2004 Legislative Report

For the week ending February 11, 2005

Political Overview

Governor Jim Douglas today announced major systemic changes in the Administration. Effective February 21, the secretaries of human services and administration are switching positions in the next phase of the Governor's efforts to strengthen government services, save Medicaid and reform health care.

Charlie Smith will become Administration Secretary, state government's equivalent of a chief operating officer and Mike Smith will become Human Services Secretary, overseeing the largest and most costly agency in state government, including Medicaid which is facing huge deficits.

Other changes include: Finance Commissioner Robert Hofmann will become Corrections Commissioner, Steve Gold, the current Corrections Commissioner, will become the Deputy Secretary of the Administration, Personnel Commissioner Cynthia LaWare will become the Deputy Secretary of Human Services and Deputy Commissioner of Budget and Finance James Reardon will fill Hofmann's role as finance commissioner.
In the legislature, health care continued to dominate committee debate, which has not surprisingly, s become more partisan. Republicans held a press conference on Thursday proposing to open the health insurance market to more competition, by allowing Vermonters to import more affordable health insurance from out of state. This proposal seemed in part to be a jab at Democrats’ preoccupation with prescription drug re-importation than a serious policy proposal. The Republicans feel that if we can import drugs from other countries; why not import more affordable health insurance from other states?. Even though the Governor is expected to sign the prescription drug reimportation bill once it passes the Senate, he has complained that he hopes Democrats move on to more serious health care reform issues soon. At any rate, pressure from both sides of the aisle appears to be building on creating a “real” health care solution. With six weeks already gone in this session, time is ticking.
VAHHS Issues
Medicaid
On Wednesday, providers, Josh Slen from the Office of Vermont Health Access (OVHA) and representatives from the Senate committees of Health & Welfare and Appropriations, House committees on Appropriations, Human Services and Health Care met to discuss Medicaid and health care reform. Chaired by Senate Appropriations Chair Susan Bartlett, these weekly meetings are designed to maximize provider input during the Medicaid budget process. This week’s meeting was a very general discussion with no policy decisions. With the release of additional budget details this week from the Administration, these meetings will no doubt become much more detailed and focused.
One concept well received at the meeting is to split the budget and have a health care budget, much like with the current transportation and education budgets.
The committee will be meeting every Wednesday from 3:30 p.m. – 5:00 p.m. in Senate Appropriations.
Mental Health
With the release of the final Vermont State Hospital (VSH) Futures Report last week, a joint hearing of the Mental Health Oversight Committee, Senate Health & Welfare and House Human Services was held on Tuesday afternoon. Agency of Human Services Secretary Charlie Smith stated that they plan to reduce the number of patients at the state hospital from the current level of 50 to 35 over the next 6 weeks. Retreat Healthcare in Brattleboro has begun taking patients and has capacity to take as many as fifteen patients. The four other designated hospitals are also collaborating with Commissioner Jarris to accept additional patient transfers.
Mental health advocates and some lawmakers expressed their concerns about how quickly patients are being moved, but the Administration repeated their resolve to continue with this new strategy because they believe it is in the best interest of the patients.
A team of psychiatrists from the designated hospitals and a psychiatric nurse, led by Dr. Andrew Pomerantz of the VA, did a “peer review” of the written treatment plans for the patients at VSH. The peer review process would give the designated hospitals a better understanding of the patient mix and what roles hospitals want to play. They did not report on the team’s findings.
The Agency will send out a Request for Proposal (RFP) to solicit interest for replacement programs. The agency is recommending 16-subacute beds, 10 hospital diversion beds and 6 secure residential beds. Where exactly these will be located is still under discussion.
House Appropriations
House Appropriations took testimony this week from Dr. Mimi Reardon on behalf of the Area Health Education Centers (AHEC) in Vermont. Dr. Reardon stated that she is very thankful for the ongoing support from Vermont’s 14 acute care hospitals, the University of Vermont College of Medicine, federal grants from the Health Resources and Services Administration, and the General Assembly’s funding of loan repayment programs. Dr. Reardon stated that due to changes in federal policies, AHEC lost $1.25 million in support in 2004. AHEC is requesting $175,000 for each of the four AHEC’s as an annual appropriation in order to maintain its effectiveness in strengthening the health care system in Vermont.
House Human Services
The House Human Services committee spent the majority of this week on H. 115, An Act Relating to Advanced Directives for Health Care. VAHHS testified on two portions of the bill and brought in experts from Central Vermont Hospital (CVH), Mt. Ascutney Hospital and Health Center (MAHHC), and Fletcher Allen Health Care (FAHC). Cheryl Funk, Director of Medical Records at CVH, and Cheryl Briere of MAHHC, testified on the section related to the execution of the advance directive. On VAHHS’ behalf, both recommended that they add the requirement that advance directives executed using visual media must be transcribed. Hospitals must be able to access the information in advance directives quickly and easily. Advance directives in a visual format do not allow for that, particularly in urgent or emergent care situations in which the advance directive is not on file in advance.
Merle Edwards-Orr of FAHC testified on the Patient Bill of Rights section. Edwards-Orr testified that the language related to information about hospice care is overly broad and suggests that hospitals must provide hospice information to all patients, no matter what their clinical condition.
A blanket requirement will result in generic information being provided to many patients who do not need it creating an administrative burden that is unlikely to insure, by itself, that patients in need of hospice services receive information that is tailored to their individual needs.
This committee also heard from Josh Slen on the Governor’s plan to save Medicaid. Slen began going through the 23 areas of change with the committee. This discussion will continue next week.
Bea Grause testified on H. 58, An Act Relating to Education Loan Forgiveness for Nursing Faculty in support of the bill and urged full funding at $200,000. The Committee later passed H.58 out of Committee funded at $100,000.
House Health Care
This committee continues to take background testimony from a number of individuals. This week the committee heard from Paul Harrington of the Vermont Medical Society, Church Hindes from the Chittenden County VNA, Jim Hester of MVP and Stephan Morse, Chair of Coalition 21.
House Judiciary
The House Judiciary Committee continues to take testimony on the H. 163, An Act Relating to Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults. The purpose of the bill is to increase the crime level from a misdemeanor to a criminal charge. VAHHS is carefully watching what the committee does in the abuse by restraint section of the bill. VAHHS is concerned with the language that states that “a person who willfully, knowingly, or recklessly uses or threatens to use a restraint on a vulnerable adult unnecessarily, unlawfully, or as a means of discipline or retaliation shall be imprisoned not more than two years or fined not more than $10,000.00, or both.” What constitutes “unnecessarily” is unclear.
Senate Finance
Senate Finance took testimony on the Governor’s health care bill, H. 102, Prescription for a Healthy Vermont. BISHCA Commissioner John Crowley gave an overview of Health Savings Accounts and how they work. Paulette Thabault, Deputy Commissioner, gave more details on the other aspects of the Governor’s plan on tax credits and the reinsurance pool. Thabault stated that the Department believes that with the reinsurance pool there will be a reduction in uncompensated care because these individuals will now have insurance. With the reduction in uncompensated care, BISHCA will expect to see a reduction in hospital rates.
More testimony will be taken on this bill, including testimony from VAHHS President Bea Grause. Thabault stated that Senator Vincent Illuzzi will introduce a companion bill on the Senate side.
Senate Health & Welfare
The Senate Health & Welfare committee took testimony on the removal of the sunset date on H. 6, Clinical Trials for Cancer Patients. The Senate is expected to move on this quickly because it is due to sunset on March 1, 2005.
The Committee also received program history and financial background on the Medicaid program from Josh Slen. Slen is slated to be in this committee 4 times over the next two weeks to discuss the Governor’s plan to save Medicaid and the global commitment.

Bills of interest introduced this week:
H. 183 - AN ACT RELATING TO HEALTH CARE RIGHTS OF CONSCIENCE: This bill proposes to respect and protect the fundamental rights of conscience of all individuals who provide health care services.

H. 194 - AN ACT RELATING TO WHISTLEBLOWER PROTECTION: This bill proposes to extend whistleblower protection to all employees in Vermont.

H. 199 - AN ACT RELATING TO REGULATION OF PROFESSIONS AND OCCUPATIONS: This bill proposes to make adjustments to general provisions relating to the regulation of all professions and occupations regulated by the office of professional regulation or by boards attached to that office and makes specific adjustments to the systems for regulating the following professions: nursing home administrators, architects, barbers, cosmetologists, estheticians, nail technicians, chiropractors, dentists, professional engineers, funeral directors, optometrists, pharmacists, physical therapists, real estate brokers and salespeople, veterinarians, land surveyors, opticians, radiologic technologists, psychologists, private investigators and security guards, clinical social workers, clinical mental health counselors, real estate appraisers, marriage and family therapists, psychotherapists, tattooists and body piercers, electrologists, auctioneers, and respiratory care practitioners. This bill also proposes to authorize statutorily the office of professional regulation to regulate motor vehicle racing as an advisor profession.

H. 200 - AN ACT RELATING TO STUDY OF SURROGACY FOR HEALTH CARE DECISIONS: This bill proposes to establish a study of surrogacy for health care decisions and to appropriate funds for the department of health to establish an electronic registry for advance directives.
H. 203 - AN ACT RELATING TO HEALTH CARE PROVIDERS’ UNREIMBURSED MEDICAL SERVICES INCOME TAX CREDIT: This bill proposes to create an income tax credit for health care providers’ unreimbursed medical services.
H. 215 - AN ACT RELATING TO MEDICAL GUARDIANSHIP: This bill proposes to create a unified statutory definition for competency for medical decision-making and clarify the role of the probate court in substitute decision-making.
H. 216 - AN ACT RELATING TO THE VERMONT FREEDOM AND UNITY HEALTH PLAN: This bill proposes to establish the Vermont freedom and unity health plan to cover certain health-related services for all Vermonters.
H. 225 - AN ACT RELATING TO THE PROHIBITION OF PRESCRIPTION DRUG ADVERTISING ON BROADCAST MEDIA: This bill proposes to prohibit the advertising of prescription drugs on broadcast media.
H. 227 - AN ACT RELATING TO SAFE STAFFING AND QUALITY PATIENT CARE: This bill proposes to ensure that there is sufficient nurse staffing in health care facilities in order to promote optimal health care outcomes.

S. 83 – AN ACT RELATING TO REQUIRED LEGISLATIVE APPROVAL FOR IMPLEMENTATION OF CERTAIN CHANGES IN THE SYSTEM OF FEDERAL FINANCIAL PARTICIPATION IN THE MEDICAID PROGRAM: This bill would require the approval of the legislature before any agreement or waiver of the federal Medicaid law could be implemented in Vermont which transformed the program from a system of state-federal matching grants to any other system of federal financial participation, such as global funding commitments or block grants.

S. 84 - AN ACT RELATING TO COMPREHENSIVE MANAGEMENT OF EXPOSURE TO MERCURY: This bill proposes to establish a comprehensive approach to reducing the exposure of citizens to mercury released in the environment through mercury-added product use and disposal. This bill proposes to authorize the agency of natural resources to participate in regional efforts to coordinate mercury product regulation with other states and entities in the Northeast. It proposes to require that manufacturers of mercury-added products provide certain notice to the agency and report on total mercury contained in certain products. It proposes to ban the distribution or offering for sale of mercury-added novelties, fever thermometers, thermostats, and dairy manometers after a certain date and to restrict the use of elemental mercury. It proposes to restrict the distribution and sale of other mercury-added measuring devices and mercury switches and relays after a certain date unless an exemption is granted by the agency under specified criteria, including lack of technically feasible alternatives at a reasonable cost. It proposes to modify the existing labeling requirements for mercury-added products and packaging by expanding the types of products subject to labeling, including formulated mercury-added chemical products. It proposes to allow alternative product labeling methods and specifies labeling methods that are approved for appliances, motor vehicles, and products containing mercury-added lamps as backlighting. It proposes to require manufacturers of mercury-added products to submit certified labeling plans to the agency for approval. It proposes that mercury-added button cell batteries and photographic film are not subject to labeling requirements. It proposes to ban disposal of mercury-added products in landfills and incinerators, to require source separation of discarded mercury added products, and to require solid waste management facilities to inform customers of disposal bans and collection programs for mercury-added products. It proposes to require the agency of natural resources to conduct a study of methods to remove effectively and feasibly mercury-added components from automobiles, appliances, and other equipment at solid waste management facilities and metal salvaging businesses. It proposes to prohibit the purchase and use of mercury-added products and elemental mercury in primary and secondary schools. It proposes that dental offices be required to follow mercury waste management practices as established by the agency and to install dental amalgam separators on the wastewater discharge by a certain date if mercury-added dental amalgam is used in or removed from patients. It proposes to require hospitals to submit a mercury reduction plan to the agency every three years and to exempt hospitals that achieve 95 percent reduction in mercury-added product use. It proposes to continue a mercury public education and outreach program in the agency of natural resources and the department of health. It proposes to continue an advisory committee on mercury pollution to report annually to the legislature with recommendations on reducing mercury contamination and risk. It proposes that the agency and the department of health develop a research plan to understand better current trends of mercury contaminant levels in fish and water bodies and report to the legislature on matters including the cost to implement the plan.

S. 90 - AN ACT RELATING TO PRESCRIPTION DRUGS AND SUBSTANCE ABUSE: This bill proposes to establish a prescription drug monitoring program in order to promote the public health and welfare, detect and prevent substance abuse, and support the legitimate medical use of controlled substances.
S. 93 – AN ACT RELATING TO THE PROHIBITION OF PRESCRIPTION DRUG ADVERTISING ON BROADCAST MEDIA: This bill proposes to prohibit the advertising of prescription drugs on broadcast media.

S. 94 – AN ACT RELATING TO PAYMENT OF LIABILITY INSURANCE MEDICAL CLAIMS: This bill would authorize the commissioner of banking, insurance, securities, and health care administration to direct a liability insurance carrier required to defend and indemnify an insured to pay all or part of medical costs of a claimant in cases where the liability of the insured for those costs is reasonably established as determined by the commissioner, notwithstanding any pending judicial determination.
S. 95 – AN ACT RELATING TO SAFE STAFFING AND QUALITY PATIENT CARE (companion bill to H. 227): This bill proposes to ensure that there is sufficient nurse staffing in health care facilities in order to promote optimal health care outcomes.

S. 96 - AN ACT RELATING TO PROHIBITING MANDATORY OVERTIME: This bill proposes to prohibit mandatory overtime for hospital employees.

Other items of importance
Joint Public Hearing on Fiscal Year 2006 Budget on Vermont Interactive Television - Appropriations Committees: Monday, February 14, 2005, 5:00 to 7:00 p.m. - The House and Senate Appropriations Committees will hold a joint public hearing on Vermont Interactive Television (V.I.T.) to give Vermonters throughout the state an opportunity to express their views about the State’s budget for fiscal year 2006. All VIT sites will be available for the hearing: Bennington, Brattleboro, Canaan, Castleton, Colchester, Johnson, Lyndonville, Middlebury, Newport, Randolph Center, Rutland, Springfield, St. Albans, Waterbury and White River Junction. VIT’s web site has an up-to-date location listing, including driving directions and telephone numbers: www:vitlink.org
For further information about the format of this event, call the House Appropriations Committee office at 802/828-2251. Requests for interpreters should be made to the office no later than 4:00 p.m. on Friday, February 4.

Joshua Slen, Commissioner of the Office of Vermont Health Access, is currently scheduled in front of House Appropriations for the entire day on Friday, February 18, 2005, to discuss the FY 2006 Medicaid budget.
Introduction of Senate Bills: Drafting requests for introduction of bills must be in by Wednesday, February 16, 2005.

Rules Committee
The Senate deadline for bill introductions is Friday, February 25. The House deadline for bill introductions is Monday, February 28. The Rules Committee is recommending that members utilize the “short-form” or “concept” format due to the number of bills yet to be drafted. A “concept” or “short-from” bill draft contains no statutory text.