VAHHS Legislative Report

For the week ending April 15, 2005

Political Overview

Both sides have had their share of wins this session and although it took time the Democrats in the Senate and the House have been able to push one of their most important agenda items this year to the dismay of the Governor. The Department on behalf of the Governor argued that economic development is critical to Vermont and one obstacle to encouraging business in the state is high electric rates. After many hearings and often contentious debate, S. 52, An Act Relating to Renewable Energy Portfolio Standards, Appliance Efficiency Standards, and Distributed Electricity, was debated on the House Floor this week. The House version has incentives for Vermont utilities to buy more electric power from generators that don't burn fossil fuels. It offers financial incentives for utilities that develop their own renewable projects or partner with developers. Utilities could count the megawatts from these renewable projects toward the bill's target for increased “green power” (green power is a term to describe what they deem to be environmentally friendly sources of power, in particular renewable and non-polluting power, such as wind or solar) while also selling renewable energy credits. Business advocates view this as mandate to order utilities to buy green energy and remain opposed to the bill.

Another hot and highly debated issue this week was a bill on appraisals and education funding. H. 504, An Act Relating to Appraisals and Education Finance, ultimately passed the House, but not before much debate. The bill is designed to ease the burden of education on property taxes caused by spiraling real estate values. Republicans attempted to postpone action on the bill until next Wednesday, but were defeated because the House plans to debate the health reform bill on Wednesday of next week. Critics of H. 504 say the bill is likely to do little to control property tax bills under the current education funding formulas known as Act 60 and Act 68. The latest crisis in school funding is caused by the reliance on the property tax. The Act 60 system requires the state to apply a formula that modifies annually the property values on which taxes are based. When there's inflation in real estate prices, as there have been for the past few years, tax bills jump as well.

VAHHS Issues

Medicaid:
The joint House/Senate Medicaid working group met both Tuesday night and Wednesday this week and the discussion focused on the Administration’s global commitment. The work group’s frustration and anxiety is increasing as members try to understand the constantly changing budget numbers. At one point Senator Dick Sears, D-Bennington, stated, “At some point you just have to say you’ve got to trust Steve,” meaning Steve Kappel of Joint Fiscal. The House Appropriations Committee continues to review the Medicaid budget as well, but will not make any determinations until later this month.

Health Care Reform
The House Appropriations Committee did a walkthrough of H. 524, An Act Relating to Universal Access to Health Care in Vermont. Rep. Harry Chen, D-Rutland, reported the bill in House Appropriations. Martha Heath, Chair of the Committee, stated that the committee needs to understand the details of the bill, but her committee would make recommendations on only the appropriations section of the bill. The committee had many questions related to policy in many areas of the bill including: ERISA, the “super-Banking, Insurance, Securities and Health Care Administration (BISHCA)” agency, and regional board to name a few. BISHCA and the Office of Vermont Health Access (OVHA) jointly testified in both the House Health Care and Appropriations Committee strongly recommending that they push the dates back. Commissioner Crowley recommended that they add another study to the bill related to the reorganization and that the report be submitted to the General Assembly in January 2006. Governor Douglas has publicly stated his opposition to the bill and the Commissioner John Crowley of BISHCA and Director Joshua Slen of OVHA, have both sent letters detailing their grave concerns as drafted (see BISHCA letter and Slen letter/chart).

The bill will be debated on the House floor beginning next Wednesday.

H. 115 – An Act Relating to Advance Directives for Health Care
This week the House passed H. 115 and this bill will now move on to the Senate. The link to the House passed bill is: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/house/H-115.HTM

S.20/H. 163 - An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults

The Senate Judiciary took testimony on S.20/H.163 this week. Committee members raised issues about a number of changes to the bill made by the House including the narrowing of the definition of vulnerable adults and the definition of abuse by restraint. The committee took testimony today, most of it in favor of the bill. VAHHS and the Vermont Health Care Association raised concerns about the broadening of the definition of neglect and strongly supported the definition of abuse by restraint passed by the house. The committee plans to take it up again next week and hopes to vote it out of committee soon.

H. 168 – An Act Relating to Death With Dignity

The House Human Services dedicated most of the entire week on H. 168, An Act Relating to Death With Dignity. The bill as proposed would allow a mentally competent patient who is expected to die within six months to end his or her life in a humane and dignified manner by prescription medication. The committee heard from both sides of the issue and there is a strong pull from both sides to both leave it alone and pass legislation. In the end the committee decided that they will get back to this bill, but did not commit to when. It could be this session or next.

H. 404 and 411 – Mental Health Parity

The House Human Services committee has decided to move forward with H. 404, An Act Relating to Access to Mental Health and Substance Abuse Providers and H. 411, An Act Relating to Mental Health Parity. Chair Ann Pugh asked that committee members spend time over the weekend developing questions they would like addressed during testimony. The Chair would like the testimony to be focused when the bill is taken up.

H. 518 – An Act Relating to Capital Construction and State Bonding
The Senate Institutions committee passed out the Capital Bill late last week. The pieces of interest for VAHHS include the appropriation for state hospital renovations. The House had appropriated $150,000 and the Senate increased that amount to $307,888. The other area of interest includes an appropriation to the department of buildings and general services for the agency of human services to begin planning, site selection and design of new hospital facility for psychiatric patients. The House appropriated $330,000 and the Senate increased this back to the $725,000 proposed by the Administration. The Senate is expected to debate this on the floor next week. There are many different between the House and Senate versions and a conference committee is likely to be appointed to work out the differences.

S. 40 – An Act Relating to Fire Safe Cigarettes
The Senate passed a bill that would require all cigarettes sold in Vermont to be self-extinguishing. The legislation is viewed favorably because it does not create enforcement for possession of regular cigarettes. The proposal is believed to have widespread support in the House, and the governor has indicated he would sign it into law. If this bill passes and becomes law, Vermont would be the second state to require that all cigarettes sold within its borders be self-extinguishing. The bill has widespread support from firefighters, emergency medical technicians, low-income advocacy groups and insurance companies.

S. 84 - An Act Relating to Comprehensive Management of Exposure to Mercury

The House Fish, Wildlife and Water Resources voted S. 84 out of committee late Tuesday afternoon and reported it on the floor this week. The debate in committee centered on language that stipulates that as long as dental offices comply with state-established best management practices for mercury disposal, they will satisfy legal requirements. In the end the language was removed in the committee's amendment to the bill because of the precedent it could establish. VAHHS’ recommendations that the bill have a baseline year of 2002 for the mercury reduction plan and to have a hospital representative on the advisory committee stands. The full House passed the bill on Friday. If the Senate concurs with the changes done by the House it will go to the Governor for his signature. If the Senate does not concur a conference committee will be appointed to work out the differences.

Home Health

The Senate Health &Welfare committee began discussing a draft bill that would codify the existing practices and arrangements of home health agencies as well as provide for further state oversight of the delivery of home health services in Vermont. For a number of months now the Department of Justice has been investigating the practice of Vermont’s 12 nonprofit home health agencies as a noncompetitive monopoly that have exclusive rights to care for the state’s home-bound Medicare and Medicaid population. Megan Price of Professional Nurses Services (PNS) also testified stating that excluding for profit agencies is bad for patients. PNS has twice been denied a certificate of need (CON) to offer services except in a small number of highly specialized areas. PNS is trying for a 3^rd time to have full access to patients and will having a ruling from BISHCA next month. IF BISHCA allows this, the draft bill being reviewed by Senate Health & Welfare will not reverse BISHCA’s ruling and will recognize PNS as a “designated agency.” The draft bill will not change state policy, but will offer better regulation and oversight of the home health agencies.

Bills of interest introduced this week:

H. 524 - AN ACT RELATING TO UNIVERSAL ACCESS TO HEALTH CARE IN VERMONT: This bill would establish the goal of universal access to essential health care services through a publicly financed, integrated, regional health care delivery system in Vermont, provide mechanisms for cost containment in the system, and provide a framework, schedule, and process to achieve that goal. This bill is known as “Green Mountain Health.”