VAHHS Legislative Report

For the week ending May 6, 2005

Political Overview

Health care reform again dominated the political agenda this week. Two business groups introduced their health proposals, and Governor Douglas capped a hectic week with the release of a new comprise health care reform proposal (see attached outline). With four or so weeks remaining tensions and tempers are mounting, legislators are working to advance priority issues before time runs out.

VAHHS Issues

Health Care Reform:

The Senate committees on Health and Welfare and Finance continued to take testimony on the Senate version of H. 524 as the bill continued to change on an hourly basis. Late Friday afternoon, at the urging of Senate President Pro Tempore Peter Welch, the committee passed out the bill on a 5-1 vote.

The plan was for the committee to pass the bill this week, and irrespective of that, the committees took testimony on new proposals, such as the “Grocers Plan” last week. This week the Vermont Businesses for Social Responsibility (VBSR) and the Vermont League of Cities and Towns also came out with their proposals. The stumbling block for every proposal is how to finance it. The VBSR proposal is based on the amendment proposed by Rep. Tom Koch during the House floor debate two weeks ago. (link to Rep. Koch’s amendment can be found at: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/calendar/hc050421.html)

On Thursday morning the Senate Health & Welfare Committee heard testimony by phone from Michael McCormack, Board Chair at RRMC, on Hospital Board member concerns regarding H.524 and the so-called Banking, Insurance, Securities and Health Care Administration (BISHCA) amendment. He indicated that word of H.524 has already negatively impacted physician recruiting and expressed serious concern for the level of discretion that the Commissioner of BISHCA will have to require staff changes or service closure. Deputy Commissioner Paulette Thabault testified next in an attempt to clarify that the "BISHCA amendment" was not BISHCA's initiative but rather a "response" to Senator Welch's request as to what more could be done to dig deeper in hospital budget reviews. She stated that BISHCA was comfortable with the current process and that it was effective. BISHCA had not been comfortable with the earlier proposal to limit hospital budget growth to CPI plus 3 %. She admitted that the provisions put forward in the amendment were perceived as overbearing and over reaching and BISHCA did not believe they were needed. While Sen. Flanagan asked whether it was an anomaly for the administration to take orders from Senators, Chairman Sen. Leddy was less amused concluding that the administration proposed something that it did not mean thereby wasting their time. He asked her to review the proposal and identify the provisions which improve the process.

It is unclear what the Senate will do now that there are four additional proposals out on the table in addition to the three plans (including the VAHHS reform plan) already released.

Medicaid and Budget:

The House passed H. 537, the Medicaid budget bill, on the floor Friday on a vote of 111-16. Many amendments were offered and overall they were either defeated or passed on party lines. The bill contains provider cuts as follows: reduces hospital spending by $8,975,000 from projections; reduces physician payments by $2.5 million; reduces home health by $1,000,000; reduces dentists spending by $234,309; and assumes nursing home occupancy rates of 93%. Last week the committee unanimously agreed to continue to the inflation factor for nursing homes and not go with the governor’s recommend. The bill now goes to the Senate Appropriations committee.

S.20/H. 163 - An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults
The Senate voted out H. 163 on the floor this week. There are number of changes from the House-passed version. If the House does not concur with the Senate bill a conference committee will be appointed to work out the differences.

H. 227 – An Act Relating To Safe Staffing and Quality Patient Care
The House General, Housing and Military Affairs committee continued to take testimony on H. 227 this week. Mary Shriver, executive director of the Vermont Health Care Association, testified on behalf of the nursing homes stating that nursing homes basically do all that is required under the amendment, but that tracking and posting information on the positions they currently don’t track would be burdensome. Shriver stated that she supports the position of VAHHS and the Vermont Organization of Nurse Leaders. We are hopeful that this bill will not advance any further this session.

H. 258 - An Act Relating to the Disclosure of Rates of Hospital-Acquired Infections
The Human Services Committee continued to take testimony on H. 258. The committee heard from a number of advocates and experts, including Kemper Alston, M.D., Chair of the Infection Control Committee at Fletcher Allen Health Care and Larry Rammuno, Chief Quality Officer at the Northeast Health Care Quality Foundation. Both Dr. Alston and Dr. Rammuno stated that hospitals agree that consumers have a right to more information about the health care they receive, including infection rates. The state of the art of infection rate measurement does not yet allow for accurate comparisons between hospitals, surveillance and collection of accurate data is very complex. Hospitals monitor infections and procedures that are most risky for their specific patient population. This makes it difficult to compare infection rates between hospitals. In Fletcher Allen’s case as Vermont’s only tertiary facility, they are not able to compare rates with any others hospitals. Hospital witnesses also argued that the state of Vermont cannot invent a strategy for public reporting on infection outcomes any faster than national experts already working on infection measures. Supporters of this bill state that disclosure of this information will inform consumers on the safest hospitals to seek treatment and giving hospitals a strong incentive to improve their infection control program and reduce the chance of acquiring an infection. The committee plans to move this bill in some form.

H. 404 and 411 – Mental Health Parity
The House Human Services committee took testimony on H. 404, An Act Relating to Access to Mental Health and Substance Abuse Providers and H. 411, An Act Relating to Mental Health Parity. The committee heard testimony from both sides of issue. The committee has decided to move forward with H. 404 this year and postpone action on H. 411 until next year. The committee had little sympathy for the insurers whose argument is that passing this bill will increase the cost of health care in part due to opening the network and the credentialing process. Rep. Tom Koch, R-Barre Town, quickly calculated how much it would likely cost insurers to open their networks and his estimation is approximately $38,000. The committee has decided to move forward with H. 404 this year and will vote the bill out of committee Tuesday.

S. 40 - An Act Relating to Reducing Fires Resulting from the Careless Use of Cigarettes and to Other Tobacco-Related Issues (Self-Extinguishing Cigarettes)
The House General, Housing and Military Affairs committee took testimony on S. 40. Lucie Garand of VAHHS testified in support of the Senate-passed version of the bill. The intent is to require that only reduced ignition propensity cigarettes be sold in Vermont. Although these cigarettes are not guaranteed to self-extinguish, they are expected to reduce fires caused by cigarette smoking and related personal injury and property damage. We expect the bill to pass.

S. 113 - An Act Authorizing Nonprofit Hospitals to Convert Charitable Assets
The House Commerce Committee voted on S. 113 early this week on a vote of 10-0-1. It was debated on the House floor this week and passed. S. 113 in its amended form will not impact hospitals, but VAHHS has testified that this bill is unnecessary. VAHHS does not believe a conference committee will be appointed and that the bill will go to the Governor for his signature. The bill can be viewed in the Senate calendar dated March 30 at the following link: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/journal/sj050330.htm

S. 174 - Home Health
The Senate passed S. 174 today on a vote of 24-2-4. This bill codifies the existing practices and arrangements of home health agencies as well as provides for further state oversight of the delivery of home health services in Vermont. This bill will now go to the House. Another aspect related to home health that occurred this week is the commissioner of BISHCA made a preliminary decision to allow competition of home health services in the state. The Vermont Assembly of Home Health Agencies has asked the commissioner to give them 6 months to cure deficiencies in the system rather than the 6 weeks the commissioner as proposed. The commissioner will give his decision on Monday evening whether the extension will be granted.

Bills of interest introduced this week:

H. 537 - AN ACT RELATING TO APPROPRIATIONS FOR THE MEDICAID PROGRAM AND THE OFFICE OF VERMONT HEALTH ACCESS: This bill would appropriate funds for fiscal year 2006 for the Medicaid program, the Vermont Health Access program, and the Office of Vermont Health Access and make adjustments in premiums, rebates, and provider assessments of Medicaid and VHAP programs.

S. 174 - AN ACT RELATING TO HOME HEALTH AGENCIES: This bill proposes to provide for enhanced state oversight of the practices and arrangements of home health agencies regarding access to and the cost and quality of home health services offered in Vermont.

Other items of interest:

S. 84 - An Act Relating to Comprehensive Management of Exposure to Mercury
The Governor did a bill signing ceremony for this bill on Tuesday. The bill as signed by the Governor can be downloaded from: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/S-084.HTM