VAHHS Legislative Report

For the week ending February 17, 2006

Political Overview

More clarity on the statewide races occurred this week. Progressive Representative David Zuckerman of Burlington announced that he would not seek the U.S. House seat. The Republicans now have three individuals vying for the lone House Seat. They are Adjutant General Martha Rainville, Senator Mark Shepard of Bennington, and Dennis Morrisseau of West Pawlett. With the announcement of Martha Rainville running for the House seat, the election of the new Adjutant General of the Vermont National Guard will take place on Monday, February 27 by a joint session of the General Assembly. Depending on the length of the election, committees may opt to meet since crossover will be Friday of that week.

Other big issues this week include: lack of funding for farmers and open records law. Members of the House and Senate Agriculture committees blasted the governor this week on their view of his lack of commitment to farmers with an increase in the budget of only $7,000 in a $14 million budget and doesn’t reflect the governor’s own agricultural priorities with both committees stating that he did not even fund his own dairy task force recommendations. This likely will become a campaign issue.

A hotly contested bill was debated on the floor of the House this week. H.615, An Act Relating to the Public Records Act and Application of the Deliberative Process Privilege, rules out the “deliberative process” exemption to open records law. Vermont enacted its public records law in 1976, establishing the rule that records produced or acquired by state agencies as part of their day-to-day business are open for public inspection. The Democratic leadership stated that recently it has become more common for state agencies to deny the public's requests for documents by invoking what is called deliberative process privilege, a privilege that until now has not been used in Vermont. The Douglas Administration is opposed to the bill because it would apply to the executive branch, but not the records of local government, judiciary and legislature.

VAHHS Issues

Health Care Reform

Major movement occurred on the health care front this week. Both House Health Care and Senate Health and Welfare passed out their health reform bills, much to the relief of both committees after seven long weeks of working on their respective bills.

H. 861 – An Act Relating to Affordable Health Care for Vermonters, passed out of committee on Thursday afternoon on a vote of 9-2-0. Representative Joseph Baker, R-West Rutland, offered an amendment that would include the employer-sponsored insurance (ESI) plan offered by the Governor in his health reform bill, minutes before the committee was to take a final vote on the bill. Chairman Rep. John Tracy, D-Chittenden, voiced his anger and frustration with the Administration for throwing this bomb minutes before the vote. After a brief break, the committee reconvened and Rep. Baker withdrew his amendment. The bill is now in the House Ways and Means committee to look at revenue sources in addition to Global Commitment funds to support the program. Provisions of the bill include: addressing the chronic care infrastructure and prevention, disease management for high-utilization Medicaid and state enrollees, Catamount Health administration and benefit structure, cost-shift reduction for primary care physicians and links future increase in reimbursements to the Blueprint Standards. The bill has language that states the goal of the Medicaid pilot projects to integrate and improve collaboration among health care professionals and community partners. It requires the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) to ensure for appropriate reductions in cost shift due to increase Medicaid reimbursement and reduction in bed debt or charity care. It also requires BISHCA to convene a task force to determine how the cost shift reductions are reflected in health insurance premium rates. The benefit structure refers to a comprehensive primary care, preventive, chronic care and hospital services that would be actuarially equivalent to the Cigna plan offered to state employees. The financing of the various initiatives will be provided through the Global Commitment and will require additional tax revenues as well. Tax revenue increases have not yet been identified and will be looked at next week in House Ways & Means. Appropriations in the bill include: $200,000 for the hospital pilot projects and $2.9 million for increased Medicaid reimbursement to primary care physicians.

Friday afternoon the Senate Health & Welfare committee passed the Common Sense Initiatives (CSI) bill on a vote of 5-0-1. This committee has had its fair share of ups and downs over the last few weeks as well. Provisions in the bill include: healthy lifestyle insurance discounts for the small and nongroup markets; establishes a grant fund for communities to create wellness programs; creates a medical event reporting and patient safety improvement systems; requires infection rate reporting in hospital community reports; establishes a common claims and procedures work group; requires a common credentialing form; coordinates initiatives around health information technology; creates a consumer health care price and quality information system; establishes a loan repayment program to recruit and retain medical providers in underserved areas; and revises the advance directives law.

The committee incorporated the adverse event program developed by VAHHS, Vermont Department of Health (VDH), Vermont Medical Society and Jeanne Keller into the CSI bill. The program is essentially unchanged from the original proposal to the committee, although some language was reworked. VAHHS opposes the funding provision of the bill. It calls for $160,000 in general funds and $40,000 in a hospital bill back in the first year of the program, and a 50/50 split between general fund and bill back thereafter. The provision that allows the health department to hire additional external consultants to investigate specific cases at the expense of hospitals was not included in the bill.

The total appropriation in the bill is $3,703,500 including the $500,000 from the federal government for community wellness grants. There is a shortfall of $85,000 in relation to the Governor’s recommend. Commissioner of Budget and Finance Jim Reardon stated that he would find the money somehow. Distribution of the $3,503,500 is as follows:

General funds of $2,963,500
Ø $500,000 for VITL

Ø $1,003,500 for community wellness grants

Ø $160,000 for adverse event reporting

Ø $400,000 to BISHCA for development of the multi-payer database

Ø $850,000 for the loan repayment program

Ø $50,000 to VDH for the advance directive registry

BISHCA
Ø $200,000 for VITL

Ø $500,000 from the federal government for community wellness grants

Hospitals
Ø $40,000 bill back to hospitals for the adverse event reporting system

The bill will be sent to the Senate Appropriations committee for their review.

House Appropriations

Peter Cobb, Executive Director of the Vermont Assembly of Home Health Agencies, testified that the number one issue for the home care industry is the addition of $1 million to the High Tech Home Care Program. Cobb testified that the program is running on 1993 money as the rates have only increased 10%since 1990. Agencies are at a point where further losses could end the program. The committee was sympathetic, but it is unclear what they will propose. The House Appropriations Committee hopes to get its work done on the state government section today. The goal for the committee is to have the entire budget completed by March 17. The Medicaid budget will likely be one of the final budgets to be done.

H. 713 – An Act Relating to the Eradication of Cervical Cancer

The House Human Services and Appropriations committee took testimony on H. 715 and quickly moved the bill to the floor for action. The bill proposes to establish a task force on the eradication of cervical cancer in Vermont and make specific recommendations to the Vermont Department of Health by January 15, 2007 on issues such as community and provider awareness, cost/coverage of health care related to cervical cancer, and best-practices related to testing and treatment. It also requires the commissioner of health to report to the General Assembly on the findings of the report by February 1, 2007.

S. 198 – Act Relating to Reporting Medical Errors and Establishing a Sorry Works Program

The Senate Judiciary Committee asked provider and attorney groups to try to develop consensus language for a safe apology that would include explanations to patients. The committee also asked those groups to rework the Sorry Works provision of the bill to something more general, modeled on the Illinois language that VAHHS supports. We have done so and submitted that language to the committee. In the meantime, insurance carriers for the hospital that was prepared to pilot the program have made it clear they will not cover a participating hospital. That leaves the committee with no volunteers for the program. We have alerted the committee chair and expect that will be discussed next week.

Senate Economic Development, Housing and General Affairs

The committee took brief testimony on the workers compensation medical fee schedule. The committee will draft a bill that will set the workers compensation fee for hospitals and physicians at Medicare levels and plan to take testimony before town meeting week.

Medicare Part D

The House and Senate passed H. 851 this week. The bill extends the benefit for additional two weeks for a total of $11 million the stated has committed. The bill also includes $400,000 from the Global Commitment fund to the Department of Aging and Independent Living to assist individuals with enrollment. It now goes to the Governor for his signature.

H. 567 - Program for All Inclusive Care for the Elderly (PACE)

This bill has been signed by the Governor.

Bill of Interest Introduced this Week

H. 861 – An Act Relating to Health Care Affordability for Vermonters (Committee on Health Care): This bill proposes to: 1) enhance and improve the delivery of chronic care to Vermonters by codifying the Vermont blueprint for health chronic care prevention and management plan, unifying the chronic care efforts within the state, and initiating chronic care prevention and management in Medicaid and catamount health; (2) establish catamount health, a comprehensive health benefits plan for uninsured Vermonters, and to direct the legislative health access oversight committee to monitor implementation; (3) increase Medicaid reimbursements for primary care services; and (4) strengthen the authority of the department of banking, insurance, securities, and health care administration to reduce health insurance premium growth rates as a result of reductions in the uninsured population and increases in Medicaid rates.

S. 309 – An Act Relating to Prescription Drug Pedigrees (Campbell of Windsor): This bill proposes to require wholesale drug distributors to maintain a drug pedigree identifying the chain of distribution of the drug.