Lawmakers raced to meet the "crossover" deadline this week in anticipation of Town Meeting week.    School budgets will again be a major Town Meeting focus.  Vermonters will vote on school budgets and it looks like the hit to the education fund will be bigger than expected.  If all the schools budgets that Vermonters vote on next week pass, the Joint Fiscal Office estimates that the state will need to divert about $1.7 million from the Education Stabilization Reserve (ESR) to cover payments to schools.    If voters approve the budgets, the Department of Education estimates that school spending would increase an average of 6.45 percent instead of the 5.2 percent.  This increase would deplete the ESR.    Gov. Jim Douglas signed a law last week that drops the statewide property tax rates for residential and commercial/vacation properties by 8 cents. The new rates are $1.02 per $100 of assessed value for Vermont homeowners and $1.51 per $100 of value for businesses and vacation homes.  This property tax reduction will result in less funding for education.

The Senate approved an anti-voyeurism bill, which would make it illegal to view or photograph a naked person without their consent in a location where they have a reasonable expectation of privacy.   The bill prohibits store owners from putting surveillance in dressing rooms unless a sign warns customers of the practice and prohibits cameras in store bathrooms.    Store owners who misuse surveillance cameras could be fined $10,000.  A person found guilty of viewing prohibited images could be fined up to $1,000 and face a two-year prison sentence for a first offense. Two or more offenses could mean a person would be included on the sex offender registry.  

The Judicial Retention Committee on Thursday recommended that all four of the Vermont Supreme Court justices up for review return to the bench for another six years.   All four faced scrutiny because of their respective opinions on  Act 60 education funding and civil unions for same-sex couples.   Lawmakers will have a joint session on Thursday, March 17 to make a final determination.

The Vermont Yankee nuclear plant dry-cast storage discussion continues.   To change the way Entergy stores radioactive rods, it needs the Legislature’s permission this year.  The current storage pool will run out of storage by 2008.  Without new storage the plan will have to shut down and Vermont could lose its cheapest source of power.  

A public hearing was held Thursday night at the Statehouse to hear whether the Legislature should enact a law banning smoking in bars all over the state. Bans already have been enacted in Burlington, South Burlington, Williston and Winooski.  Vermonters overwhelmingly encouraged lawmakers Thursday to close a 12-year-old loophole in the state's Clean Indoor Air Act and ban smoking in all public places, including bars and private clubs. Democrats who control the House and Senate have introduced two competing bills — both ban smoking in all public places, while one exempts private clubs.   Private club members and employees also encouraged lawmakers not to compromise and ban smoking everywhere.

The Senate gave preliminary approval Wednesday to a renewable energy bill, which requires some of a utility's power to be derived from renewable sources, such as solar energy.  The renewable portfolio standards bill would require Vermont utilities to buy renewable power as they increase the total amount of electricity they buy.  Under the bill as drafted, the Department of Public Service could allow utilities to get out of the requirement if the renewable power is too expensive and risked driving up electricity rates.  The Senate heard testimony that the bill could raise rates by 3.4 percent if it didn't allow an escape clause.  To address this possibility the Senate included an "opt-out" provision.  

Also of note for this week were the confirmation hearings of the two “Smith’s”.    Secretary of Administration Charlie Smith was confirmed by the Senate Government Operations Committee and Secretary of the Agency of Human Services Mike Smith was confirmed by Senate Health & Welfare. 

The House/Senate Medicaid Working Group met again on Wednesday, with prescription drug spending again a focus of discussion.   The committee will look to develop a 4 year plan related to drug spending.   Rep. Patty O’Donnell stated that there is statutory language that states the Medicaid preferred drug list utilize generic drugs whenever possible.   This area has seen the greatest increases and the committee will look to the Maine program for ideas. It is the committees hope that this will force drug companies to negotiate prices.  The committee also discussed the amount of bad debt and free care delivered by hospitals and what can be done to curtail the use of the emergency room.

Speaker Gaye Symington has tasked the House Health Care Committee to produce an “interim” health care reform bill by April.   Former representative Paul Cillo has been hired to assist the committee.   Cillo was a key individual involved with the Act 60 legislation.     

House Appropriations
Office of Vermont Health Access Commissioner Joshua Slen continued his walk through of the Governor’s 23 step plan to save Medicaid.   Slen briefly reviewed the global commitment concept paper and timeline with the Committee.

House Human Services
The House Human Services Committee will wrap up testimony and mark up this week on H. 115, An Act Relating to Advance Directives for Health Care.   This bill attempts to streamline and update the way Vermonters can direct their end-of-life care decisions.

House Health Care
Tom Huebner, VAHHS Board Chair and President of Rutland Regional Medical Center, presented VAHHS’ five-year plan for health care form.  The committee was particularly interested in:  the idea of pilot projects as a way of making change, the idea that there should be a full-time funding legislative/public body to oversee health progress and the idea that we should use specific measures and milestones to chart our progress.  Huebner’s "50,000 foot" message was:   1) "First do no harm": The current proposal on Medicaid will further harm a fragile system.  We need a revenue bridge so that thoughtful reform can be designed.  2)   Define the problem: Health reform is not a problem it is a solution.  Clearly identify the problem we are trying to fix.  We are not sure there is a consensus. 3)  Identify measures:  So that we all know that the problem really is being fixed. 4) Create trust/collaboration: Fund a full time committee led by legislature to include administration, consumers, providers and other key stakeholders to manage the process of system redesign.  As Tom stated yesterday, “Trust happens when people do real work together.” 5.  We believe reform should include: quality improvement and patient safety, assurance of reasonable access, bending the cost curve and improved information flow.  The committee has asked VAHHS to work with them to provide more detail on our proposal.  The Committee is planning to introduce an interim bill by April. 

House Judiciary

House Judiciary continued to take testimony on the H. 163, An Act Relating to Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults.  Most significantly, the committee heard testimony from Linda Purdy, Assistant Attorney General, several times this week.  Working with a broad group of advocates, on Friday she presented "consensus" language to the committee on the definition of a vulnerable adult, unlawful restraint and confinement and sexual abuse.    These are sections that have proved troublesome this year and in years past.  VAHHS was part of the consensus group.  She suggested that the committee (1) use the existing definition of vulnerable adult in Title 33 and (2) use the existing language for unlawful restraint and confinement from Title 33, adding a phrase requested by VAHHS to make it clear that protecting the safety of a patient or others is an appropriate use of confinement, restraint and medication.  She modified the language regarding sexual abuse to address concerns raised by the committee about whether or not the language criminalizes some appropriate sexual relationships by adding a misdemeanor level of penalty.  The committee suggested several changes to the definition of vulnerable adults one of which would potentially broaden the definition to include all patients in hospitals (not the intended result of the change) and several others which would narrow the definition.  The committee will review a second draft of the bill incorporating the new language from Ms. Purdy on Wednesday March 9.

The committee continues to take testimony on fire-safe cigarettes.  Currently New York State has the only mandate to require that cigarettes be fire safe.   The Vermont Medical Society is leading the charge on this bill and VAHHS supports this bill as well. 

Senate Natural Resources & Energy
The Committee has been taking testimony and mark up on S. 84, An Act Relating to Comprehensive Management of Exposure to Mercury.   The bill 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.   Most hospitals already have plans and policies in place as a result of a collaborative effort between member hospitals and the Agency of Natural Resources two years ago.

Senate Finance
Bea Grause testified on the Association’s 5-year plan (see House Health Care Committee report above for message).  

Bills of interest introduced this week:
H. 313 –  AN ACT RELATING TO VHAP ELIGIBILITY FOR SELF-EMPLOYED INDIVIDUALS: This bill proposes to allow self-employed individuals to deduct payroll tax contributions when determining income eligibility for the Vermont health access plan.

H. 328 - AN ACT TO REQUIRE PARENTAL NOTIFICATION PRIOR TO PERFORMING AN ABORTION ON AN UNEMANCIPATED MINOR: This bill proposes to require at least one parent or a guardian of an unemancipated minor to receive written notice at least 48 hours before an abortion is performed on the minor.  Notification is not required if the abortion is necessary to prevent death or serious bodily injury to the minor, or if a court finds one of the following by clear and convincing evidence:  (1)  the minor is sufficiently mature to decide whether to terminate her pregnancy and provide for her own postabortion care, and understands the nature, risks, and consequences of the procedure to be performed; (2)  notification would place the minor at substantial risk of being physically or emotionally harmed by a parent or guardian; (3)  notification would cause irreparable harm to the minor’s relationship with her parent or guardian; or (4)  notification is not in the best interests of the minor.  The bill also requires health care providers to provide, to the extent already required by the providers’ code of professional conduct, pregnancy counseling and information before providing pregnancy-related services to a minor.  The requirement does not apply in cases of medical emergency.

H. 329 –  AN ACT RELATING TO PROCEDURES INVOLVING MEDICAL MALPRACTICE ACTIONS: This bill proposes a number of changes related to medical malpractice actions.  The bill: (1)  requires the Vermont property and casualty guaranty association to pay medical malpractice claims which were timely filed against insolvent insurers; (2)  provides for public inspection of all rate filings; (3)  shortens the time period within which minors may bring medical malpractice actions; (4)  sets standards for the qualification of physician expert witnesses; (5)  limits damages for pain and suffering in medical malpractice actions to $250,000.00, adjusted every other year beginning in 2008 based on the Consumer Price Index; (6)  makes an expression of regret or apology made by or on behalf of a health care provider inadmissible in any civil or administrative proceeding against the provider; (7)  provides limited immunity to health care practitioners providing volunteer or public health services; and (8)  establishes a mandatory arbitration process for medical malpractice actions.

H. 339 - AN ACT RELATING TO SMALL GROUP CARRIERS: This bill proposes to repeal the law mandating small group insurance carriers to require that 75 percent of the employees or members of the small group participate in the carrier’s plan.

H. 340 – AN ACT RELATING TO PAYMENT OF INSURANCE CLAIMS: This bill proposes to prohibit health insurers from denying claims solely because they were not submitted in a timely manner, provided the beneficiary submits a proof of loss within one year of the loss.

H. 345 – AN ACT RELATING TO ABORTIONS PERFORMED ON MINORS:  This bill proposes to make it a crime for a person other than a physician licensed to practice in Vermont to perform an abortion on a minor less than 18 years of age, unless:  (1)  the minor is accompanied by a parent; or (2)  the person is supervised by a physician licensed to practice in Vermont who personally consults with the minor before the abortion and provides follow-up care to the minor after the abortion.

H. 347 – AN ACT RELATING TO REPORTING TREATMENT OF SERIOUS BURNS AND FIREARM INJURIES:  This bill proposes to require physicians and health care institutions to report the treatment of serious burns and firearm injuries to state officials for the purpose of assisting investigations of arson, identifying victims of assault, and promoting public safety.  Reporting of gunshot wounds already is currently required by law.  The bill recodifies the gunshot wound law and adds an immunity provision for reporting in good faith.

H. 349 – AN ACT RELATING TO EMPLOYER LIABILITY AND CIVIL ACTIONS AND WORKERS’ COMPENSATION:  This bill proposes to provide an injured employee with the choice of damages from workers’ compensation or a civil action when the injury occurred as the result of the employer’s willful disregard of obvious dangers inherent in the employment duties.

H. 359 – AN ACT RELATING TO THE PURCHASE OF HEALTH INSURANCE: This bill would allow Vermonters to purchase health insurance policies from insurance companies domiciled in other states, provided certain requirements of Vermont law are met, including minimum capital, surplus, and reserve requirements; disclosure and reporting requirements; and grievance procedures.  The bill would also require that prospective Vermont enrollees be provided adequate and full disclosure of how the out‑of‑state health insurance plans may differ from Vermont health insurance plans in a format approved by the commissioner of banking, insurance, securities, and health care administration.

S. 113 – AN ACT AUTHORIZING NONPROFIT HOSPITALS TO CONVERT CHARITABLE ASSETS: This bill proposes to codify standards and a procedure when a nonprofit hospital service corporation seeks to convert to a for‑profit entity or to sell, transfer, lease, exchange, option, commit, convey, or otherwise dispose of charitable assets of the nonprofit hospital service corporation.  Any conversion of a qualifying amount of such assets must be approved by the attorney general and the commissioner of banking, insurance, securities, and health care administration as a transaction that will promote the public good of the state.

S. 115 – AN ACT RELATING TO REGISTRATION OF LOBBYISTS:  This bill proposes to:  (1) expand the definition of “gift” in the chapter relating to registration of lobbyists; (2) permit lobbyists and their employers to register electronically with the secretary of state; (3) increase registration fees for lobbyists and lobbyist employers; (4) require the secretary of state to provide internet access to lobbyist and lobbyist employer information; and (5) expand the information required for disclosure by lobbyists and lobbyist employers.

S. 121 – AN ACT RELATING TO FELONY CONVICTIONS AND PROFESSIONAL LICENSURE: This bill proposes to eliminate the requirement that a felony conviction unrelated to the practice of a profession be grounds for unprofessional conduct.

S. 123 – AN ACT RELATING TO THE PURCHASE OF HEALTH INSURANCE: This bill would allow Vermonters to purchase health insurance policies from insurance companies domiciled in other states, provided certain requirements of Vermont law are met, including minimum capital, surplus, and reserve requirements; disclosure and reporting requirements; and grievance procedures.  The bill would also require that prospective Vermont enrollees be provided adequate and full disclosure of how the out‑of‑state health insurance plans may differ from Vermont health insurance plans in a format approved by the commissioner of banking, insurance, securities, and health care administration.

S. 125 – AN ACT RELATING TO CHIROPRACTIC COVERAGE IN MEDICAID AND VHAP:  This bill proposes to reinstate chiropractic coverage under the Medicaid and VHAP programs.

Public Hearing Announcement:   Thursday, March 10, 2005 - House Chamber - 7:00 - 10:00 PM - House Committee on Health Care - Health care system - challenges and solutions.

There will be no report next week.   Lawmakers will be on recess for Town Meeting week.