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For the week ending April 2, 2004
In the interests of wrapping up the session, the Senate this week attempted to put the breaks on all new bills coming over from the House. Much to the chagrin of many House members, the Senate adopted a resolution that requires all House bills that come to the Senate for the first time after April 1st to go to the Senate Rules Committee, with the exception of key bills such as the budget and fee bill. This means that the five-member Senate Rules Committee must agree to release a bill and send it to the appropriate senate committee or it will die in the rules committee. A few bills of interest to VAHHS, including H.759, the Governor's health care bucket bill, H.609, the bill to license respiratory therapists and H.752, the bill related to advance directives/pain management, will be sent to the rules committee if they pass the House. Of course if Senators really want to pass a particular bill this extra hurdle is no obstacle.
As we enter the last six weeks of the session, money bills will take center stage. The Governor's "tax equity proposal," would revise the way that capital gains are taxed and the way that corporations report income and redistribute the resulting additional state tax revenue to other taxpayers, remains in the House Ways and Means Committee. Republican House Speaker Walter Freed fears that if this bill moves out of the House the Senate Democrats will spend the approximate $15 million generated by closing these tax loopholes, rather than reduce taxes. The Senate Democrats are in fact planning to direct these funds into social service programs such as Medicaid, that have large projected deficits. The FY05 budget is balanced but the state projects a $40 million Medicaid deficit for FY 06. Medicaid's impending deficits is clearly part of the discussion this year.
H.759, Health Insurance Market Reform
By an 8-3 vote, the House Ways and Means Committee approved its version of H.759 on Friday, April 2nd. Their version contains a tax credit for small employers offering health savings accounts and pays a portion of the savings account deposits and deductibles (limited to $4 million starting in FY06). This bill also contains the "healthy living" discounts for insurance rates, an "any willing mental health provider" section and an insurance trade practices section. Significantly, the $15 million hospital provider tax was removed along with the reinsurance pool for the small and non-group markets the tax was intended to fund. The Health Care Cost Containment Council was also deleted. It is unclear at this time if the bill will be referred to either the House Appropriations Committee or the House Commerce Committee. If not, the bill could be up for debate on the House floor as early as Wednesday, April 7th. House Democrats may try to substitute a VHAP Buy-In or similar proposal on the floor, arguing that the $4 million cost of the tax credits could be better spent another way. Here is a link to the House Calendar for April 6, 2004, with the amendments approved by the House Ways and Means Committee.
Workers' Compensation (H.632)
The Senate Economic Development, Housing and General Affairs Committee is working hard on H.632, the Governor's bill to reduce the cost of workers' compensation insurance rates. This bill affects hospitals both as employers, who have an interest in reducing workers' compensation insurance premiums they pay for their employees, and as providers of medical services to injured workers. The parts of the bill that may interest hospitals as employers include provisions that increase the penalties for workers' compensation fraud, simplify compensation rates, impose a penalty on insurers for late payment of compensation benefits, reduce the statute of limitations for filing claims from six to three years, authorize rules regarding vocational rehabilitation, clarify the burden of proof for coverage of claims related to on-premise recreational injuries and limit the period of time for which an injured worker may collect temporary disability benefits, among other things. From a medical service provider perspective, the bill now contains a provision to require that the Commissioner of the Department of Labor and Industry impose a medical fee schedule on hospitals (similar to the one that currently exists for physicians) no later than January 1, 2005, and update it no later than every three years thereafter. The bill requires that reimbursement for medical services, hospital services (both inpatient and outpatient) and durable medical equipment be based on Medicare reimbursement methodologies for each area. Currently, hospitals are reimbursed at 90 percent of the charge for the service. The committee has not formally adopted these provisions at this time but will likely complete its work on the bill next week.
Pain Management/Advance Directives (H.752)
The House passed H.752, a bill related to pain management and advance directives this week. A somewhat controversial amendment related to medical marijuana passed on the House floor by a 79-57 vote. That amendment revised Section 10 of the bill, which directs the department of health, in collaboration with interested parties, to investigate and evaluate methods for improving pain management. The amendment requires the study group to develop "enhanced training in pain management, including the use of medical marijuana, in the medical school, residency training programs, and nursing schools in Vermont." Here is a link to the bill as it passed the House. Pursuant to Senate Resolution 25, the bill was referred to the Senate Rules Committee.
Medical Marijuana (S.76)
Late this week by a 6-5 vote, the House Health and Welfare Committee voted to take up S.76, a bill to legalize medical marijuana. The committee scheduled two days of hearings on the bill, April 14 and 15. Here is a link to the bill as it passed the Senate last year.
BISHCA Housekeeping Bill (S.247)
This week the House Commerce Committee advanced S.247, a bill that contains miscellaneous housekeeping provisions related to BISCHA. One provision of interest to hospitals is a change to last year's hospital regulation bill (Act 53) whereby the various CON thresholds 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 to clarify the intent of Act 53 to ensure that these thresholds apply 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. Here is a link to the House Calendar for April 6, 2004, with the text of the bill as advanced by the House Commerce Committee.
Mental Health
The House Heath and Welfare Committee continued to take testimony from numerous interested parties this week on Vermont's mental health system. The committee is expecting to finish taking testimony next week on this issue. Some of the topics that seem to have caught the committee's attention are whether the licensing standards at the Vermont State Hospital should be revised, how individuals with mental health conditions are transported by the department of corrections and the use of restraints. There is no formal bill the committee is considering on this subject so it is unclear at this time what the outcome of this inquiry will be. After they complete their work on mental health, the committee will turn its attention to S.288, the prescription drug bill.
Phosphorus Ban (S.284)
This bill proposes to ban use of soap containing in excess of a trace amount of phosphorus in dishwashers after April 1, 2008. The bill preserves the current exemption for soaps used "for cleansing medical and surgical equipment and food and beverage processing equipment." Those soaps could continue to contain up to 8.7 per cent by weight of phosphorus. Under the bill, however, hospitals, other institutions and restaurants could no longer use soap with more than a trace amount of phosphorus in dishwashers used to clean plates, silver ware, pots and pans and other items used in preparing and serving food or in laundering garments or other cloth. This bill passed the Senate and is pending in the House Natural Resources Committee. Here is a link to the bill as it passed the Senate. VAHHS is determining what impact this bill may have on hospitals.
Fee Bill - Hospital & Nursing Home Provider Tax/Hospital Licensing Fees (H.772)
This week the Senate Finance Committee took testimony on H.772, the fee bill. The bill proposes to increase the hospital base licensing fee from $10 to $1,000 and impose a new $25 per bed fee. This is expected to raise $57,225 per year for the Department of Health (DOH) to administer hospital licensing. DOH Commissioner Paul Jarris testified that his department would like these fees to be increased and that he is still working it out with VAHHS. Licensing fees for physicians, physician assistants and anesthesiologist assistants are also increased in the bill. The bill also increases the hospital provider tax from 4.50 to 4.84 percent of net patient revenue (less chronic, skilled and swing bed revenues) starting July 1, 2004, in order for the state to draw down the maximum allowable disproportionate share hospital (DSH) payments. The bill increases the nursing home bed tax from $3,388.25 to $3,676.06 per bed starting July 1, 2004. Here is a link to the bill as it passed the House.
Civil Monetary Penalties (H.566)
H.566, a bill that proposes to impose civil monetary penalties for provider
fraud, is pending on the Senate Calendar. The Senate is meeting only for an
hour each day to allow for more committee time and they are skipping over bills
that were passed by the House and focusing their attention on bills that have
yet to pass the Senate. The bill no longer contains a section making "reckless
disregard" (or unintentional acts) actionable. Therefore, the bill now
covers provider fraud only when it is done with "actual knowledge." Here
is a link to the Senate Calendar for Tuesday, April 6, 2004, with the text
of the bill as it was advanced by the Senate Judiciary Committee.