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For the week ending April 16, 2004
The question of how to best reform Vermont's health insurance market took center stage this week as the House prepares for a full debate on the floor next week of H.759, the remnants of Governor Douglas's "bucket bill." At dueling press conferences this week the Democrats and Republicans outlined their respective health care reform proposals that highlight the philosophical differences between the parties. Republican Governor Jim Douglas and the House Republicans support a market approach that provides small businesses that are not currently providing health insurance coverage to their workers with a tax credit as an incentive to offer coverage. The House Democrats, on the other hand, propose to allow small employers to buy into a state-sponsored health insurance program as a means to provide health insurance for their employees and also allow uninsured individuals to join the program. At his weekly press conference, the Governor charged that the proposal the Democrats offered must not be serious given that it has been proposed so late in the session. The Democrats shot back by pointing out that they had announced their health care reform plan as early as December, 2003. Given that it is an election year and the House is closely divided, the lively floor debate on this bill will be aimed as much at the press and those outside of the State House as it will be to persuade fellow legislators inside the building.
Health Insurance Market Reform (H.759)
By a 6-5 vote, the House Appropriations Committee advanced H.759, the Governor's health care "bucket bill" this week. The only change the committee made to the bill was to strike the section that makes the failure of health insurance companies to settle claims promptly an unfair trade practice. On Tuesday, April 20th, the bill will be up for action on the House floor. At their caucus this week, the House Republicans appeared united in supporting the Ways and Means Committee version of the bill which contains the tax credits for employers offering high deductible health savings accounts and healthy living discounts, but not the $15 million tax on hospitals. The House Democrats are offering a buy-in program for small employers as an alternative to the tax credits. Here is a link to the House Calendar for Tuesday, with the text of H.759, as advanced by the Ways and Means and Appropriations Committees, as well as the buy-in amendment to be offered by Rep. Michael Fischer, D-Lincoln, and Rep. Steve Maier, D-Middlebury.
Mental Health (no bill number yet)
The House Heath and Welfare Committee took one day of testimony this week regarding Vermont's mental health system. They distributed a 16-page draft bill that proposes to authorize the secretary of human services to develop a strategic plan related to mental health services. The existing Vermont State Hospital (VSH) advisory committee, of which Bea Grause and Dr. Peter Tomahow (CVH) are members, would advise the secretary on developing the strategic plan. If for some reason the existing VSH advisory committee could not serve this purpose, a new advisory committee would be established, and designated hospitals would be represented. The bill also creates a legislative oversight committee to oversee the development and implementation of the strategic plan. By January 1, 2005, the secretary must file a report containing recommendations for replacement of the functions of the Vermont State Hospital, among other things. The bill also contains provisions related to transportation of patients in state custody and imposing VSH licensing standards.
Medical Marijuana (S.76)
The House Health and Welfare Committee took two days of spirited testimony from both proponents and opponents of S.76, a bill to legalize medical marijuana. The committee intends to take the bill up again on April 27, 2004. Here is a link to the bill as it passed the Senate last year.
Naturopathic Physicians (S.184)
This week the House Health and Welfare Committee took up S.184, a bill that requires insurance companies to cover services provided by naturopathic physicians. They heard extensive testimony from both proponents and opponents of the bill but took no action. The committee intends to decide whether they want to move forward with this bill on Tuesday, April 20th. Here is a link to the bill as it passed the Senate.
Whistleblower (S.154)
The House Judiciary Committee took testimony this week on S.154, the bill that provides whistleblower protections for hospital employees. The committee heard from a number of witnesses in favor of the bill, including Jennifer Henry a nurse representive of the union at Fletcher Allen Health Care. The committee intends to take the bill up again next week and Bea Grause is expected to testify. Here is a link to the text of the bill as it passed the Senate.
Fee Bill - Hospital & Nursing Home Provider Tax/Hospital Licensing Fees (H.772)
Lucie Garand testified before the Senate Finance Committee this week in favor of the hospital licensing fees and provider tax in the fee bill, H.772. VAHHS worked closely with the Department of Health (DOH) over the past several months to develop a comprehensive reporting and surveying system for quality in Vermont hospitals. The Association has agreed to the fee arrangement over the next three years provided that the Commissioner reports directly to VAHHS's Board on the oversight process. VAHHS and DOH will work on language to submit to the Senate Finance Committee early next week outlining this proposal. With regard to the hospital provider tax, VAHHS is working with the Office of Vermont Health Access (OVHA) to ensure that the state does not over-tax hospitals and that the return to hospitals via Medicaid payment rates is as equitable as possible. Here is a link to the bill as it passed the House.
Respiratory Therapists (H.609)
H.609, a bill that proposes to license respiratory therapists, passed the House this week. The bill was then referred to the Senate Rules Committee. This week VAHHS and the respiratory therapists worked to resolve an issue that two registered polysomnographic technologists (RPSGT) raised about the bill. Once that issue is resolved the Senate Health and Welfare Committee will likely formally ask the Senate Rules Committee for this bill in order to take testimony on the bill. Here is a link to the bill as it passed the House.
Long Term Care 1115 Waiver (H.735)
The Senate Health and Welfare Committee advanced H.735, 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. The committee made a revision to the bill related to hospital discharges that VAHHS is reviewing to see if it needs to be fixed. Here is a link to the Senate Calendar for Tuesday, April 20th, with the text of H.735 as advanced by the Senate Health and Welfare Committee.
Long Term Care Insurance/Vermont Partnership for Long Term Care (H.737)
The Senate Finance Committee advanced H.737, a bill that proposes to bring 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 assets to purchase long term care insurance to cover at least three years of long term care services. Here is a link to the Senate Calendar for Tuesday, April 20th, with the text of H.737, as advanced by the Senate Finance Committee.
Workers' Compensation (H.632)
The Senate Finance Committee took testimony this week regarding H.632, the Governor's bill to reduce the cost of workers' compensation insurance rates. The committee made no decisions about the section of the bill related to the implementation of a medical fee schedule for medical, hospital, pharmaceutical and durable medical equipment claims. The Committee will likely take the bill up again next week. Here is a link to the Senate Calendar for April 8, 2004, with the text of H.632 as approved by the Senate Economic Development, Housing and General Affairs Committee.
Civil Monetary Penalties (H.566)
H.566, a bill that proposes to impose civil monetary penalties for provider fraud, passed the Senate this week. The Senate-passed version of the bill covers provider fraud only when it is done with "actual knowledge." The House-passed version contains a section making "reckless disregard" (or unintentional acts) actionable. A conference Committee has been appointed consisting of the following members: Rep. Michael Kainen, R-Hartford, Rep. Richard Marek, D-Newfane, Rep. Bill Lippert, D-Hinesburg, Sen. Dick Sears, D-Bennington, Sen. John Bloomer, R-Rutland, and Sen. Susan Bartlett, D-Lamoille. The conference committee has not met to date.
Pain Management/Advance Directives (H.752)
The Senate Health and Welfare Committee took testimony regarding H.752, a bill related to pain management and advance directives this week. They were focused on the provisions related to the ability of a person to control the disposition of his or her remains after death. H.752 authorizes an individual in his or her durable power of attorney for health care to appoint an agent to direct the manner of disposition of the individual's remains after death. Senator Diane Snelling, R-Chittenden, introduced S.231, a bill that proposes to allow an individual to execute a "declaration of final disposition" to govern how his or her bodily remains will be treated after death. When it continues its work on this bill next week the committee is likely going to incorporate some version of S.231 into H.752. Here is a link to H.752 as it passed the House:
Here is a link to S.231 as it was introduced.
BISHCA Housekeeping Bill (S.247)
This week the Senate accepted the House proposal of amendment on S.247, a bill that contains miscellaneous housekeeping provisions related to BISCHA. This means the bill will not have to go to a conference committee but will head directly to the Governor for his consideration. 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.
Capital Construction Bill (H.767)
This week the Capital Construction Bill, a bill that funds capital projects for state government, passed the Senate and a conference committee was appointed to work out the differences in the House and Senate-passed versions of the bill. The bill as passed by the Senate contains the following provisions of interest to hospitals and nursing homes:
-A $485,000 appropriation to the Vermont Economic Development Authority (VEDA) for the North Country Hospital in Newport to assist with the creation of a nine-station hemodialysis center within the hospital. The appropriation requires the North Country Hospital to repay the funds to the state, without interest, in 20 equal annual payments commencing July 1, 2005. The bill also prohibits any portion of this appropriation to be disbursed until evidence is provided to VEDA that federal, community, or other non-state funds are available for this project in the amount of $840,000. (See Sec. 3)
-The bill earmarks to the Vermont State Hospital a total of $625,000 ($25,000 for planning, $500,000 to create two specialized acute stabilization units and $100,000 to soundproof four existing seclusion rooms). Also $150,000 is appropriated for the Department of Corrections to make modifications to existing space to be used as a secure mental health and medical unit for women incarcerated in the Dale II facility (See Sec. 3).
-The bill includes language related to the history and corporate status of the Vermont Veteran's Home. (See. Secs. 76-79).
Here is a link to the bill as passed by the Senate.