VAHHS Legislative Report

For the week ending April 22, 2005

Political Overview

Senator Jeffords’ announcement earlier this week that he would not seek reelection after 40 years of service, has significantly altered Vermont’s political landscape as many legislators consider new horizons. Congressman Bernie Sanders has long stated that he will run for the Senate seat. The top potential Republican contender is Governor Jim Douglas, but he’s refraining now from throwing his hat in the ring. With a potential vacancy in the U.S. House seat, several names have already surfaced: Senator Matt Dunne of Windsor, Attorney General Bill Sorrel, Lt. Governor Brian Dubie, and let’s not forget former Speaker of the House Walter Freed. Depending on what contenders decide, could create even more new vacancies and opportunities for those seeking higher office. State tuned.

We are now in the 16th week of the 2005 legislative session and one can only hope that we are seeing the light at the end of the tunnel. Committees are working diligently on bills that they want to see pass this session. With committees passing their “must need” bills, both the House and Senate will be spending long days on the floor and not much time in committee. Things tend to get very dangerous this time of year with members tacking on their wish list items onto moving bills.

VAHHS Issues

Health Care Reform:
After hours of debate over two the past days, the House passed H. 524, An Act Relating to Universal Access to Health Care (Green Mountain Health) on a party-line vote of 86-58. The republicans unsuccessfully offered several amendments. Even, the most promising amendment offered by Rep. Tom Koch of Barre Town, attempted to reach common ground didn’t get any bipartisan support. It tried to amend the bill by removing many of the more controversial aspects including: reorganizing state government and setting specific implementation dates. The amendment left intact the economic studies and target dates that would determine what medical coverage the state can afford, and delayed reorganization and coverage dates until after the studies are complete. The bill now moves to the Senate. Senators have praised the work of the House Health Care, but have stated that they plan to make some changes to the bill. Senator Cummings reported today that they will determine a more specific course for this bill next week, but it most certainly will be taken up by Senate Finance and Senate Health and Welfare. An area of concern for the Senate is funding the system through a broad-based tax, as the House bill proposes. The Senate is likely to consider a more public-private partnership for paying for health coverage. VAHHS opposes this bill in its present form and will work to improve H.524 in the Senate.

Medicaid and Budget:
The joint House/Senate Medicaid did not meet this week, but have landed on $54 million for the Medicaid deficit. The House Appropriations committee will work very hard to finish their work on the Medicaid budget next week.

The Senate Appropriations Committee has been taking testimony on H. 516, An Act Making Appropriations for the Support of Government. The committee will begin markup of the bill next week. The game plan at this point will be to incorporate the House-passed Medicaid budget into the appropriations bill. This will allow the conference committee that is appointed to negotiate one budget rather than two.

Provider Tax:
Jim Reardon, Commissioner of the Department of Finance and Management, shared with the finance and appropriations committees of the House and Senate, his provider tax proposal for FY06. Included in the proposal is the FY05 one-time adjustment to bring the hospital provider tax to 6% in order to capture additional funds. The adjustment needs to occur prior to June 30. The FYO6 tax will be 6% of net patient revenues. The Brattleboro Retreat has its own tax rate of 4.3% and there will be no change to their rate. Although the Retreat pays a provider tax, unlike acute care facilities, they are not able to receive their tax back in the form of DSH payments.

The tax on nursing homes beds will be raised to $3787.79 per bed. This is an increase of $111.73 per bed. Normally nursing homes would receive additional tax monies as an inflationary factor, but under the Governor’s recommended restraints and modifications proposal to save Medicaid, nursing homes will not receive this. In essence, nursing homes will be paying additional taxes of $111.73 per bed, but will not receive this back.

The current tax on home health agencies is 16% and will be increased to 21.5% for FY06. The increase had two components. 3.4% will raise $825,000 and this amount will be eligible for federal match and will generate $2 million. The Vermont Assembly of Home Health Agencies has recommended increased revenues in lieu of payment reductions. The other 2.1% will be allocated to the Department of Aging and Independent Living for their availability for rate reimbursement to providers.

The Department is also advocating for a provider tax on Vermont pharmacies of $.10 per prescription. The tax is based on the number of prescriptions and refills sold by the pharmacy.

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

The Senate Judiciary took testimony on H. 163 and began markup on the bill. The committee agreed to leave in the definition of abuse by restraint developed by the House. They narrowed the definition of abuse by neglect somewhat from the House version based on testimony from VAHHS last week and Linda Purdy, Assistant Attorney General. The committee will take up the definition of vulnerable adult next week. The definition from Title 33 was significantly narrowed by the House. They will also consider the affirmative defense provision in the sexual abuse section and review some concerns raised about the posting requirement.

H. 518 – An Act Relating to Capital Construction and State Bonding
The Senate passed the Capital Bill on the floor this week and sent it back to the House with their proposed amendment. The $725,000 appropriation for the Vermont State Hospital has more details on how the money should be spent. It specifically states that the department may use up to $250,000 for planning, evaluation and program work provided in the plan submitted to the general assembly in February and that the departments use the remaining $475,000 in connection with the work required by the plan. The funds will only be disbursed if the work is initiated. There are many differences between the House and Senate versions and a conference committee will be appointed to work out the differences. The conference committee won’t be as exciting as in the past with Senator Vince Illuzzi or Representative Bob Wood at the table.

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

This week the Senate concurred with the House proposal of amendment. The bill now goes to the Governor for his signature. The link to the House proposal of amendment is: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/house/S-084.HTM

Home Health

The Senate Health &Welfare committee continued to take testimony on home health issues this week. Although there is consensus in the committee to 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, time is not on their side. The bill is very controversial and may not even make it out of committee, not to mention the entire Senate and House before adjournment. Without passage of this bill, the survival of the current nonprofit home health system in light of the Department of Justice investigation remains a very real question.