1. JOINT COMMISSION ON HEALTH CARE Patrick W. Finnerty Executive Director November 26, 2001 Richmond, Virginia

2. Joint Commission on Health Care 2 Presentation Outline Joint Commission on Health Care 2001 Legislative Studies Probable 2002 Legislative Recommendations Results of 2001 “Health Access Survey”

3. Joint Commission on Health Care 3 Chairman Senator William T. Bolling Vice Chairman Delegate Harvey B. Morgan Sen. Benjamin J. Lambert, III Del. L. Preston Bryant, Jr. Sen. Stephen H. Martin Del. Jay W. DeBoer Sen. Linda T. Puller Del. Alan A. Diamonstein Sen. Nick Rerras Del. Franklin P. Hall Sen. Kenneth W. Stolle Del. Philip A. Hamilton Sen. William C. Wampler, Jr. Del. S. Chris Jones Del. Robert H. Brink Del. Kenneth R. Melvin The Honorable Louis F. Rossiter (ex officio)

4. Joint Commission on Health Care 4 Broad Range of Issues Joint Commission on Health Care Health Insurance/Access for Uninsured Medical Education Health Care Cost & Quality Health Workforce Long-Term Care

5. Joint Commission on Health Care 5 Study Requests (Bill/SJR/HJR/Budget) Public Comment Period GeneralAssembly Session (Jan-Feb/Mar) JCHC Policy Initiatives Study Reports (May-Nov) JCHC Recommend. (Dec.) JCHC Legislation to G. A.

6. Joint Commission on Health Care 6 On The Internet The JCHC web site includes meeting schedules, studies, reports, and legislation Interested parties can access the full text of JCHC reports and provide public comments through the Internet Visit the Joint Commission at: http://legis.state.va.us/jchc/jchchome.htm E-Mail address: pfinnerty@leg.state.va.us

7. Joint Commission on Health Care 7 Presentation Outline Joint Commission on Health Care 2001 Legislative Studies Probable 2002 Legislative Recommendations Results of 2001 “Health Access Survey”

8. Joint Commission on Health Care 8 2001 Legislative Studies Long-Term Care Related Studies — Voluntary Closure of Long-Term Care Facilities (SB 845/HB1920) — Exceptions to Medicaid Reimbursement for Nursing Facilities (SB 1249) — Long-Term Care Insurance Reforms (HB 2228) — Employment Exceptions for Nursing Facility Employees (HB 2748) — Nurse Staffing Ratios in Nursing Facilities (SB 1125/HB 2257)

9. Joint Commission on Health Care 9 2001 Legislative Studies Virginia Medical Savings Account Program Local Health Partnership Authorities (HB 2060) Palliative Care Reimbursement Multi-State Nurse Licensure Compact Certificate of Public Need (COPN) — Follow-up to last year’s plan to phase out COPN

10. Joint Commission on Health Care 10 Presentation Outline Joint Commission on Health Care 2001 Legislative Studies Probable 2002 Legislative Recommendations Results of 2001 “Health Access Survey”

11. Joint Commission on Health Care 11 Probable 2002 Legislative Recommendations Establish a state “Critical Access Hospital” program through Medicaid cost-based reimbursement Revise Virginia Medical Savings Account Program Revise premium rate-setting process for long-term care insurance — Implements recommendations of National Association of Insurance Commissioners Establish a tax credit for persons who volunteer in a long- term care facility

12. Joint Commission on Health Care 12 Probable 2002 Legislative Recommendations Eliminate the local government “match” requirement for the state’s Auxiliary Grant Program — AG Program provides assistance to low-income residents of assisted living facilities Require state agencies conducting licensure or certification inspections of long-term care facilities to notify Adult Protective Services of any citations for adult abuse or exploitation Extend peer review/disclosure protection to patient safety/medical errors information shared among providers and expert safety organizations

13. Joint Commission on Health Care 13 Probable 2002 Legislative Recommendations Revise requirements of state’s dental scholarship to require recipients to be participating providers in Medicaid and FAMIS Extend authorization of health care data reporting for additional 5 years to 2008 Allow part-time nursing students to be eligible for existing nurse scholarship programs

14. Joint Commission on Health Care 14 Probable 2002 Legislative Recommendations Authorize Board of Dentistry to issue temporary permits to graduates of dental schools who have not yet been licensed and are practicing in Free Clinics or Community Health Centers Authorize “general” supervision of dental hygienists — Likely will not be legislation... Board of Dentistry has authority to revise supervision requirements through regulations Numerous budget amendments also will be introduced

15. Joint Commission on Health Care 15 Presentation Outline Joint Commission on Health Care 2001 Legislative Studies Probable 2002 Legislative Recommendations Results of 2001 “Health Access Survey”

16. Joint Commission on Health Care 16 Virginia Health Care Foundation Sponsored 2001 Health Access Survey Survey completed by Southeastern Institute of Research Telephone survey of 1,959 households; data on 4,801 individuals — Findings are estimates only; statewide margin of error: 2%, others range from 2-5% unless otherwise noted 2001 survey updates data collected in 1993 and 1996 Two general types of measures are used in presentation: — Uninsured rate: refers to the percentage of a population group that has no health insurance For example... “14.9% of Virginians are uninsured” — Distribution of uninsured: refers to the percentage of the uninsured who fall into a particular category For example... “20% of uninsured have income at or below the poverty level”

17. Joint Commission on Health Care 17 The Uninsured Rate For All Virginians Has Increased Since 1996 Source: Health Access Surveys: 1993, 1996, 2001

18. Joint Commission on Health Care 18 Regional Uninsured Rates Range From 11% to 20% Source: Health Access Survey 2001

19. Joint Commission on Health Care 19 Number Of Uninsured Virginians Has Grown Due To Population Growth And Increase In Uninsured Rate Source: Health Access Surveys: 1996, 2001

20. Joint Commission on Health Care 20 Number of Uninsured Persons By Region Source: Health Access Survey 2001

21. Joint Commission on Health Care 21 Persons At/Below 200% of Federal Poverty Level (FPL) Are Nearly Twice As Likely To Be Uninsured Source: Health Access Survey 2001

22. Joint Commission on Health Care 22 The Highest Uninsured Rate Is Among Young Adults Source: Health Access Survey 2001

23. Joint Commission on Health Care 23 Uninsured Rate By Race Source: Health Access Survey 2001 Note: Error margins are in the range of 2% for statewide estimate; 2-5% for African-American and White estimates; and as much as 15% for “other” category

24. Joint Commission on Health Care 24 Employees Of Very Small Firms Have Highest Uninsured Rate Note: Error margins are in the range of 2% for statewide estimate; 4% for firms with 1000 or more; and 8-11% for other categories Source: Health Access Survey 2001

25. Joint Commission on Health Care 25 Distribution of Uninsured By Race Source: Health Access Survey 2001

26. Joint Commission on Health Care 26 Distribution of Uninsured By Income Source: Health Access Survey 2001

27. Joint Commission on Health Care 27 Persons With Higher Incomes Represent An Increasing Share Of The Uninsured Population 34.0% 29.0% 37.0% 49.6% 30.0% 20.4% Source: Health Access Survey 2001

28. Joint Commission on Health Care 28 Over Two-Thirds Of Uninsured Adults Are Employed Full-Time Source: Health Access Survey 2001

29. Joint Commission on Health Care 29 Percent Of Uninsured Adults Who Are Employed Full-Time Has Increased Substantially Since 1993 Source: Health Access Survey 2001

30. Joint Commission on Health Care 30 Approximately 133,000 Uninsured Children (0-18) Appear To Be Eligible For Medicaid/FAMIS Note: margin of error ranges from 4-11% Estimated Total Number of Uninsured Children: 254,300 82,286 132,783 Source: 2001 Health Access Survey

31. Joint Commission on Health Care 31 Uninsured Persons Have Less Access To Health Care Source: 2001 Health Access Survey