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Political Overview
The Vermont General Assembly reconvened Tuesday, January 6, 2004, for the second year of the current biennium. Bills that did not pass during the first year of the biennium are still alive and will pick up where they left off in the process. Leadership and committee assignments carry over from the first year.
The House of Representatives is made up of 74 Republicans, 69 Democrats, 4 Progressives and 3 Independents, for a total of 150 members. The Senate has 19 Democrats and 11 Republicans among its 30 members. Speaker Walter Freed, R-Dorset, presides over the House and is the political leader of the Republicans. Republican Lieutenant Governor Brian Dubie presides over the Senate, but the political leader of the Senate is President Pro Tem Peter Welch, D-Windsor. The Lieutenant Governor wields the gavel and breaks tie votes but has little other power.
Governor Douglas gave his State of the State Address on Tuesday, January 6th to a joint assembly of the House and Senate. The only surprise in the speech was his proposal for “tax equity” for both individual and corporate tax payers. For example, the Governor is proposing to increase taxes on some well-off Vermonters by eliminating the 40 percent exemption for long-term capital gains so that low to moderate income Vermonters will pay less. This was well received by members of all parties in the General Assembly.
The State of the State Address did address health care but was short on specifics.
Governor Douglas said in the weeks ahead he will “present a series of
carefully crafted proposals that will make improvements to the health care
delivery system and make Vermont’s health care laws more flexible so
that consumers can have more low cost options that address their individual
circumstances.” One of the Governor’s proposals will almost certainly
be revisions to Vermont’s community rating law for health insurance.
On Tuesday, January 20th, the Governor will give his budget address for fiscal
year 2005 before a joint assembly. It is possible that some of his key health
care initiatives will be unveiled as part of that speech.
VAHHS Issues
Both the House and Senate Health and Welfare Committees met this week and discussed their priorities for the session.
The House Health and Welfare Committee
The House Health and Welfare Committee will discuss long term care issues for the month of January, including the 1115 waiver, allocation of nursing home beds, assisted living, nursing home rate setting (they want to understand it), long term care insurance and advanced directives such as living wills and health care powers of attorney. The Committee will next move to mental health issues including the Vermont State Hospital, community mental health, children’s mental health, implementation of Vermont’s health insurance parity law for mental health and substance abuse conditions and looking at the intersection of mental health and corrections. The Committee will also take testimony regarding the federal Medicare law and how it will mesh with Vermont’s prescription drug programs. It is worth noting one issue the committee will NOT take up this session. Chair Rep. Tom Koch, R-Barre Town, said that the physician assisted suicide bills “will remain on the wall” and will not be advanced by the committee this year because there are not enough votes in the Senate Health and Welfare Committee to pass these bills even if the House acted. The Committee will, however, hold a public hearing on February 4th and 5th on end of life care at the State House to continue the public dialogue on this issue (so many witnesses already signed up to testify that they are no longer taking names).
The Senate Health and Welfare Committee
The Senate Health and Welfare Committee will start the session by working
on drug abuse treatment and prescription drug reimportation and other provisions
in S.288, a prescription drug bill that Sen. Jim Leddy, D-Chittenden, sponsored.
Here is a link to S.288
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2004/bills/intro/S-288.htm
The committee will also review the implementation of premiums in the Medicaid
program, a bill related to optometrists (S.54) and a bill that will expand
the facilities where methadone can be distributed beyond hospitals (S.279)
(see attached link).
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2004/bills/intro/S-279.htm
On Jan. 28th, the committee is holding a hearing regarding the cost of health
care and its impact on employers. No date has been set yet but they also intend
to hold a hearing for health care providers to discuss health care coverage.
Long Term Care
This week Department of Aging and Disabilities Commissioner Patrick Flood
testified before the House Health and Welfare Committee on the 1115 Waiver
that will create an entitlement to home and community-based services paid for
by Medicaid to complement the entitlement to nursing home care that exists
now. The Douglas Administration submitted the application for this 1115 Waiver
to the federal government for approval this fall. Commissioner Flood said that
the average cost of caring for someone through home and community-based services
is about two-thirds the cost of nursing home care. In previous testimony he
said it was half as expensive. Flood has not yet completed a study documenting
the full cost to the state, beyond Medicaid, of home and community-based care,
but some members of the committee asked for that information again. Commissioner
Flood also reported that he hopes to create a new 30 - 40 bed nursing home
facility in Orange County to replace Brookside in Bradford. The Brookside facility
is the proposed site of a new 80-bed drug treatment facility.
Jill Olson from VAHHS testified before the committee outlining concerns regarding
the 1115 Wavier relating to hospital capacity, the need for a strong nursing
home system and weakness in the quality oversight plan proposed by the Department.
She also reiterated VAHHS’s support of efforts to create incentives
for long term care insurance.
A number of advocates for elderly and disabled Vermonters testified as well,
mostly in support of the waiver proposal.
Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) Commissioner John Crowley testified about long term care insurance. He outlined the existing long term care insurance statutes and regulations. Crowley suggested that the legislature amend Vermont’s law to bring it in line with the National Association of Insurance Commissioners (NAIC) model law on long term care insurance. Crowley will present suggested amendments to Vermont’s long term care insurance statutes to the committee within the next few weeks.
VAHHS Inpatient Mental Health Committee
VAHHS’s Inpatient Mental Health Committee met this week with Sen. Jim Leddy, D-Chittenden, Rep. Tom Koch, R-Barre Town and Rep. Anne Donahue, R-Northfield, to discuss mental health issues. The VAHHS committee let the legislators know that they want to be involved in discussions about mental health issues and offered assistance to the legislators.
Dialysis Services
The House Health and Welfare Committee will hear from Dartmouth Hitchcock Medical Center, Fletcher Allen Health Care, North Country Hospital and Northeastern Vermont Regional Hospital regarding starting up a dialysis program in the Northeast Kingdom. A hearing is scheduled for January 21, 2004, on this issue.
Act 53 Implementation Update
Deputy Commissioner of the Division of Health Care Administration within BISHCA, Paulette Thabault, provided an update to the House Health and Welfare Committee on implementation of the hospital regulation bill that passed last year (Act 53). They have sent letters to the 13 individuals chosen to sit on the Health Resources Allocation Plan (HRAP) Advisory Committee. The advisory committee’s first meeting is scheduled for February. BISHCA is also in the process of assessing existing health care data and is seeking grants to assist in the preparation of the HRAP; assembling workgroups to develop the community report formats and content that will be incorporated in rules; and working with VAHHS to prepare an initial draft of the community assessment format. They are also going to hire a consultant to help them develop the HRAP and are in the process of reviewing the applications received through a competitive bid process before awarding the contract.
FY04 Medicaid Budget Adjustment
The Senate Appropriations Committee heard from Agency of Human Services Secretary Charlie Smith this week about areas in the FY04 budget that need adjustment. With regard to Medicaid, the agency is proposing a total of $22 million in increased spending for FY04 ($7.5 million state funds with $14.5 federal matching funds). The $22 million is divvied up as follows:
Removal of cost sharing obligation for Medicaid - $7.2 million
Lund Home - $600,000
Nursing homes - increased utilization/Veterans Home - $5.5 million
Physicians - to cover increased cost per claim, enrollment and acuity of patients
- $3.2 million
Pharmacy - higher cost per claim - $1.9 million
Personal Care services - $1.7 million
Other services - increased utilization (mental health, chiropractors, psychiatrists,
etc.) - $1.6million
The $7.2 million for removing co-payments and other cost sharing obligations for Medicaid recipients will likely be offset by premiums collected by the state in the next few months. Also, the vast majority of the $5.5 million for nursing homes will go to the Veterans Home and they are providing funds to draw down a federal match to cover this. Therefore, according to Smith, these two items are “a wash” in terms of cost to the state.
S.247, BISHCA Housekeeping Bill
S.247 contains “housekeeping amendments” to some statutes under
BISHCA’s purview. One amendment of interest to hospitals is a change
to last year’s hospital regulation bill (Act 53) whereby the $1 million
CON threshold for both hospital and non-hospital projects involving the purchase
or lease of a single piece of “durable medical equipment” will
be changed to the purchase or lease to a single piece of “diagnostic
and therapeutic equipment.” This is clarify the intent of Act 53 to ensure
that this $1 million threshold applies to diagnostic equipment such as MRIs
and not just pieces of durable medical equipment such as wheelchairs. The bill
states that this provision will apply retroactively to all health care projects
on or after July 1, 2003.