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For the week ending February 6, 2004
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Political Overview This week former Senator Peter Shumlin announced that he will not run for Governor in 2004. With Shumlin out of the race, it appears that the Democratic nomination is wide open for Burlington Mayor Peter Clavelle, formerly a Progressive. Clavelle is expected to announce he will run for Governor as a Democrat in 2004 on Saturday, Feb. 8th in Winooski, his hometown.
Since it is now likely that the race for Governor will be a match up between Governor Jim Douglas and Mayor Peter Clavelle, without a third party candidate, partisan politics will almost certainly heat up for the remainder of the legislative session. The House Republicans and the Senate Democrats will be vying hard to score political points for their respective parties for the upcoming election.
The conference committee discussions between the House and Senate on the permit reform bill that stalled last session are an early example of this dynamic. The Senate Democrats charge that the House Republicans and Governor Douglas are unwilling to compromise on key issues in the conference committee because the Republicans want the bill to fail so they can use it against the Democrats in the upcoming elections. This dynamic will almost certainly intensify as the session winds down later this spring.
VAHHS Issues
Health Insurance Reform (H.713) This week the House Health and Welfare Committee started work on H.713, the Governor's health insurance reform bill, the so-called "bucket bill." The hearing started with committee member Rep. Steve Maier, D-Middlebury, placing and assortment of buckets in the middle of the table, including a rusty bucket, riddled with holes and patched with duct tape, a reminder of the metaphor Governor Douglas used in his budget address of health care being a leaky bucket. The committee heard lengthy testimony from the Commissioner and Deputy Commissioner of the Department of Banking, Insurance, Securities and Health Care Administration, regarding health insurance market reform. Information they presented showed that Vermont's nongroup and small group markets are more expensive than other markets because the average age in this pool is nearing 50 and that younger, healthier Vermonters are opting out of the market because it is unaffordable. The committee also learned the mechanics of health savings accounts. The committee will continue taking testimony on this bill for the next few weeks.
Civil Monetary Penalty (H.566) On Wednesday, February 4th, the House Judiciary Committee took testimony on H.566, a bill related to civil monetary penalties for provider fraud. The bill proposes to establish a state false claims act, similar to the federal law. Both the Attorney General's office and Commissioner Mike Hall, of the Department of Prevention, Assistance, Transition and Health Access (PATH) testified in favor of the bill. They support the bill because they claim there is a gap in state law to civilly prosecute those that submit fraudulent Medicaid claims with "reckless disregard" or conscious avoidance." Commissioner Hall also added that he viewed H.566 as an interim bill that would permit prosecution for Medicaid fraud without dropping providers from the Medicaid program. (It was not clear why PATH would want to retain bad actors in the Medicaid program). Bea Grause and Madeleine Mongan from VMS testified in opposition to the bill because: the new standards could put providers at risk for prosecution for inadvertent billing errors; the state has ample legal tools to address Medicaid fraud; and the state has failed to demonstrate a need for the bill.
Whistleblower Protections (S.270, S.154) The Senate Economic Development, Housing and General Affairs Committee took testimony on S.270, and another whistleblower bill, S.154, on Thursday, February 5th. The committee heard testimony from representatives of nurses unions at Fletcher Allen and Copley Hospital and from Steve Kimbell on behalf of VAHHS. The committee asked VAHHS to collect non-retaliation policies that exist at Vermont hospitals and deliver them to the committee. (email request sent 2/6/04) Both bills apply to every Vermont employer but the testimony so far focused on hospitals. The ultimate scope and fate of this legislation remain uncertain. Additional hearings have not been scheduled.
Hospital Licensing Fees/X Ray Equipment Fees The Department of Health (DOH) is proposing significant increases in hospital licensing fees as part of the Douglas Administration's miscellaneous fee bill. The proposal is to increase the hospital licensing fee from a $10 application fee (established in 1949) to a $7,250 base fee, plus impose a new fee of $25 per hospital bed - an increase of 72,400%. A hospital can reduce the base fee to $4,250 if it is accredited by the Joint Commission on Accreditation of Health Care Organizations. These fees are estimate to generate an additional $120,825 per year, which the DOH proposes to use to cover the cost of staff that handles the licensure process.
The DOH also proposes to impose a new x-ray equipment registration fee of $100 per tube per year. This is expected to raise $150,000 to be used to cover the cost of inspecting x-ray machines. Finally, the DOH proposes to raise the licensing fees for physicians, podiatrists, anesthesiologist assistants and physician's assistants, in order to cover the cost of regulating these professions.
The House Ways and Means Committee will take testimony on these fee proposals on February 11th.
Prescription Drugs (S.288) The Senate Health and Welfare Committee took testimony all week on S.288, a prescription drug bill. Chair Senator Jim Leddy, D-Chittenden, anticipates additional hearings over the next two weeks. This week, the committee heard from the attorney general's (AG) office, pharmacists, a benefit manager of a health insurance trust, pharmacy benefits managers and federally certified rural health clinics.
The key issues identified by the committee are "transparency" of pricing of prescription drugs and the ability of health plans to audit. The bill would give the AG investigative powers with respect to pharmaceutical marketing companies.
The Attorney General's office offered a fairly sweeping amendment to section 1 of the bill. This amendment would require all pharmacy benefit managers to provide to pharmacists an electronic cost list with the "cost" of each prescription drug provided under each pharmacy benefit management plan, including the cost to the plan and the co-pays paid by the consumer. Pharmacists would be required to provide, upon request of customers and health care providers, the cost from the cost list or the "usual and customary" price to customers who are not beneficiaries of a pharmacy benefit management plan. The bill would apply to pharmacists when the pharmacist updates its computer software, but in no event later than 1/1/06. To the extent hospitals have pharmacies this provision may affect them.
Department of Aging and Disabilities FY05 Budget Department of Aging and Disabilities (DAD) Commissioner Patrick Flood testified before the House Appropriations Committee this week regarding his department's FY05 budget. According to Flood the nursing home budget is projected to increase by $5.7 million in FY05. This is due to an annual inflation increase of approximately $1 million; approximately $2 million for re-basing proposed to take effect on January 1, 2005 (this figure represents the cost for 6 months); and to cover the projected average daily rate for Medicaid for FY 05 of approximately $153 after re-basing takes place. In addition, the Waiver budget is proposed to increase $4,030,769, including 100 new home and community based Waiver slots.
Advanced Directives/Palliative Care On February 17th and 18th, the House Health and Welfare Committee plans to hear recommendations from the Attorney General's workgroup regarding amendments to Vermont's advanced directives statutes and the on issue of palliative care. There is some discussion in the AG's group to propose an amendment to the hospital and nursing home bill of rights to say that a patient has a right to a pain assessment and treatment and to require continuing medical education on palliative care for physicians and nurses.
Long Term Care The status of the three long term care bills that the House Health and Welfare Committee advanced last week is as follows:
H.735, Long Term Care 1115 Waiver Bill - This is the bill that relates
to the federal Medicaid 1115 waiver application that the Department of
Aging and Disabilities (DAD) submitted to CMS to enable home and community-based
services to be an entitlement the same way that nursing home care is
today. This bill passed the House on Friday, February 6th.
H.736, Funding for Home and Community Based Services - This bill provides
for a $2.3 million general fund appropriation to the agency of human
services for the provision of home and community based services to accommodate
the initial growth in those services due to the Medicaid 1115 Waiver.
The bill was referred to the House Appropriations Committee.
H.737, Long Term Care Insurance/Vermont Partnership for Long Term Care
- This bill brings Vermont law in line with the National Association
of Insurance Commissioners (NAIC) model law on long term care insurance.
This bill also proposes to establish the Vermont partnership for long-term
care services that would require the state to seek another waiver from
the federal government to provide an incentive to Vermonters with a lot
of assets to purchase long term care insurance to cover at least three
years of long term care services. Action on this bill on the House floor
was postponed until February 11th to allow the House Commerce Committee
time to review the bill.
Nursing Home Wage Supplement H.585, the FY04 Budget Adjustment bill, passed the Senate this week. The House version contains $300,000 in general funds for the nursing home wage supplement, which will draw down federal matching funds. The Senate version contains $233,000 in general funds, which will draw down approximately $367,000 in federal funds for a total of $600,000. A conference committee will likely be appointed to work out of the differences in the House and Senate passed versions of the bill. This will likely be one item the conference committee will consider.
Vermont State Hospital Agency of Human Services Secretary Charlie Smith and Department of Developmental and Mental Health Services Commissioner Susan Besio testified before the House Institutions Committee this week regarding the Vermont State Hospital (VSH). The testimony focused on the history of the hospital and the recent decertification by CMS. Commissioner Besio said the Department must define the clinical profiles of patients and the number of patients that truly need to be at the VSH before deciding what to do with the infrastructure. Commissioner Besio stated that the Department needs to talk with both community hospitals and mental health centers to see whether they are capable of treating some VSH patients. There is talk of a summer study committee to look at the issues around mental health. Secretary Smith prefers a legislative oversight committee in lieu of a summer study. Smith stated that an oversight committee worked well with the AHS reorganization and believes it will be more effective than a summer study.
Respiratory Therapists (H.609) This week the House Ways and Means Committee voted 10-0-1 to advance H.609, a bill to license respiratory therapists. The bill was then referred to the House Appropriations Committee. It will likely remain in that committee until they complete the FY05 budget bill sometime in early March.
Methadone (S.279) The Senate passed S.279, a bill related to methadone. The bill includes the following provisions:
Expanded scope of opiate treatment providers - The bill removes the
requirement that methadone clinics must be hospital based and gives authority
to the Commissioner of Health to approve qualified treatment programs.
Qualified treatment programs include mobile methadone treatment (3 units
to serve up to 600 people); buprenorphine medication treatment hubs (the
proposal is to establish programs where treatment is initiated at a central
location and once a patient is stabilized, long term care will be managed
by doctors out of their offices); and outpatient methadone treatment
programs (allow centers similar to FAHC but outside hospitals). * Overdose Prevention - The bill creates an overdose prevention program to improve monitoring of drug overdose death data; expand education and outreach; expand the use by first responders, hospitals and opiate addicts of the medicine that can rescue a person from overdosing on drugs; and report on whether those seeking emergency care for an overdosing person should be afforded immunity from criminal prosecution, among other things. * Inmate Treatment - The bill requires that short-term inmates and detainees that are undergoing opiate treatment be allowed to continue the treatment while in Vermont prisons.
The bill was referred to the House Health and Welfare Committee.
Public Hearing on End of Life Care
The House and Senate Health and Welfare Committees will jointly hold a public hearing regarding "End of Life Care: Choices and Challenges," on Thursday, February 26, 2004, at 7 pm in Room 11 of the State House.
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