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For the week ending April 23, 2004
In anticipation of a hotly debated election season, the General Assembly is moving toward an earlier than usual adjournment this year. It is likely that the legislature will adjourn by the second or third week of May. One hallmark sign that the session is drawing to a close came this week as the Senate Appropriations Committee advanced the FY05 budget bill (H.768) to the full Senate for debate. As a rule of thumb, it takes two to four weeks for the session to end after the Senate passes the budget bill. Over the past week there has also been a noticeable shift from lawmakers working in their respective standing committees to working in conference committees, consisting of three House members and three Senate members, where they hammer out the differences in the House and Senate-passed versions of key bills. In the second year of the biennium there is always the possibility that the session will be held up if one body insists it must have a particular bill before going home. Past sessions were delayed by bills related to mercury labeling and reapportionment. It is unclear at this time if any "sleeper" bill will emerge to hold up the 2004 session once the budget bill passes both bodies.
Health Insurance Market Reform (H.759)
This week the House passed H.759, the Governor's health care "bucket bill," by a vote of 76-63. Significantly for hospitals, the House rejected the $15 million provider tax on hospitals. The House-passed bill contains the following provisions: tax credits as an incentive for employers to offer high deductible health savings accounts to their employees; a Health Care Cost Containment Council; healthy living discounts for health insurers; provisions related to common claims forms (including a bill back provision that requires hospitals to pay 50 percent of the cost); an "any willing provider" mental health mandate for health insurers; a section that makes the failure of health insurance companies to settle claims promptly an unfair insurance trade practice; and provisions related to a statewide health care information database plan. The House Democrats' amendment to require the state to contract with a private insurance company in order to allow small employers to offer health insurance to their employees failed by a 61-80 vote. After the bill passed the House it was referred to the Senate Rules Committee. It is unclear at this time what Senate committee, if any, will take the bill up. Here is a link to the bill as it passed the House.
FY05 Budget Bill (H.768)
The Senate Appropriations Committee unanimously voted to advance H.768, the FY05 budget bill. The bill contains a $1.5 million increase in FY05 for hospital inpatient rates, similar to the House passed version of the bill. The $5.4 million for nursing home rebasing (for 5 months in FY05) and the $1 million for the nursing home inflation factor remained unchanged from the House-passed version of the bill. A few changes the Senate Appropriations Committee made to the House-passed bill include:
-added $250,000, along with federal matching funds, to be used to increase reimbursement paid for specific procedures by Medicaid when access by Medicaid beneficiaries to those services is threatened by increasing malpractice insurance costs to service providers (the department of PATH, in consultation with the Vermont Medical Society, is directed to identify the procedures based on percentage and dollar premium increases and volume of care paid for by Medicaid) (Sec. 128(b))
-added a modified version of S.156, the bill related to a medical malpractice study committee, that requires hospitals to provide certain information to BISHCA (Sec. 292)
-removed the "sustainable health care study committee" that was directed to review activities in other states and other sources of information on sustainable financing of health care programs (especially Medicaid) and submit a report to the General Assembly (See Sec. 290 of the House passed bill).
- removed a study regarding the development of a self-insurance pool for small businesses in Vermont (See Sec. 287 of the House passed bill).
-added $60,000 general fund (plus $90,000 federal matching funds) to give a one percent increase in Medicaid payments to dentists (the House also included this increase in their version of the bill but the Governor did not)
- added a section that requires that when the commissioner of BISHCA and the commissioner of health, are issuing a license to a hospital or approving a hospital budget, they must ensure the applicant hospital has rules and procedures in place to protect patient privacy particularly in regard to the transcription of medical records that are performed through contracts where the contractor is based outside Vermont (Sec. 83)
- contains many prescription drug cost control mechanisms from S.288, the prescription drug bill that passed the Senate
-adds a section related to the powers and duties of the "Medical Care Advisory Committee" (formerly known as the Medicaid Advisory Committee) (Sec. 130a)
- creates an advisory committee comprised of various state officials and interested parties to study the mental health system (Sec. 141)
Here is a link
to the bill as it was advanced by the Senate Appropriations Committee.
Workers' Compensation (H.632)
A House-passed bill making changes to Vermont's Workers' Compensation law (H.632) was approved on April 23rd by the Senate Finance Committee, which added language directing that the cost control mechanisms for all medical services required by an earlier version of the bill be "designed to lower overall costs of those services and supplies by at least four percent." The services included in this requirement are "medical, surgical, hospital, nursing services and supplies, prescription drugs, and durable medical equipment." Depending on the rules that are issued to implement this requirement, it could have an effect on reimbursement to hospitals. An earlier version of this amendment requiring a 10 percent reduction in reimbursement to hospitals only was rejected by the committee after a representative of VAHHS testified about the cost shifting effect that such a provision would have. There is no similar requirement in the House-passed bill, so this provision will be a subject of conference committee deliberations if the bill passes the Senate, which is likely. The Senate version of this bill would create a new Workers' Compensation Fraud Unit with two employees within the Department of Labor and Industry. This provision may cause the bill to be referred to the Senate Appropriations Committee before it reaches the Senate floor. Here is a link to the Senate Calendar for Monday, April 26, 2004, with a copy of the bill as advanced by the Senate Finance Committee.
Mental Health (H.588)
The House Health and Welfare Committee advanced H.588, a bill related to studying and reforming Vermont's mental health system. The bill will now likely go to the House Appropriations Committee and may even be placed in the FY05 budget bill (H.768) when the budget bill is in a conference committee. Here is a link to the House Calendar for Tuesday, April 27, 2004, with the text of the bill as advanced by the committee.
Whistleblower (S.154)
Bea Grause testified in opposition to S.154, the whistleblower bill, in the House Judiciary Committee this week. At the direction of the Committee Chair, Bea is negotiating with representatives of the nurses union to see if there is a compromise proposal that all parties can support. The committee intends to take the bill up again next week. 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)
The Senate Finance Committee continued working on H.772, the miscellaneous fee bill. The bill contains new fees to cover hospital licensing by the Department of Health that are phased-in over a three year period. The proposal as it stands now sets a base fee for each hospital at $6,421 in calendar year 2005, $7,450 in 2006, and $7,667 in 2007. The base fee for each hospital that is accredited by the Joint Commission on Accreditation of Health Care Organizations is reduced by $3000 in 2005, and $2,750 in 2006 and 2007. On top of the base fee, there is a per bed fee of $20.00 for each licensed bed in calendar year 2005 and 2006, which increases to $25 in 2007. The Senate Finance Committee also included an annual fee of $100 per x-ray tube to fund an x-ray radiation safety program. The hospital and nursing home provider taxes are also revised in the bill. Here is a link to the bill as it passed the House.
Respiratory Therapists (H.609)
The Senate Health and Welfare Committee voted 5-0-1 to advance H.609, a bill that proposes to license respiratory therapists. The committee made minor revisions to the bill to resolve issues involving registered polysomnographic technologists (RPSGT) and anesthesiologist assistants. The bill is in the Senate Rules Committee so Sen. Jim Leddy, D-Chittenden, will have to formally ask for the bill before the bill can move forward. It is unclear at this time if the bill has to go to the Senate Finance Committee before it goes to the full Senate for a vote. Here is a link to the bill as it passed the House.
Long Term Care 1115 Waiver (H.735)
At the request of VAHHS and the Department of Aging and Disabilities (DAD),
this week the Senate Health and Welfare Committee advanced a "substitute" or
corrected version of H.735, the bill that relates to the federal Medicaid 1115
waiver application that DAD submitted to CMS to enable home and community-based
services to be an entitlement the same way that nursing home care is today.
VAHHS requested that the language involving hospital discharges be revised
and as a result now supports the substitute report of the committee. Here is
a link
to the Senate Calendar for Monday, April 26, 2004, with the substitute
report of Senate Health and Welfare Committee.
Long Term Care Insurance/Vermont Partnership for Long Term Care (H.737)
The Senate passed 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 a portion of long term care services. Here is a link to the House Calendar for Tuesday, April 27th, with the text of H.737, as passed by the Senate.
Pain Management/Advance Directives (H.752)
The Senate Health and Welfare Committee took additional testimony regarding H.752, a bill related to pain management and advance directives this week. They will continue taking testimony next week. Here is a link to H.752 as it passed the House.
S.288, Prescription Drugs/S.279, Opiate Treatment
The House Health and Welfare Committee started taking testimony on S.288, a prescription drug bill this week. The committee will continue taking testimony next week. It is possible the committee will incorporate the language in S.279, related to opiate treatment, into S.288. Here is a link to S.288 as it passed the Senate.
Here is a link to S.279 as it passed the Senate.
S.54, Optometry
By a 10-1 vote, the House Health and Welfare Committee advanced S.54, a bill that revises the scope of practice of optometry. The committee proposed no changes to the Senate-passed version of the bill. Here is a link to the bill as it passed the Senate.