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State studies expansion of ‘charity care’

As state lawmakers mull Medicaid expansion under the federal health care law, there’s one ramification that hasn’t gotten a lot of press: the effect on charity care.

Virginia has long required many hospitals and other health care facilities to get a “certificate of public need” from the state to open, expand or offer certain services, to prove that those services are needed for the local population.

In many cases, those certificates include provisions requiring the health care facility to provide a certain percentage of charity care to the uninsured.

But if Virginia were to expand its Medicaid eligibility, up to 400,000 currently uninsured Virginians could have insurance, which would remove them from the group currently considered charity care.

If health care facilities aren’t able to provide as much charity care as their certificate requires, they must write the state a check to pay the difference.

State Sen. Bryce Reeves, R–Spotsylvania, hopes to expand the definitions of what counts as charity care to include services provided, for example, to disabled veterans who might live far from a veterans’ hospital.

He filed a bill in this year’s General Assembly session to do that. It was changed a lot in the legislative process, and in its final form, signed last week by the governor, the bill doesn’t exactly expand the definitions. But the process did draw together stakeholders who plan to work on the issue in the coming months.

Reeves said his bill was originally sparked by concerns from a Spotsylvania medical practice that saw the state raise its charity care requirements after it moved to a new facility. Reeves said the practice was having difficulty meeting the higher requirement and that paying the state the difference would be a hardship.

He wanted the bill to clarify that in such cases, when the state changes a medical practice’s certificate, the medical practice has a way to appeal that.

But he also wanted to look more broadly at the definitions of charity care, with the idea that expanding those definitions would give health care facilities more opportunities to meet the requirements.

“My goal in the bill was one, have an appeal process, and two, figure out a way if the charity cases aren’t there, how can we allow these guys to make their goal of having that kind of charity,” Reeves said.

Reeves has done work with military and veterans groups and thought it would make sense to let health care facilities get charity care credit for serving certain disabled veterans, so those patients could get medical care at home rather than have to travel to a veterans’ hospital that might be far from their families.

“I thought that was really important because there’s no better place for a veteran to get service than in their own locality around their families,” he said.

Reeves brought together state officials from the health and veterans’ services departments, and representatives of hospital associations.

They agreed, he said, that it was a good idea, but had concerns about how to implement it.

Thus the bill in its final form allows the state to consider amendments to certificate conditions relating to “patients requiring specialized care or related to the development and operation of primary medical care services in designated medically underserved areas of the certificate holder’s service area.”

It also calls for the Department of Health, the Virginia Department of Veterans Services, the Virginia Health Information Exchange, the Virginia Hospital and Healthcare Association and others to review the state’s charity care provisions, as well as the federal Affordable Care Act, with an eye toward the charity care provisions of the certificate of public need requirements.

“The work group shall consider the potential impacts of the Patient Protection and Affordable Care Act on Virginia’s uninsured population and certificate holders’ ongoing ability to meet their conditions,” the bill says. “The work group shall also consider expanding the categories of patients whose care may be included in conditions on certificates, including disabled veterans with service-related injuries, patients receiving services under the state plan for medical assistance, and others.”

“We all agreed that these are good ideas, but they’re complex,” said Paul Speidell of the VHHA.

He said the work group expects to meet this summer, with a goal of making recommendations in time for the 2014 General Assembly session.

Chelyen Davis: 540/368-5028