Virginia Regulatory Town Hall
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Virginia Department of Health
 
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State Board of Health
 
chapter
Virginia Radiation Protection Regulations: Fee Schedule [12 VAC 5 ‑ 490]

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9/14/09  2:17 pm
Commenter: John Davis

Rad material fee schedule.
 

I feel that any fees requited by the Dept. should not exceed those fees established by the NRC

CommentID: 9959
 

9/14/09  10:26 pm
Commenter: Harvey Lankford / Endocrine and Diabetes Management Center, Inc

Petition to amend RMP Nuclear fee schedule
 

Copied below is the "petition to amend" letter that I sent to Health Commissioner Remley on Aug 18, 2009.  This was the official act that opened this evaluation of the Virginia Radiological Materials Program (VA-RMP)  Fee Schedule.

As I am new to this website, and others will be as well, I hope that I have entered this information correctly. I had hoped my petition would have already been automatically posted.

I will have other comments to post later, but first will be the official letter, below **

                         Harvey Lankford MD , Endocrine and Diabetes Managment Center Inc, 804-288-0202

**

Karen Remley MD

State Health Commissioner

VA Dept Health, Box  2448

Richmond, VA 23218

          RE: Petition to Amend 12VAC5-490 VA-RMP Nuclear Materials License Fee Schedule

Dear Dr. Remley:

This letter is a petition to amend a regulation in accordance with the Code of Virginia Section 2.2-4007

The legal authority for the Board of Health to take the requested action in this case is Code of Virginia Section 32.1-229.

The purpose of this request is to amend 12VAC5-490 Nuclear Materials License Fee Schedule of the VA-RMP (Radiological Materials Program) such that the regulations are consistent with the claims made in the Virginia Register of Regulations Volume 24, Issue 21- 12VAC5-490 Virginia Radiation Protection Regulations: Fee Schedule. Specifically, I am requesting that the Board of Health:

  • Establish fee schedules that "shall not exceed comparable federal Nuclear Regulatory Commission fees." (as stated in Virginia Register of Regulations Volume 24, Issue 21, pages 2954 and 2955)
  • Amend the regulations to be consistent with the comment that "It is also advantageous to businesses currently using radioactive materials under a federal license to pay a lesser fee when the Commonwealth enters into an agreement with the NRC. " (as stated in Virginia Register of Regulations Volume 24, Issue 21, page 2955)
  • Amend the regulations to be consistent with the comment that " the proposed fee schedule for radioactive materials will be significantly reduced in most cases from the fees the licensees are currently paying to the NRC ( as stated in Virginia Register of Regulations Voume 24, Issue 21, page 2955)

Importantly, the significant differences between the Virginia Register publication of the Department of Health's intent compared to the actual regulations speaks strongly to the need for regulatory review and amendment. In fact, the broad discrepancy evident between the apparent intent of the initial proposed regulation published in the Virginia Register, when compared to the resulting final regulations raises the question as to whether or not the promulgated regulations exceed the intent or authority of the initial notice.

As an example of the magnitude of this issue, the federal Nuclear Regulatory Commission (NRC) provided me with a list of 105 Virginia Nuclear small business users affected by the fee structure. As for my own nuclear license, the former NRC yearly fee of $ 2,300 is now a Virginia RMP category 7D fee of $ 4,000 and clearly not the decrease as promised. As stated in the paragraphs above, I hereby request a formal petition to amend.

                                                                                                               Sincerely,

                                                                                                               Harvey V. Lankford MD

 

 

 

 

 

 

 

CommentID: 9960
 

9/15/09  9:01 am
Commenter: Richard Bowdel, S. R. Draper Paving Company

Request for reducing radiological license fees
 

We were paying $500 annually to NRC for small business license. We were assured before the Virginia Department of Health took over this program that rates would not increase and would probably decrease.

We are now being charged $1,000 annually by the Virginia Department of Health, a 100% increase.

Following are two excerpts from  proposed regulation The Virginia Register 12VAC5-490. Virginia Radiation Protection Regulations: Fee Schedule (adding 12VAC5-490-30, 12VAC5-490-40).

"It is also advantageous to businesses currently using radioactive materials under a federal license to pay a lesser fee when the Commonwealth enters into an agreement with the NRC.

Pertinent matters of interest to the regulated community: VDH does not anticipate any issues from most of the radioactive materials licensees, since the proposed fee schedule for radioactive materials will be significantly reduced in most cases from the fees the licensees are currently paying to the NRC."

We hope that you will correct this injustice, either by instituting a small business rate or some other method. Being a small business, we consider this 100% fee increase (especially under the above cited circumstances) unfair and unreasonable.

Thank you for your consideration.

CommentID: 9961
 

9/16/09  7:51 am
Commenter: Peter S. Ross, MD, N. VA Endocrinologists

Excessive licensing fee
 

Apparently because of the absence of a small business discount, you charge nearly twice what we were paying to the NRC for the same service. 
 
We are the largest private practice provider of thyroid I131 therapies in N. Virginia.  Our ability to treat our own patients offers huge benefits to our patients in terms of convenience and, most importantly, safety (no misadminstrations in some 3,000+ cases over nearly thirty years), and cost.  However, our revenues--maybe $30,000 per year--from our program barely cover our costs.  In fact, economics have already forced us to give up I123 scans and uptakes. 
 
Doubling of our licensing fee is quite likely to force us out of nuclear medicine completely.  I think this would be bad for us, our patients, and for RMP--I suspect that RMP's costs to license our simple program (receive I131 capsules; administer same.  Period.) are lower than even the NRC rate for small business.
 

CommentID: 9962
 

9/16/09  2:21 pm
Commenter: Janis Rosenberg, Business & Communications Director, Cardiology of Virginia

Regarding excessive fees
 
As a small cardiology practice we work hard every day to provide the best care for our patients.  It isn’t always easy, given that we see declining receivables due to a surge in uninsured and indigent patients.  What’s more, the threat of Medicare’s 20% fee reduction looms ahead and we wonder what costs we will have to cut in order to provide the same quality of care for less money.
 
Now we find that we are paying twice as much in licensing fees as we did last year. We can understand instituting a gradual increase, but to double our rate the first year is truly shocking.  We had thought the fees would be comparable to NRC’s, as touted in the information we received from our organization.  This simply has not been true.
 
 I am writing to ask you re-evaluate the RMP fee schedule and to reconsider providing a discount to small practices.  We are working too hard to stay afloat in this economy to be crippled by our own government.  Please hear our request.
CommentID: 9963
 

9/16/09  9:16 pm
Commenter: Mark McClanahan, MD, Diabetes and Thyroid Associates, PC

Materials fee schedule
 

At the request of the VA Board of Health, I wrote a letter to the NRC in support of Virginia becoming an Agreement State.  I did this with the assurance that fees would not be higher and indeed should be lower.  This was particularly appealing to me as I have a small nuclear program.  I began my program about 11 years ago when there was instability in our local hospital program when the nuclear medicine physician left the area and the treatment by committee approach that followed left my patients dissatisfied with the care they received.  Since then I can say unequivocally that the care my patients have received has improved with fewer re-treatments being needed  and patient satisfaction has improved as they receive their nuclear treatments directed from the physician that will provides their ongoing thyroid and endocrine care.  This improved care is at no extra cost to the patient or to his insurer.

The burdensome increase in fees that has resulted from the elimination of the Small Business Entity has placed our in jeopardy by further stressing an already slim profit margin.  If small business entities are forced out of the nuclear business, quality will suffer and there will be less income to the Virginia licensing program.  I respectfully request that the Virginia program follow the example set by the NRC and restore the Small Entity fees.

CommentID: 9964
 

9/17/09  10:07 am
Commenter:  

VDH/RMP Radiation Protection Fee Schedule
 

I striongly urge the commission to revise the above referenced fees to more consistently follow the NRC fees as originally promised and to include an affordable small business fee available to those who meet the defined requirements.

I have ben paying a $500.00/annum small business fee to the NRC since inception of my license which permits the use of portable gauges to perform materials density testing for residential and comercial building. My VDH/RMP fees have doubled plus a partial year fee and a partial year ending NRC fee all basicaly due at the same time in the current economy are a strain on the budget.

I must also advise that upon request and with the information requested by VDH, my fees are now allowed to be paid in quarterly payments helping the untimely situation and lack of current workload a great deal. Commissioner Remley, Les Foldesi and Mike Welling all have my thanks.

Despite this immediate assistance, I still believe that the overall fe schedule needs to be revised to more closely conform to the NRC fee schedule to include the small business qualification. I am a firm of only a few people with the gauges representing only 5% - 10% of my gross.

Thank you for this opportunity. ZE

CommentID: 9965
 

9/17/09  11:28 am
Commenter: Harvey V. Lankford MD, Endocrine and Diabetes Management Center, Inc

Update letter on nuclear fees - Director Foldesi VDH
 

I received a comprehensive letter from Director Les Foldesi, Division of Radiological Health regarding progress toward revision of the nuclear license fees. There are appears to be good news, so I would like to thank Director Foldesi and look forward to working with him.

I assume the information in the letter is public, so the pertinent part I copied below to be part of the Town Hall.  I have some follow-up responses and will add them here later.

Harvey V. Lankford MD

Endocrine and Diabetes Management Center, Inc, 7231 Forest Ave Suite 103, Richmond, VA, 23226    804-288-0202         h_lankford@comcast.net

 

****** from Mr.Foldesi letter:

The Virginia Department of Health (VDH) has received about 18 complaints regarding the fee schedule. All of the complaints have come from those licensees who were granted a small business fee reduction under the Nuclear Regulatory Commission (NRC)  and now pay a higher fee to VDH. During the rule-making process for establishing the fee schedule, a provision for a small business fee was not included and the projected impact was estimated to affect about 25 licensees who would pay a higher fee.  After the agreement with the NRC was implemented, VDH learned that 103 of the 429 licenses that transferred to the Commonwealth of Virginia received the small business fee reduction instead of the 25 previously thought. There are now 65 licensees whose fees range  from $1,000 to $8,000 and are higher than those of the NRC. The remaining 38 small businesses' fees range from $500 to  $2000 and are less than what they paid to the NRC. Those 323 licensees who were either not eligible for the small business fee or did not  apply for it, received substantial fee reductions under the Agreement State Program; even more so next year since NRC published a new fee schedule with an approximately 50%  increase in their fees, although the small business fees remained the same.

Meanwhile VDH staff has developed a proposed fee schedule which will further reduce the radioactive materials licensing fees and provide relief to many of the small businesses. The definition of a small business stated in the Code of Virginia (Section 2.2-4007) includes those business entities  that are (i) independently owned and operated and (ii) employs fewer than 500 employees or has a gross annual sales of less than $6 million. This definition could very well apply to most of our licensees. Your comments regarding how best VDH should address small business's fees would be greatly appreciated  as well as any other concerns you may have with the fee schedule.

If you have any questions regarding the fee schedule or the petition for rule-making, please call me at 804-864-8151, or by email at Les.Foldesi@vdh.virginia.gov or send a letter to the address below.

                                                                                    Sincerely,

                                                                                    Leslie P. Foldesi, M.S., CHP, Director

                                                                                     VDH-Division of Radiological Health

                                                                                    1090 Governor Street, Room 730

                                                                                     Richmond, VA 23219

                                                

 

 

 

CommentID: 9966
 

9/17/09  11:32 am
Commenter: James Clarcq ,CNMT Cardiology of Virgina

radioactive materials fee schedule
 

       I am writing in regard to the fee schedule from the RMP. As the head of the Nuclear department in a small cardiology practice, I am faced with many challanges. I don't believe one of them should be an increase in fees to perform our job that was promised to be reduced or stay the same. I urge RMP to reduce the fees to the same or below the cost of the NRC fees as promised in the original agreement.

   As a small business it is becoming harder to provide quality care to our patients as our revenues keep declining. To not have an increase in our fees as we have had will go a long ways in helping us provide the necessary care our patients need. Thank - you for hearing our concerns.

CommentID: 9967
 

9/17/09  11:52 am
Commenter: Bruce Boller, Radiation Safety Officer, Virginia Military Institute

Excessive License fee
 

Virginia Military Institute is a state funded school and subject to economic downturns like the one we all are currently experiencing. We are a non-profit organization and we should not be classified as a small business. There should be a separate category for non-profit organizations and the license fee should be changed to reflect our status. Charging us $1000 a year is excessive.

CommentID: 9968
 

9/18/09  8:12 am
Commenter: Charles Baird, Jr. / Virginia Heart Institute

Amend Rad Fee Schedule
 

Virginia Heart Institute, Ltd. fully support's Harvey Lankford, M.D.'s Petition to Amend 12VAC5-490 VA-RMP Nuclear Materials License Fee Schedule for all reason's stated in his letter to Karen Remley, M.D., State Health Commissioner.

 

CommentID: 9971
 

9/25/09  9:44 am
Commenter: Harvey Lankford / Endocrine and Diabetes Management Center, Inc

Refund of fees overpaid in 2009
 

As VDH and RMP begin the process to change the nuclear license fees, especially for small business users, I have the following comments/observations:

1. The excess fee in 2009 should be retroactively corrected. The RMP should consider providing a refund for entities that have been charged fees above their NRC  level. A refund is preferable to a credit.

2. If the RMP fee schedule is reduced in accordance with the petition, it would be undesirable if new user fees (such as inspection fees) were then implemented. As previously stated, one of the proposed benefits of the RMP was to reduce user costs.

Personal notes on our small nuclear office:

3. The State inspector who visited us in spring 2009 was given a choice of inspecting either us or a larger location that day. She chose us: small, organized, quick.

4. Our small office inspection took only an hour. A second hour was granted by us to share with her information about radioiodine for RMPs use at other inspections.

5. Note that the inspection of a large facility takes a whole team of personnel several days.

6. We were told that our use of both I-123 and I-131 might justify a higher fee. I disagree with that for the following reasons (A) the higher category 7d Medical user fee already factors that in, (B) the NRC did not see it that way, allowing the small business reduced fee, (C) see items 3,4,5 above.

 

Thank you for allowing us to participate in this process. I look forward to working with VDH and RMP.

                                                                          Harvey V. Lankford MD

 

CommentID: 9972
 

9/29/09  9:45 am
Commenter: Jeff Buthe, Medical Society of Virginia

Radiological Materials Program Fees
 
On behalf of the Medical Society of Virginia (MSV), I would like to thank you for the opportunity to comment on this petition. MSV is a professional organization for physicians with approximately 9,000 members. 
 
We are in support of the petition’s request that the radiological materials fee schedules be re-examined and revised so that they do not exceed comparable federal Nuclear Regulatory Commission (NRC) fees. Following implementation of the Virginia fee schedules, we received notice from members indicating that their new fees were substantially higher than the fees they would have paid to the NRC, since they no longer received a “small business” discount. This occurred despite several references in the regulatory promulgation documents assuring that their fees would not increase and would likely actually be reduced after the transition to the Virginia program. The feedback we received suggested that such assurances kept those who were negatively affected by the fees from objecting to the initial proposal.
 
We do not believe that the current fee schedules coincide with intent that the regulations establish equal or reduced fees, so we support that the fees be revised accordingly. Again, we appreciate the opportunity to comment on this matter.
 
Jeff Buthe
Senior Policy Analyst
CommentID: 9975
 

10/4/09  5:00 pm
Commenter: Mary Y. Martin, Owner; Raymond M. Martin, RSO Martin Industrial Testing Inc

Licensing fees
 

The correspondance I received from the state regarding licensing fees stated that the fees may decrease by sixty percent, not increase by eight hundred percent.  This is an unfair increase for a small business ( two employees) with revenues of less than $250,000 per year, especially when radiography is a small part of our business.  Once again we pay more and get less and still have to maintain an NRC licence so we can service our regular customers in the state of Virginia, where Virginia has no jurisdiction. 

I support the petition for amendment of licensing fees.

Sincerely,

Mary Y Martin, Owner                                                                                                                 

Raymond M. Martin, RSO

Martin Industrial Testing, Inc

 

CommentID: 9993
 

10/4/09  10:17 pm
Commenter: Pole Brothers Imaging

License Fees
 

First we recieved an invoice for "Initial invoice" (set up charges) of $1,328.00 then a week later our "Annual Fee Notice" of $4,000.00 To say  this whole process has become a real hemorrhoid would be an understatment.

As a company employing less than 5 people the NRC and our Maryland Reciprocity costs combined are less than Virginia's why wasn't any consideration given to small bussiness? I have heard the argument that it is the portability and the type of equipment we use that puts us in the "higher barcket" ... this does not pass the smell test, as this same equipment poses the same risks to the NRC and Maryland juisdictions that also requlate our company as A SMALL BUSSINESS.

We agree that that Virginia should review and revise the current fee structure.

 

Tad Pole

CommentID: 9994
 

10/5/09  3:53 pm
Commenter: John F Schmedtje Jr., MD Roanoke Heart Institute PLC

Radioactive Materials Fee Schedule for Small Business
 

Thank you for the opportunity to comment on the radioactive materials fee schedule.

I have a small practice that I started in 2003. By keeping overhead reasonably low, we have been able to grow over the last 6 years. However, given a series of unfunded mandates and increasing expenses, as well as reduced fees for our services, we may not be able to provide the same individualized care to our patients that put us on the map in the first place.

The huge increase in fees for small business licensees that is now charged by the Commonwealth of Virginia, when compared with those those charged by the NRC, is yet another assault on our practice model.

I believe it would be more fair to charge a fee to small businesses that is similar to that the NRC has charged. Thank you for your consideration.

John F. Schmedtje Jr., MD

CommentID: 9995
 

10/5/09  4:33 pm
Commenter: Dan & Graham Leasing, Inc.

Additional Fees with the Commonwealth
 

We qualify as a small business as well and are against paying more with the Commonwealth as a small business than we have with the NRC in past years. As a small business, these sorts of fees impact our cash flow more severely than larger firms and our budgets have been developed using the former NRC rate. Please reconsider the rates for small businesses, a rate at or near that of the NRC’s would be a great relief, especially in today’s economic climate where small businesses do not have the extra money for these sorts of inflations. Thank you for your reconsideration.

CommentID: 9996
 

10/5/09  11:10 pm
Commenter: Laurance Kam, MD Cardiology Specialists of Virginia

VDH fee schedule
 

As an owner of a small cardiology practice, I concur with the previous comments attesting to the burden that the lack of a small business fee reduction would impose onto us.  The costs of inspecting a small practice like ours cannot be compared to that of a large corporation.

CommentID: 9997