Week in Review

During the 13th week of the 2002 session, the House and Senate spent equal amounts of time in committee work and floor debate. The House considered Senate amendments to H.14, legislation passed by the House last year to repeal the state's shelf labeling law for mercury products. The Senate amended that bill to essentially ban products containing mercury. After some parliamentary maneuvering, the House ultimately sent the bill to the Committee on Natural Resources and Energy for further consideration. The House also continued debate on the state's purchase of the Champion Land in the Northeast Kingdom. In other House floor action, the Senate-passed reapportionment bill arrived in the House this week, and was immediately ordered to lie by the House. In House committee work, the Ways and Means Committee passed an Act 60 reform bill while the Appropriations Committee reached consensus on H.765, the Medicaid budget and reform bill.

Meanwhile, without debate the Senate passed H.505, the transportation fee bill that adjusts motor vehicle registration fees, totaling approximately $10 million. Many of these fees have not been raised in years, and are being increased this year to help fund various areas of state government that deal with transportation. Committees worked on legislation dealing with stormwater permits, drug testing and housing.

H.765 Medicaid Reform - Reimbursement Levels and Cigarette Tax
Late Friday afternoon the House Appropriations Committee approved H.765, the Medicaid reform bill previously passed by the House Health and Welfare Committee. This bill also contains the details of the Medicaid budget that was deliberately eliminated from the FY2003 Appropriations Bill passed by the House last week.

Rep. Rich Westman (R-Cambridge) stated the scope of the hard work his committee faced-noting that decreasing state revenues, the increasing enrollments, and increased utilization all make the Medicaid budget difficult to control and contain costs. After much anguish, the Committee approved the bill on a 6-4 party line vote. The following provisions are included in the bill:

Reimbursement

• Hospital outpatient at cost-based reimbursement ($1.6 million)
• Hospital inpatient at 1.5%, an annual cost of service increase ($257,000)
• DSH payments - provider tax plus $1.25 million
• Physicians COLA ($300,000 state funds)
• Dentists COLA ($74,000)

Coverage

• VHAP professional - $10 per visit
• VHAP Hospital Outpatient - $50 per visit
• VHAP Hospital Inpatient - $250 deductible
• Emergency room visit - $50 co-pay
• Vision - all beneficiaries - 50% co-insurance
  

Other adjustments include continuation of the current comprehensive adult dental care, and adult podiatry. Dentures and adult chiropractic services were eliminated as the Governor recommended in the Administration budget.

The committee struggled to strike a balance in preserving the pharmacy assistance programs restoring 60% of the governor's cuts but not without increases in co-payments and deductibles for beneficiaries. The bill proposes increased co-payments of $3 and $6 with a $500 maximum for the traditional VHAP program; increased co-payments of $5 and $10 for VSCRIPT with a $1000 deductible; and 50% co-payment with a $1000 deductible for VSCRIPT Expanded.

The Committee also removed language related to mandatory spending caps and automatic program adjustments to meet the cap. In its place the bill requires that the governor's budget include an annual financial plan for Medicaid as well as a five-year Medicaid budget. The plan would include anticipated revenues and expenditures, caseloads, utilization and other key information for the legislative budget process. The committee also supported the House Health and Welfare Committee's provision for Health Access Trust Fund and specified that it would be the single source to finance health care coverage for beneficiaries of all state health programs administered by PATH. The bill also allows allows the Commissioner of PATH to contract out or retain the administration of health benefit plan coverage based on cost benefit analysis.

Rep. Westman expressed hope that the Federal government would take action to alleviate the problems that the states' are experiencing in the Medicaid budgets and that the Federal government would grant Vermont the waivers outlined in the bill. Absent these two possibilities, the Legislature would continue to struggle with the Medicaid budget.
Finally, the committee voted a 36-cent increase in the tobacco tax, 30 cents less than the 67-cent increase approved by the Health and Welfare Committee. At the end of the day, the Committee passed the bill attempting to strike a balance between decreased revenues and Medicaid needs while fulfilling a promise that no one would be cast out of existing programs and that no program would be cut.

No Action On…

• H.416 Medical Record Confidentiality
• S.258 Open Meeting Law
• S.254 VHAP Buy-In
• S.286 CON Regulation

Gross Negligence
After an intense joint lobbying effort by VAHHS, the Medical Society and the Dental Society, it's possible a mid-course correction will materialize this week on the gross negligence issue. It became evident last week that a floor war was looming between the House Government Operations and the House Judiciary Committees. Knowing no winners would come of such action, all parties combined to attempt to avert the committee clash. The House Judiciary Committee met with the Government Operations Committee to attempt to modify the language to insert incompetency language into the bill. Their efforts failed. The Government Operations Committee stood firmly by its work, continuing to support the simple negligence standard in place of the current gross negligence standard.

The three provider groups met with the Speaker of the House, Walter Freed (R-Dorset) who appointed Vice Chair of the Government Operations Committee, Rep. Rick Hube (R-Londonderry) as a broker between the two committees to find language that would satisfy the committees and the Medical Society, VAAHS, and the Dental Society. The Government Operations Committee will meet Tuesday to discuss the compromise language.

On the Agenda This Week
House Appropriations Committee - The will finalize the Medicaid Reform bill on Tuesday and then turn their attention to the Transportation bill and the Capital bill.

House Health and Welfare Committee - The committee will spend most of the week reviewing the Senate proposal of amendments to H.31, the pharmaceutical bill.

Senate Appropriations Committee - The focus this week will be on the Human Services Agency including the PATH budget.

Senate Health and Welfare Committee - The committee will be reviewing the Governor's recommended budget cuts in the Agency of Human Services.

House Government Operations Committee - The committee will work this week on the compromise language on the gross negligence standard.