VAHHS Legislative Report

For the week ending March 3, 2006

NOTE: THERE WILL BE NO LEGISLATIVE REPORT FOR THE WEEK ENDING MARCH 10. The Legislature will be on town meeting break. The next report will be March 17.

Political Overview

The most highly and contentious debate this week was on health care. Catamount Health eventually passed Friday afternoon on a vote of 77-58, but not before legislators exhausted themselves with procedural minutia. Points of orders were thrown left and right from both sides. At one point during debate over a point of order, there was a mass exodus of Republicans from the floor leaving the Democrats sitting in amazement wondering how long their glory will last.

All attention will now turn to the Senate for the next steps in this year’s health care reform debate.

VAHHS Issues

Health Care Reform

The House passed H. 861, An Act Relating to Health Care Affordability for Vermonters, on a 77-58 vote. In preparation for cross-over, both of the major healthcare reforms bills from the House and Senate (H.861 - Health Care Affordability for Vermonters, S. 310 - Common Sense Initiatives) were passed to the floor ensuing further debate about the potential of such legislation in achieving any kind of effective reform.

On Thursday, representatives of the House Health Care Committee presented an overview of H. 861 focusing largely on the Catamount Health, a benefit program to cover the uninsured. As it stands presently, the main components of the bill are: 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 is 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 bill uses two kinds of tobacco dollars to raise $66.2 million over four years to fund H. 861. Beginning on July 1, the tax on cigarettes would increase by 60-cents to $1.79 a pack. Twenty-two percent of the revenue collected would go toward Catamount Health for the uninsured and for those individuals with chronic conditions. It is projected that revenues would increase over the next four years anywhere from $13 million and slowly decreasing to $11.2 million in 2010. The committee also recommended using the $13 million in tobacco settlement funds that begin in 2008. The rest of the funds would come from the Global Commitment savings.

VAHHS worked proactively to disseminate our advocacy materials to legislators and hospital CEOs on our positions and reasoning for opposition to H. 861. Each legislator received a copy of our position paper including concerns over financing of Catamount Health and the lack of provisions to address the cost-shift. Additional materials were provided to legislators for further clarification on issues such as Catamount payment rates and funding sustainability.

Rep. Janet Ancel of House Ways and Means provided explanation of the amendment from House Ways and Means that included funding of Catamount Health jointly through tobacco funds and general funds from the Global Commitment. During the course of discussion on the floor, issues were raised regarding the effect of increased taxes on over-border purchasing of tobacco and the additional financial burden placed on the mentally ill that heavily rely on cigarettes.

Several amendments were proposed including those brought forth by Rep. Kurt Wright to refer the bill back to the House Health Care Committee and another by Rep. Ann Donohue to postpone passing of the Catamount Health parts of the bill so that additional proposed studies could be completed. All were defeated.

Common Sense Initiatives

The Common Sense Initiatives bill, S. 310, passed on the Senate floor this week. Senator Jim Leddy, Chair of the Senate Health and Welfare Committee, presented an overview of the bill. 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 medical event reporting section of the bill calls for an appropriation of $160,000 in general funds and $40,000 in a hospital bill back in the first year of the program. In subsequent years it calls for a 50/50 split between general fund and bill back thereafter. VAHHS opposes the funding provision of the bill.

The Senate Appropriations committee reallocated some of the funds in the bill. An additional $30,000 was added to the loan forgiveness program bringing the total appropriation to $880,000. The additional $30,000 for the loan forgiveness program was taken from the community wellness grants, which lowers that appropriation to $973,000.

Senator Leddy stated that S. 310 is only a piece of health care reform and without passage of the House health care reform it is only a token piece of legislation.

Medicare Part D

As reported last week the state will make the big switch back to Medicare Part D on March 8. There continues to be concern among lawmakers that the switch will occur while the legislature is on town meeting break, not allowing the committee to intercede if need be. The House Human Services introduced and passed H. 873, An Act Relating to Procedural Protections for Vermonters eligible for Medicare Part D and VPHARM. The purpose is to ensure that pharmacists provide immediate referrals and transitional prescriptions to meet an individual’s immediate medication needs while the individual’s prescription drug coverage problem is resolved. All House rules were suspended and the bill was taken up for immediate action. The bill passed and the same process took place in the Senate.

H. 306 – An Act Relating to Transportation of Children in the Custody of the State

The House passed on the floor a bill that discourages the use of leg-irons, shackles, or similar restraining devices when transporting a child who is in the custody of the state unless public safety requires that such methods be used. The bill also requires the commissioner of the Department for Children and Families to report the House Human Services Committee and the Senate Health & Welfare committee data on the number and gender of children transported to various locations, and the method of transports. Retreat Healthcare is very supportive of this bill. The bill is now in the Senate.

H. 480 – An Act Relating to Precursor Drugs of Methamphetamine

The House passed H. 480 on the floor this week. The bill would require pharmacies and retailers to remove common cold medications from over the counter to locked display cases or behind counters. The bill targets cold medicines such as Sudafed that contain ephedrine, pseudoephedrine or phenylpropanolaimine, chemicals that can be cooked with other substances in rudimentary laboratories to produce methamphetamine, a highly addictive drug. It would also require retailers to track how many packages of these pills are sold to individuals because of the limits placed in the bill. Customers would have to show identification and sign log books when purchasing cold medications with these ingredients. It also requires the Vermont Department of Health to publicize and educate the public about the restrictions. The goal of the legislation is to restrict access to the critical ingredients that make methamphetamine.

H. 864 – An Act Relating to Capital Construction and State Bonding

The House passed the Capital Bill on the floor this week. Health related pieces in the bill include: $1 million for planning for the replacement of the Vermont State Hospital. As reported in last week’s report, the committee put conditions on the release of the funds. An amendment offered on the floor by Rep. Alice Emmons, D-Springfield, passed which supports the statement in the Vermont futures strategic implementation plan that supports the expertise and experience of the current Vermont State Hospital staff is a valuable resource by identifying potential avenues that would enable current qualified staff to maintain their status and benefits as state employees. The bill is now in Senate Institutions.

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

The Senate reported S. 198 on the floor this week. The Senate Appropriations Committee recommended that the Department of Banking, Insurance, Securities and Health Care Administration initiate a dialogue with insurers and encourage them to participate in the Sorry Works pilot program with any hospital that is willing to commit to the program in order to gain the participation of insurers necessary to enable hospitals to participate and implement the program. The committee also removed the $75,000 appropriation for the program. This bill will be up for 3rd reading after the town meeting break.

Workers Compensation Medical Fee Schedule

The Senate Economic Development, Housing and General Affairs met today and recommended language that sets workers compensation reimbursement for hospitals at 110% of Medicare. VAHHS staff is meeting with Commissioner of Labor Patricia McDonald on Monday to support the original rulemaking that has reimbursement pegged at 85% of charges. There is a favorable chance that the original rulemaking will prevail.

Title 20 – An Act Relating to Emergency Management and Public Safety

The House Government Operations Committees took testimony on Title 20 revisions again this week. Draft 1.5 was distributed during the hearing. VAHHS, the Vermont Department of Health (VDH) and Vermont Medical Society submitted joint testimony again on changes we would like to see related volunteers, workers compensation, liability and disability protections. Because parties had not had an opportunity to review the current draft the chair of the committee, Donna Sweaney, recommended that all parties meet immediately after and work out the remaining pieces. The committee hoped to vote the bill out on Thursday, but because of too many unresolved issues, the committee delayed vote on the bill. Because the bill will be a committee bill the crossover deadline does not apply, but will need to be released by the Rules Committee. The committee will take up the bill on March 15, 2006.

Bills of Interest Introduced

H. 873 - AN ACT RELATING TO PROCEDURAL PROTECTIONS FOR VERMONTERS ELIGIBLE FOR MEDICARE PART D AND VPHARM (Committee on Human Services): This bill proposes to provide procedural protections for individual’s eligible for Medicare part D and the state pharmacy programs who are unable to access Medicare coverage due to continuing operational problems.