1. Basics of the Virginia General Assembly and 2010 General Assembly Session Overview Shirley Gibson, MSHA, RN, FACHE President Virginia Nurses Association

2. OBJECTIVES  To understand the Virginia General Assembly Structure  To understand the General Assembly Session  To review 2010 Legislation  To discuss 2011 Legislation and Emerging Issues

3. Virginia House of Delegates  Consists of 100 members referred to as “Delegates”: Each Delegate represents 71,000 citizens Delegates are elected for two year terms There are no term limits The Speaker of the House is the presiding officer Annual salary is $17,640 59 Republicans 39 Democrats 2 Independents

4. Senate of Virginia  Consists of 40 members referred to as “Senators”: Each Senator represents 176,000 citizens Senators serve four year terms There are no term limits The Lieutenant Governor is the presiding officer Annual salary is $18,000 22 Democrats 18 Republicans The Lieutenant Governor votes only in the case of a tie

5. State-Wide Offices  Office of the Governor Current Governor is Bob McDonnell (R) The Governor serves a four year term The Governor cannot serve consecutive terms Virginia’s Governor wields immense power  Controls the Cabinet  Controls most state agencies  Has almost total regulatory control  Crafts the state’s budget

6. State-Wide Offices, cont’d.  Office of the Lieutenant Governor Current Lt. Governor is Bill Bolling (R) The Lt. Governor serves a four year term The Lt. Governor can serve consecutive terms  This is Lt. Governor Bolling’s second term The Lt. Governor presides over the Senate of Virginia Assumes the place of the Governor in the event of the Governor’s death or inability to continue in office

7. State-Wide Offices, cont’d.  Office of the Attorney General The current Attorney General is Ken Cuccinelli (R) The AG provides legal advice and representation to the Governor, executive agencies, state boards, commissions, and institutions of higher education Provides written legal advice in the form of official opinions to members of the General Assembly and government officials Defends the constitutionality of state laws when they are challenged in court

8. How a Bill Becomes Law  Bills start as ideas These ideas come from:  Legislators  Special Interest Groups  Constituents These ideas are submitted to “Legislative Services” by:  Delegates  Senators  The Governor

9. How a Bill Becomes Law, cont’d  Legislative Services “drafts” the bill and then: The bill is signed by the “patron” The signed bill is submitted to the Clerk of the House or the Clerk of the Senate The Clerk submits the bill to the Speaker of the House or the President Pro Tempore of the Senate The Speaker or President Pro Tempore assign the bill to a “committee”

10. How a Bill Becomes Law, cont’d  The Committee Process Committees are broken down by subject area Committees are further split into sub- committees Once the sub-committee acts on a bill it is sent to full committee  If a bill fails in sub-committee it will usually fail in full committee or not be heard at all  If a bill passes sub-committee it will usually pass full committee  The above two points are not always true If a bill fails in full committee it is usually “dead”

11. How a Bill Becomes Law, cont’d  The Committee Process, cont’d If the bill passes full committee it goes to the floor of the House or Senate  Passing to the “Floor” Bills coming from committees are placed on the “calendar” Bills are “read” three times  The first reading is introductory  The second reading is for debate with a vote to move it to third reading  The third reading is for passage with a vote to move it to the other body where the committee process begins again  There are subtle differences in the way the House and the Senate follow the above process

12. 2010 Legislation  VNA tracked a total of 53 pieces of legislation  Sample Legislation: HB 253 Registered and practical nurses; licensure qualifications.  Patroned by Delegate Merricks  VNA opposed  Would have allowed certain military training and service to substitute for the formal nursing education requirement.  Patron agreed to “carry over” so that VNA could work with him after session.

13. 2010 Legislation, cont’d  Sample Legislation, cont’d: HB 189 Immunizations; philosophical exemption  Patroned by Delegate Purkey  VNA opposed  Would have allowed for parents to opt out of immunization requirements due to philosophical reasons  Bill died in sub-committee HB 1168 Health professionals; instruction on pain management and addiction  Patroned by Delegate Bud Phillips  VNA opposed  Would have required the schools of nursing to include instruction in pain management and addiction.  Bill died in sub-committee

14. 2010 Legislation, cont’d  Sample Legislation, cont’d: HJ 133 Mammograms, yearly; Health Commissioner to promote as an effective tool in breast cancer prevention.  Patroned by Delegate McQuinn  VNA supported  Requests the State Health Commissioner to promote and emphasize yearly mammograms as an effective tool in breast cancer prevention  Requires the State Health Commissioner to submit an executive summary and report of the progress in meeting the request of this resolution to the 2011 Regular Session of the General Assembly.  Has been passed by the House and the Senate.

15. Budget Basics  Virginia has a “biennial” budget The budget covers two “fiscal years”  The fiscal year begins on July 1 st  The budget is adopted in even numbered years A “caboose” budget is produced every year  The caboose budget makes modifications to the preceding fiscal year  The Governor crafts the initial budget Since Virginia’s Governor may not serve consecutive terms, every four years a budget is crafted by a Governor who will not be in office while the budget is debated and passed

16. Budget Basics, cont’d  The Governor crafts the initial budget  Budgets are based on “estimated revenue”  House Appropriations and Senate Finance amend the “Governor’s budget”  After the above is done, the Governor’s budget disappears and is replaced by two budgets. These are known as the “House budget” and the “Senate budget”  The two budgets are presented to their respective chambers, amended, and passed to the other body

17. Budget Basics, cont’d  Each chamber invariably rejects the others’ budget  This places the two budgets into a “Committee of Conference” Conferees are appointed by the leadership of the House of Delegates and the Senate (Usually six from each.) The job of the conferees is to take the two budgets and meld them into one The budget conference is a mystical process  No one but the conferees really understands what happens there

18. Budget Basics, cont’d  Once the conferees have finished their work, each chamber approves the new budget  New budgets take effect on July 1 st, which is the start of the new fiscal year

19. Difficulties in Reconciling the House and Senate Budgets  What took so long? How much money do we actually have to spend?  Fee increases Health care vs. Public Education  Enhanced FMAP funding from the Federal Government Public Safety vs. Public Education Do we adjourn session without a budget?  Under this scenario, session would adjourn on time  Conferees would continue to work  Once conferees were in agreement session would be reconvened and the budget passed

20. Health and Human Services Budget Outcome, cont’d  Medicaid Provider Payment Changes General Fund Most Restored with FMAP  Hospital Inpatient Payments ($14,609,580) ($24,164,264)  Hospital Capital Payments ($1,609,968) ($2,649,535)  Hospital Outpatient Payments ($6,928,731) ($10,802,339)  Indigent Care Payments to Teaching Hospitals ($7,100,000) ($7,100,000)  Modify IME Payments to Out of State Hospitals ($1,695,182) ($1,917,627)  Reciprocal Payments to Out of State Hospitals ($2,253,621) ($2,965,290)

21. Health and Human Services Budget Outcome, cont’d.  Medicaid Provider Payment Changes General Fund (cont’d.) Most Restored with FMAP  Nursing Home Payments ($11,940,294) ($13,819,962)  Nursing Home Capital Payments ($995,659) ($2,514,099)  Physician & Other Practitioner Services ($8,777,395) ($14,714,275)  Dental Services ($1,473,404) ($2,333,840)  Therapeutic Day Treatment Services ($1,494,140) ($2,253,605)  Psychiatric Residential Treatment Facilities ($1,321,092) ($1,985,800)  Pharmacy Dispensing Fee from $3.75 to $3.50 FY 12 ($,523,579)  Auxiliary Grant Payment for Assisted Lvg. Fac. FY 12 ($2,413,152)

22. The Problem with FMAP  Congress hasn’t authorized the enhanced FMAP funding Republicans killed it in the Senate Democrats killed it in the House  The states are not happy On July 1 st Virginia will implement 360 million in cuts to health care. Most states will cut much more. The Senate says it is working on passing a bill authorizing enhanced FMAP funding.

23. Emerging Issues for 2011  Title Protection for Nurses maybe inclusive of SW and Physicians – Delegate Peace  RN Circulator in OR – Ambulatory and Hospitals – Delegate Garrett  Clinical hours for nursing education  Virginia Health Reform Initiative Advisory Council  Nurse Practitioner scope of practice

24. VHRI Advisory Council  VNA President Shirley Gibson serves  Workgroups: 1. Medicaid Reform 2. Insurance Market Reform 3. Delivery and Payment Reform 4. Capacity (Co-Chair) 5. Technology 6. Purchasers Perspective  Conference Calls every other Monday

25. Nurse Practitioner Scope of Practice  Likely to emerge as a key recommendation from the VHRI  Medically underserved areas  Nurse managed clinics  Compromise language that will not be opposed by major constituency groups  Due by end of calendar year

26. Nursing Education Issues  Capacity  One in four faculty to retire in next five years  Clinical hours for schools of nursing  Certification, competency, and CE

27. Grass Roots: Be your own lobbyist  Get to know your legislator! Building a relationship is worth its weight in gold During session is not the best time to do this Legislators love having someone with area expertise they can call on  You have two things legislators need: Expertise Votes

28. Grass Roots: Be your own lobbyist, cont’d.  Building the relationship In office visits after session Invite legislators to your workplace Invite legislators to your professional meetings VNA is glad to help – join public policy email list!

29. Grass Roots: Be your own lobbyist, cont’d  Knowledge is power; online resources: Who's my legislator? (Use the link on the GA main page) Who's my legislator? General Assembly main page (http://legis.virginia.gov) General Assembly main page All the information you could ever want (http://leg1.state.va.us) All the information you could ever want Follow the money (www.vpap.org) Follow the money

30. 2010 Mid-Term Elections  What Happened Nationally? Republicans gained control of the House Republicans made gains in the Senate Republicans gained control of numerous state legislatures and governorships  What Happened in Virginia? 3 democratic incumbents lost their seats 2 of these (Perriello and Nye) were one term incumbents 1 (Boucher) was a 28 year incumbent

31. 2010 Mid-Term Elections, cont’d  Why is it important? Effectively destroys the President’s ability to set a successful agenda Puts national health care reform in serious and certain jeopardy Republicans will control redistricting in several key swing states

32. 26 th Legislative Day February 2, 2011 Marriott Hotel, Richmond

33. Questions?