in Virginia strongly supports this proposed legislation and asks members of the committee to vote yes. The American Lung Association is the oldest voluntary public health association in the United States, representing the millions of Americans living with lung diseases, including chronic obstructive pulmonary disease (COPD), lung cancer, asthma, cystic fibrosis and pulmonary fibrosis. The Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through research, education and advocacy. We are especially concerned with COVID-19 as it is a respiratory disease. The COVID-19 pandemic has continued to highlight long-standing inequities in health care coverage and access in Virginia and across the country, which has contributed to the higher incidence of the virus in Black, Latinx, and immigrant communities. Unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. As more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages access to these treatments and care is even more critical. Virginia can support wider access to COVID-19 testing, treatment and vaccination by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy. The Lung Association believes all individuals should receive vaccination at the appropriate phase of the framework regardless of immigration status. Undocumented workers are disproportionally employed in many essential industries where they have a higher risk of exposure to COVID-19, such as agriculture and home health.1 Migrant workers also have high rates of lung diseases, such as asthma, and other health conditions that may put them at greater risk for severe illness from COVID-19. If large proportions of certain communities do not receive vaccinations, the risk of COVID-19 outbreaks increases for everyone. 2 Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Providing COVID-19 care to individuals with low-incomes will help reduce the spread of the virus. The Lung Association urges the Committee to support HB 2124 and include COVID-19 testing, treatment and vaccination for all Virginians regardless of immigration status. 1Tracy Jan, “Undocumented workers among those hit first – and worst – by the coronavirus shutdown. The Washington Post. April 4, 2020. Available at: https://www.washingtonpost.com/business/2020/04/05/undocumented-immigrants-coronavirus/ 2 Holguin, Fernando et al. “Respiratory Health in Migrant Populations: A Crisis Overlooked.” Annals of the American Thoracic Society vol. 14,2 (2017): 153-159. doi:10.1513/AnnalsATS.201608-592PS

My name is Austin Chavez. I am with NAKASEC Virginia. I live in Springfield, Virginia. I support HB 2124 because I think it will help uplift all different types of families during this unprecedented pandemic. Many families are already burdened with rising unemployment and decreased wages. To offset COVID testing and treatment costs from families will be a huge benefit for the community at large. It will empower folks to get tested and seek treatment, and create a unified culture in stopping the pandemic.

Voices for Virginia’s Children is a member of the Healthcare for All Virginians coalition and supportive of this bill. As of January 17th, VDH reported 19,982 Hospitalizations. While the Black community accounts for about 27 percent of that group, they represent just 20 percent of the commonwealth’s population. Likewise, the Latinx population makes up roughly 20 percent of Virginia’s COVID-19 hospitalizations, but only 10 percent of the population. Meanwhile, the white community accounts for 42 percent of the commonwealth’s coronavirus hospitalizations, but nearly 61 percent of the population. Communities of color are experiencing much higher hospitalization rates. Black communities have almost a 7% hospitalization rate compared to the 4% average. In order to increase equitable access to healthcare, especially during this time, Virginia should follow the patterns of 12 other states that have elected to cover COVID-19 screening, testing, and all related treatment for any immigrant who meets the financial requirements for Medicaid. This clarification would allow a singular statewide message to be shared widely. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community. Thank you, Delegate Lopez, for championing this bill.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

I am writing in support of HB2124 on behalf of The Commonwealth Institute and the Healthcare for All Virginians Coalition. The COVID-19 pandemic has put into sharp focus long-standing inequities in health care coverage and access and working conditions in Virginia and across the country, which has contributed to the higher incidence of the virus in Black, Latinx, and immigrant communities. And, unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. This is particularly tragic as more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages. Virginia can support wider access to COVID-19 testing and treatment by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy, such as a heart attack or a broken bone. Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Legislation (HB2124, Del. Lopez) to make this change has been introduced during Virginia’s 2021 legislative session. This clarification would allow a singular statewide message to be shared widely and leave no doubt as to health care costs related to COVID-19 for all families with low incomes. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community.

LeadingAge Virginia supports House Bill 2154 with the amended language provided by the Virginia Health Care Association.

Support with Amendments

VPLC supports implementing these minimum standards for nursing home staffing. This bill would set in place these standards and allow adequate staffing to be defined. Virginia ranks 38th in states overall in care hours. Due to Covid-19, the issues in nursing homes have been highlighted and the needs for change is great. Sufficient staff needs to be defined and be enforced to protect vulnerable adults. Although there is a cost, the impact on people's lives has shown to be great and we urge Virginia to move forward with protections for vulnerable individuals.

Mr. Chairman and Members of the Committee, I strongly believe nursing home and long term care facilities should provide excellent care for the elderly and disabled and should have few complaints in regard to lack of care and abuse. They should be vetted, trained in regard to infection control and dosing of medications to these patients, and provided sufficient ppe. It concerns me, however, that “Medical facilities inspectors of the Department of Health are exempt from reporting suspected abuse immediately while conducting federal inspection surveys in accordance with § 1864 of Title XVIII and Title XIX of the Social Security Act, as amended, of certified nursing facilities as defined in § 32.1-123.” Suspected abuse should be reported by them.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

SUPPORT FOR HB 2156 Every day Virginia nursing home residents experience needless injury, decline and poor care because there are simply not enough nursing staff to provide for basic needs. COVID-19 has exposed the devastating effects of longstanding and persistent understaffing. We need a clear,enforceable standard to ensure sufficient staff to meet resident basic daily needs. HB 2156 takes a realistic, practicable approach toward achieving the 4.1 staffing standard that extensive research has shown to be effective. The Northern Virginia Aging Network (NVAN) urges your support for HB 2156.

AARP Virginia supports HB2156.

AARP Virginia supports HB2156.

In concert with the federal and state mandates of the Long-Term Care Ombudsman Program to bring the concerns of our nursing home residents to our leaders, we urge our legislators to enact urgently needed, enforceable standards for the minimum levels of staff nursing homes must ensure in order to meet the basic care needs of residents. Delegate Watts’s House Bill 2156 proposes a clear and practicable plan to move Virginia gradually toward an evidence-based standard that would ensure nursing homes provide enough staff to meet residents’ basic care needs. We have attached to this email a brief summary of why this legislation is critically needed. On a daily basis, ombudsmen around the state hear of tragic outcomes, unnecessary suffering, avoidable injuries, and serious and life-threatening health complications resulting from inadequate staff in many of our nursing homes. The pandemic has exposed in new and alarming ways the tragic effects of longstanding, persistent patterns of low staffing in our nursing homes. While we can never undo the devastating impacts of COVID-19 on our most vulnerable citizens – those in our nursing homes – we must take steps now to ensure a tragedy of this magnitude does not happen again. We urge that you enact legislation to create a standard that is critically needed to protect our parents, grandparents, teachers, retired military heroes, public servants, and neighbors from the undue suffering and decline and the loss of human dignity that result from the lack of adequate staff in nursing homes to meet their most basic needs. Thank you for your consideration of these urgently needed protections for those who so often cannot speak for themselves. Sincerely, Joani Latimer State Long-Term Care Ombudsman

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I want to express our support for HB1987. The ability to provide and be reimbursed for behavioral health services delivered via telehealth and telephone has been absolutely critical to our members as they have worked to meet the needs of Virginia's most vulnerable residents. We applaud DMAS, DBHDS and DMAS for their quick action to develop the regulatory framework within which services could be provided early in the pandemic and in close coordination with providers. We support efforts to continue to allow use and reimbursement for telehealth and telephonic delivery of services where appropriate throughout the duration of the current public health crisis and beyond it. Thanks to Del. Adams for introducing this bill and for her commitment to identifying how telehealth can continue to be leveraged to increase access to quality healthcare services for all Virginia residents. The VACBP also supports HB2197, which would create a workgroup to evaluate and provide recommendations for the permanent use of virtual supports and assistive technology for the ID/DD population in Virginia. We believe that such an effort that is collaborative and inclusive will yield valuable insight that can guide future policy in this space. Thanks to Del. Runion for introducing this bill.