Political Overview

Act 60 reform and the budget bill dominated activities at the State House this week. After years of failed attempts, the House Republican leadership succeeded in getting bipartisan support to pass H.480, an Act 60 reform bill. Now the bill heads to the Senate. The Senate leadership plans to "reexamine" the tax package in the bill, but intends to act on H.480 within a week or so. Governor Douglas has publicly stated his support for the House-passed bill.

The Senate successfully debated and passed H.464, the FY04 budget bill on Friday, May 2. That same day a conference committee was appointed to work out the differences in House-passed and Senate-passed versions of the bill. As a rule of thumb, it takes about two weeks for the session to wrap up once a conference committee on the budget is appointed.

This week the Senate committees were "realigned" slightly for the remainder of this session to make room for newly appointed Senator Bernier Mayo, R-Caledonia, who replaced Senator Rob Ide, R-Caledonia, who took a job with the Douglas Administration. Senator Ide sat on the Senate Transportation Committee and the powerful Senate Appropriations Committee. Senator Mayo was assigned as a sixth member of the Senate Health and Welfare Committee (a committee that traditionally has only five members) and as a member of the Senate Judiciary Committee. Senator Jim Leddy, D-Chittenden, moved from the Judiciary Committee to the Senate Natural Resources Committee. Senator Phil Scott, R-Washington, moved from the Senate Natural Resources Committee to the Senate Transportation Committee. The coveted seat on the Senate Appropriations Committee remains empty for now. It is likely that further committee shuffling will occur in January, 2004, when the General Assembly reconvenes.

Issues of interest to VAHHS addressed this week include:

Hospital Regulation, Certificate of Need (H.128)

The Senate Health and Welfare Committee approved H.128 by a 5-0 vote late Friday, May 2nd. The bill will go to the Senate floor the week of May 5th and then to a conference committee with the House.

The Senate bill is slightly improved from the House bill. The House-passed bill included a provision that required hospitals to submit a letter of intent if any project costs $500,000 or more, and gave BISHCA discretion to assert CON jurisdiction over those projects. This provision would have lowered the existing CON thresholds for hospitals in some cases. The Senate increased the letter of intent screening threshold for hospitals to $1.5 million. The Senate Committee also put in some clarifying language regarding the two-step process for projects over $20 million, and they changed the hospital needs assessment from an annual to a bi-annual requirement. They resisted pleas to add governance provisions as well as a change that would have opened up party status in CON proceedings.

At the last minute, an attorney for BISCHA noticed that the bill was missing transitional language so that the existing CON criteria would expire before the new health resources allocation plan is ready in 2005. The committee agreed to fix this.

On the down side, the bill continues to include batching provisions for CON applications. BISCHA is given rule-making authority to implement batching so VAHHS will have the opportunity to work with BISHCA on the details. The committee also added authority to bill hospitals up to $300,000 over an 18 month period to pay for creation of the health resource allocation plan, but not until an inventory of existing information and resources is done and grants applied for that might pay for doing the plan.

Here a link to the Senate Calendar for Tuesday, May 6, 2003, with the text of H.128 as the Senate Health and Welfare Committee approved it.

FY04 Budget Bill (H.464)

The Senate passed H.464, the FY 04 budget bill on Friday, May 2nd. The Senate-passed budget includes increased funding for Medicaid, substance abuse programs, human services caseload and the Housing and Conservation Trust Fund, as well as funds to open the Springfield prison on time and to fund additional state troopers. The Senate bill has $6 million more in spending than the House-passed bill. Late Friday the following conferees were appointed to work out the differences between the House and Senate passed bills: Rep. Rich Westman, R-Cambridge, Rep. Martha Heath, D-Waterford, Rep. Patricia O'Donnell, R-Vernon, Sen. Susan Bartlett, D-Lamoille, Sen. Dick Sears, D-Bennington, and Sen. John Bloomer, R-Rutland.

Significantly for hospitals, the Senate-passed proposal provides an additional $4.8 million, plus approximately $7.3 million in federal matching funds for a total of approximately $12.1 million to increase Medicaid reimbursement rates for inpatient hospital care. This $4.8 million becomes a total of $8.6 million that will be generated in state funds from a 1 percent increase in the provider tax on most hospitals. The remaining $3.8 million from the provider tax payments will be used to replace all existing co-payments and deductibles paid by Medicaid recipients with premiums.

The Senate did not make any changes to the portions of the budget that provide Medicaid funding for nursing homes, which includes an inflation factor for FY04. The Senate did, however, increase payments by $250,000 (plus federal matching funds) to residential care facilities, including Level 3 and Level 4 homes. This indirectly helps nursing homes by ensuring that these homes stay financially viable. The Senate also closed a loophole in the law that prevents bonds from being counted toward a person's total resources before they qualify for Medicaid to pay for their long-term care needs.

Fee Bill, Provider Taxes (H.472)

The Senate Finance Committee is considering the miscellaneous fee bill, H.472. This is the bill that contains the language to increase the provider taxes for hospitals, home health and nursing homes. The provider taxes for hospitals will be increased by an additional 1 percent to raise the funds to increase hospital Medicaid payments and to replace co-payments and deductibles under Medicaid to premiums. The bill also creates a new category of "mental and psychiatric facilities" and taxes them at a different rate than other hospitals. The only hospital in this class is the Brattleboro Retreat. The Retreat had already worked out this agreement with the Douglas administration before the 1 percent provider tax concept surfaced. The Senate Finance Committee will likely complete its work on the fee bill during the week of May 5th.

Anesthesiologist Assistants (S.144)

On Wednesday, April 30th, the House Government Operations Committee took testimony regarding S.144, a bill that proposes to establish a system for certifying Anesthesiologist Assistants (AAs) in Vermont. Witnesses included Anthony Otis, lobbyist for the Vermont Association of Nurse Anesthetists, Bill Wargo, counsel for the Department of Health, and Dr. Libby Turner, the chair of the Medical Practice Board. Anthony Otis offered some amendments to the bill that VAHHS opposes because they would make the bill unworkable for some hospitals. The Committee is done taking testimony and will begin discussing and "marking up" the bill on Wednesday, May 7th. We remain hopeful that the committee will vote the bill out favorably in the near future and it will reach the House floor before the end of the legislative session. The text of the bill as it passed the Senate.

Statewide Needs Assessment of Dialysis Treatment (S. 170)

On Friday, May 2nd, the House gave its preliminary approval to S.170, a bill that requires the Department of Aging and Disabilities to conduct a statewide survey and study of all dialysis treatment in Vermont. The report must identify all funding mechanisms currently paying for dialysis treatment in Vermont, identify existing gaps in the delivery system and explore alternatives to the present delivery system, including the use of mobile dialysis units. The report is due by November 15, 2003, to the House and Senate Committees on Health and Welfare and to BISHCA to assist that agency in developing the new health resource allocation plan. The bill is up for final approval in the House on Tuesday, May 6.

Birth Information Network (S. 159)

The House gave its preliminary approval to S.159, a bill that directs the Commissioner of Health to establish a birth information network designed to identify newborns that have special medical needs. Under the proposal, the Commissioner of Health must appoint an advisory committee to comment on the effectiveness of the birth information network and to gather information about funding opportunities. The advisory committee shall be composed of representatives from the primary organizations involved in network data collection and use. The Department of Health is authorized to collect information for the birth information network. The Commissioner of Health, in collaboration with appropriate partners, is authorized to "coordinate existing data systems and records to enhance the network's comprehensiveness and effectiveness" including such data systems as vital records, the Medicaid claims database, the hospital discharge data system and health records, (such as discharge summaries, disease indexes, nursery logs, pediatric logs, and neonatal intensive care unit logs) from hospitals, outpatient specialty clinics, genetics clinics, and cytogenetics laboratories. The bill will be up for final action on Tuesday, May 6th.

Agency of Human Services Reorganization (H.450)

H.450, a bill that authorizes the Secretary of the Agency of Human Services to restructure the agency, remains in the Senate Health and Welfare Committee. Due to a lot of action on the Senate floor this week and the work the committee did on H.128, the CON bill, the committee did not take additional testimony on this bill this week as expected. The committee is scheduled to mark up this bill on Monday, May 5th. This bill is likely to pass this year. The bill as it passed the House.

Safety Seats (S.25)

The House Transportation Committee advanced S.25, the bill that proposes to institute new requirements for restraining children in vehicles. The bill as advanced by the House Transportation Committee would require all occupants in a motor vehicle under the age of 16 to be properly retrained, including the use of booster seats, among other things. The committee voted to include a provision that makes the use of these restraints a "secondary offense" meaning that a driver must be stopped for the violation of another law before he or she can be ticketed for failure to properly restrain a child in the vehicle. VAHHS supports this bill. The bill is up for action this week on the House floor. Here is a link to the House Calendar for May 5, 2003, with the text of the bill as it was approved by the House Transportation Committee.

Professional Regulation H.449

This week the House passed H.449, a bill that revises miscellaneous laws in the Office of Professional Regulation. The bill makes revisions to the statutes affecting clinical mental health workers, optometrists, pharmacists, chiropractors, and naturopathic physicians, among others. It also requires that pharmacy technicians be registered with the State for the first time. One amendment added on the House floor requires that persons filing for a "sunrise report" to be licensed for the first time, or a change in the form of regulation, must pay a filing fee of $2,500, and another $5,000 for proposed legislation or rules to be drafted to regulate the profession. These fees for drafting of legislation and regulations are unprecedented and some regulated professions are working to change them. The Senate Government Operations Committee will meet to discuss the bill on May 7 at 8 a.m.

Mandatory Child Abuse Reporting (S.93)

The House Judiciary Committee unanimously advanced S.93, a bill that adds members of the clergy as those that are required to report suspected cases of child abuse. The bill adds criminal penalties to all of those who are required to report under the law, including health care providers and hospital administrators. The bill is up for action on the House Calendar this week.

Annual Report Due Date of Behavior Health Care Task Force (H.96)

The Senate Health and Welfare Committee voted unanimously to advance H.96, a bill that makes a slight change to the date that the annual report from the behavior health care task force is due to the General Assembly. The bill is up for action on the Senate floor on Tuesday, May 6th. The bill as it passed the House (the Senate is not proposing any changes to it so it is the same language that is up for action on the Senate floor).