VAHHS Legislative Report

For the week ending May 20, 2005

Political Overview

End of session mania has set in. With less than 3 weeks remaining this session, legislators are honing their end-game strategies on a variety of issues. Overall, the big issues are still the budget, healthcare reform and dry cast storage of nuclear waste. The only bill that must pass of these three is the budget bill. One big question for next week will be the legislature’s strategy on healthcare reform. Will House and Senate conferees agree to a compromise on health care reform that also works for the Administration or will they produce a bill the Governor vetoes? As a third scenario, it’s possible that House and Senate conferees fail to reach an agreement and meet over the summer and fall with a decision made early next session! Stay tuned!!!

VAHHS Issues

Health Care Reform
After two days of laborious debate and 13 roll call votes, the Senate passed H. 524, An Act Relating to Universal Access to Health Care in Vermont on a vote of 21-6. All Democrats plus three Republicans supported the bill. Senator Snelling (R-Chittenden) voted no even though she had voted with the Democrats for most of the day.

The Republicans offered a total of 13 amendments. Senator Mullin's amendment to reimburse providers at the fair market rate for health services was the only Republican amendment to pass. Both of Senator Vincent Illuzzi's amendments supporting the governor's compromise plan offered last week failed. Senator Mark Shepard (D-Bennington) offered a number of unsuccessful amendments designed to provide market-based solutions and to discredit some of the bill’s findings.

Senators Edward Flanagan (D-Chittenden), Sara Kittell (D-Franklin), and Jeannette White (D-Windham), all Democratic members of the Health and Welfare Committee, offered an amendment allowing all Vermonters to join the Green Mountain Health by 2007 and to include hospital coverage by 2008. Senator Cummings, as chair of the Finance committee, did not support the amendment. It was defeated on a voice vote.

Senator Mullin (R) moved to amend the Senate bill by requiring that Green Mountain Health initially provide catastrophic coverage rather than primary and preventive care coverage. All the Democrats plus Senator Snelling (R) opposed the amendment. It lost 8-21.

The following are some of the items included in the Senate-passed bill: creation of a commission on health care reform to study ways to integrate care of state and regional levels; development of budgets by the Office of Vermont Health Access (OVHA); OVHA proposes budget for benefits by January 15, 2006; OVHA develops rules by February 1, 2006 on payment methods; OVHA negotiates payment amounts with the goal to eliminate the cost shift and reimbursements to reflect the fair market value; hospital global budgets beginning with fiscal year 2006; Green Mountain Health Plan (GMH) will be administered by OVHA with OVHA given the option of contracting this work out (does not require individuals with insurance to terminate that coverage and enroll in GMH or contribute to financing); wellness discounts; studies to look at economic impact, financing options, and governance; Captive Medical Malpractice plan and safe apology; and a number of pharmacy provisions. Those sections with appropriations (Health Information Technology and Chronic Care Initiative) were pulled from the bill and will be included in the Appropriations bill.

The House Health Care Committee walked through a side by side comparison of the House and Senate versions of H.524 on Thursday. The committee voted 11-0 to recommend that the House non-concur with the Senate on the bill. Minutes later, the full House suspended the rules and voted to send a message of non-concurrence to the Senate, which effectively starts the House-Senate Conference process. The House appointed three members of the Health Care Committee as conferees. They are Representatives John Tracy (D- Burlington), Harry Chen (D-Rutland) and Malcolm Severance (R-Burlington). The Senate conferees are Senators Peter Welch (D-Windsor), Ann Cummings (D-Washington) and Senator James Leddy (D-Chittenden).

The Governor remains opposed to the bill.

Budget and Medicaid
The Senate Appropriations committee voted the FY2006 budget out of their committee at the end of this week. Of most concern to hospitals was the committee chair’s decision to increase hospital cuts back up to the full level that Governor Douglas had proposed. For hospitals the FY 2006 reduction now stands at $18.4 million, despite Association efforts to keep cuts closer to the House-passed level. From here, the Association will work with conferees to reduce these proposed cuts.

The Senate Appropriations Committee expects to vote this bill out of the committee with a favorable report, with a strike-all proposal of amendment late today or if necessary on Saturday. The full text of the proposal of amendment is expected to be available during the afternoon on Monday, May 23, and it will be broadcast as an addendum to the Senate calendar on the website for the Vermont General Assembly at that time. The website’s address is www.leg.state.vt.us

H. 115 – An Act Relating to Advance Directives for Health Care
Both the Senate Judiciary and Health and Welfare Committees heard testimony on H. 115, an act relating to advance directives for health care. Any judiciary changes were resolved and the bill is now waiting approval from Senate Health and Welfare.

H. 163 - An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults
The Senate conferees have not yet been appointed. The House members include: Representatives William Lippert of Hinesburg, Maxine Grad of Moretown, and Michael Kainen of Hartford.

H. 227 – An Act Relating To Safe Staffing and Quality Patient Care
The House General, Housing and Military Affairs committee again took up H. 227. Gail Zatz, the lobbyist for the nursing union, introduced another strike-all amendment to the strike-all. Apparently she will be offering another early next week. The amendment introduced will require that the community report cards include hospital staffing and require hospitals to post staffing every day at every shift. The report will also be on the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) web site. Zatz stated that hospitals already have this information and it should be easy to do and not require additional staff time. Chair Francis Brooks asked that BISHCA look at the proposed amendment and outline what the department can do. The committee plans to take more testimony on this Tuesday afternoon.

H. 258 - An Act Relating to the Disclosure of Rates of Hospital-Acquired Infections

The committee discussed their next steps related to H. 258. The Chair of the committee stated that the committee will be writing a letter to all stakeholders asking that a group be convened to discuss what is currently being done at the state level and nationally on this issue. The letter will indicate what stakeholders to include in this meeting and will ask stakeholders to report back periodically to the committee during the summer and fall. When the session reconvenes in January, the committee will decide what to do with this bill.

H. 518 - An Act Relating to Capital Construction and State Bonding
The House and Senate conferees reached an agreement on a $45 million capital budget this week. The final agreement on the Human Services section specifies that the Department of Buildings and General Services would receive $250,000 for preliminary planning and design of a new facility to replace the current Vermont State Hospital. The remaining $375,000 wouldn't be released until plans were approved by the Joint Legislative Mental Health Oversight Committee. The Administration had asked for $725,000 and ended with a total of $625,000. An additional $300,000 is allocated for maintenance work at the Vermont State Hospital. Other items included in the bill are: $1.8 million for planning and design of health and safety laboratories, $400,000 for site acquisition and development of one or more work camps for prisoners, $1.7 million for the University of Vermont and the same amount for facility maintenance at the state colleges, and $9.3 million for the state's share of school construction projects.

H. 543 – An Act Relating to Long Term Care Waiver

The House Human Services introduced a committee bill this week and passed it on a vote of 9-0-2. The bill proposes to direct the department of aging and independent living to implement a Medicaid 1115 waiver to allow home- and community-based long-term care services to be offered in the same manner as nursing home services and address issues relating to the waiver. The bill is now is House Appropriations because of changes to eligibility for the disabled population who work. This allows them to have more assets and still be on Medicaid. Because of the time constraints, this bill may become attached to the budget bill.

S. 90 - An Act Relating to Prescription Drugs and Substance Abuse
S. 90 was incorporated in to H. 524 in Senate Health & Welfare. The 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. The Senate Finance committee was uncomfortable with the language and pulled it out of the health care bill last week and asked that the Senate Judiciary committee it. Allen Gilbert from the ACLU testified in opposition of the bill. After some discussion Senator Sears decided not to move the bill along at this time. He asked Health Commissioner Paul Jarris to take the lead in forming a broad-based group to work on the bill over the next six months so that his committee could have a final bill to move quickly through next January. Senator Sears will also participate on the group.

Mental Health
The House Human Services took more testimony this week on the expansion on locations where court-order psychiatric evaluations for individuals charged with crimes can be administered. Jennifer Fauntleroy, M.D., a psychiatrist at Rutland Regional Medial Center and a member of the VAHHS Inpatient Mental Health Physician group, supported the expansion of these evaluations to designated hospitals. The committee is likely to write a letter to the Senate Appropriations Committee expressing their concerns on the process and lack of urgency in their view on pushing this through. Although there is broad support from the health care community, corrections and judges, there are concerns from committee members on creating public policy in this fashion. If the Senate Appropriations committee feels strongly about adding this language in the budget bill, the committee will request that a sunset date be added.

Premium Tax vs. Payroll Tax

Bea Grause, President of VAHHS, testified in House Ways & Means on the tax-portion of the health care reform bill. Grause testified that the Association supports raising revenue to support any new benefits the legislature creates. Ms. Grause added that any revenue raised must be sufficient to adequately support these benefits so as not to increase the cost-shift.

New bill introduced this week of interest to VAHHS

H. 543 – An Act Relating to Long Term Care Waiver

The bill proposes to direct the department of aging and independent living to implement a Medicaid 1115 waiver to allow home- and community-based long-term care services to be offered in the same manner as nursing home services and address issues relating to the waiver. The bill is now is House Appropriations and will likely be there until early next week.