Basics of the Virginia General Assembly and 2010 General Assembly Session Overview

Shirley Gibson, MSHA, RN, FACHE

President

Virginia Nurses Association

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

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

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

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

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

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

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

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”

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”

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

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.

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

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.

Budget Basics

Virginia has a “biennial” budget The budget covers two “fiscal years”

The fiscal year begins on July 1st

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

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

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

Budget Basics, cont’d

Once the conferees have finished their work, each chamber approves the new budget

New budgets take effect on July 1st, which is the start of the new fiscal year

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

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)

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)

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 1st 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.

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

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

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

Nursing Education Issues Capacity

One in four faculty to retire in next five years

Clinical hours for schools of nursing

Certification, competency, and CE

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

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!

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)

General Assembly main page (http://legis.virginia.gov)

All the information you could ever want (http://leg1.state.va.us)

Follow the money (www.vpap.org)

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

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

26th Legislative DayFebruary 2, 2011Marriott Hotel, Richmond

Questions?