Week in Review

H.128, Certificate of Need (CON)/Hospital Budgets

The members of the House Health and Welfare Committee continued to take testimony this week regarding H.128, the CON bill. The testimony focused primarily on the history of the CON process.

Harvey Yorke, CEO, Southwestern Vermont Medical Center, and Daria Mason, President, Central Vermont Medical Center, both testified regarding hospital quality reporting, benchmarks and the governance structure of their facilities. Specifically related to H.128, both Yorke and Mason stated that increased regulation is not the way to go, that this bill in its current form is too overreaching and that they believe a state health planning process is needed. They also spoke about the national quality project that all Vermont hospitals are voluntarily participating in. Mason and Yorke objected to the bill's provisions that subject hospitals to Vermont's opening meeting law for many reasons including peer review.

John Crowley, newly appointed commissioner of the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA), appeared before the committee briefly. Crowley said that the new Douglas Administration has yet to take a position on H.128 or any of the proposed hospital governance issues but is working on it.

Paul Harrington, Executive Vice President at the Vermont Medical Society raised concerns about the proposed database for physician quality and the new CON threshold for physician practices in H.128. Both provisions are vague, according to Harrington.

VAHHS representatives scheduled to testify during the upcoming week are: Wednesday, 2/12 -Spencer Knapp and Theresa Alberghini DiPalma, Fletcher Allen Health Care; Thursday, 2/13 - Anne Cramer and Bea Grause, VAHHS; and Friday, 2/14 - Tom Huebner, Rutland Regional Medical Center. VAHHS is making arrangements to have some hospital trustees testify the week of February 18th. The Committee expects to take testimony on this bill for the entire month of February.

FAHC Press Conference

On Friday, February 7th, Edwin Colodny, Interim CEO at the Fletcher Allen Health Care (FAHC), held a press conference at the State House immediately following a meeting with Governor Douglas and BISHCA Commissioner John Crowley. Colodny stated that the key areas of his focus are: to ensure that FAHC continues to deliver high quality health care, ensure that the organization is in good financial health (FAHC experienced an operating loss of $4.9 million in the first quarter) and the Renaissance Project. FAHC submitted an amended CON application to BISHCA that places the total price tag of the project at $356 million. The State House buzz after the press conference was very positive.

House Appropriations

Richard Palmisano, CEO of the Retreat Healthcare, gave the committee an overview of Retreat on bed capacity, types of services offered and the economic impact of the Retreat on the Brattleboro community. Current reimbursements do not cover costs. Although inpatient and residential admissions are increasing and patient revenue is up, deductions have doubled and expenses are being reduced. The Retreat Healthcare receives no reimbursement for the provider taxes it pays. Palmisano is working with the State to look at ways to maximize the use of the provider tax to increase reimbursement. Palmisano stated possible solutions to the Retreat's crisis will include: developing strategies related to the provider tax, ensuring fair payments for the services provided by the Retreat and allowing PC Plus to access the Retreat for addiction treatment. Palmisano will continue to work with Agency of Human Services on these issues.

S.76, Medical Marijuana

This week the Senate Health and Welfare Committee took testimony and voted unanimously to advance S.76, a bill related to the use of medical marijuana. This bill proposes to exempt seriously ill people from prosecution for using medical marijuana under a physician's supervision. The bill does not prohibit the use of medical marijuana in nursing homes or hospitals and raises questions about such use. The bill will be referred to the Senate Judiciary Committee. Text of the bill.

S.17, Abuse of Vulnerable Adults

This week the Senate Judiciary Committee took testimony and began "marking-up" this bill that proposes to increase the criminal penalties for abuse of vulnerable adults in nursing homes and hospitals. Significantly, after VAHHS and others objected, the committee removed the section of the bill that proposed to institute criminal penalties against a board of directors or a "high managerial agent" of a facility. VAHHS also raised objections to the vagueness of the "Abuse by Restraint" section of the bill. The committee is still debating this issue. The committee will take these and other issues up on Tuesday, Feb. 11th, and is expected to vote on and advance the bill at that time.

Tort Reform - New Hearing Scheduled February 20, 2003

The Senate and House Judiciary Committees held a joint hearing regarding tort liability on February 5th. Witnesses included John Crowley, Commissioner of BISHCA, and Paul Harrington of the Medical Society. The Committee asked Commissioner Crowley to get back to them with specific data on medical malpractice premium rates in Vermont and how Vermont rates compared to surrounding states. Harrington testified that physicians in Vermont pay approximately $30,000 to $50,000 a year for malpractice insurance. The two major malpractice insurance carriers in Vermont are expected to increase premiums by 15 to18 percent, compared to the Medicaid reimbursement increase to providers of 1.5 percent in FY 03 and no proposed increase for FY 04. Harrington stated that double-digit increases in insurance rates are unaffordable, especially when compared to reimbursement rates. The Vermont Trial Lawyers Association strongly opposes any move to reform Vermont's tort system, such as caps on malpractice awards. While the details are still being worked out, a public hearing before the Senate and House Judiciary Committees is scheduled on this subject for early Thursday evening, February 20, 2003, at the State House.

H.1, Department of Substance Abuse and Recovery

As mentioned in a prior report, during the last week of January, the House Health and Welfare Committee voted to advance H.1, a bill that proposes to establish a new department of substance abuse and recovery within the Agency of Human Services (AHS). H.1 was referred to the House Government Operations Committee. This is likely a purposeful tactic by the House Republicans to slow down the progress of the bill since the Douglas Administration does not support H.1. Douglas is expected to introduce his omnibus AHS restructuring bill by the end of February. A copy of H.1 as approved by the House Health and Welfare Committee was not available last week but it is now (please see the House Calendar for February 5, 2003).

H.96, Report regarding Managed Behavioral Health Organizations

H.96, a bill that proposes to change the due date of the annual report by the task force created to oversee managed behavioral health care from December 1 to January 15, passed the House this week. The bill was referred to the Senate Health and Welfare Committee. Text of the bill as it passed the House.

Public Hearing on FY 2004 budget - Vermont Interactive Television Tuesday, February 11, 2003, 4:00-6:00 p.m.

The House Appropriations Committee will hold a public hearing on Vermont Interactive Television (VIT) to give Vermonters throughout the state an opportunity to express their views about the State's budget for the fiscal year 2004. The following VIT sites will be available for the hearing: Bennington, Brattleboro, Castleton, Colchester, Johnson, Lyndon, Middlebury, Newport, Randolph, Rutland, Springfield, St. Albans, Waterbury and White River Junction. The Canaan site will be opened if a citizen makes a request to do so in advance. VIT's web site has an up-to-date location listing, including directions and telephone numbers.