VAHHS Legislative Report

For the week ending March 31, 2006

Political Overview

The momentum of political activities around health care reform accelerated this week. Both the House and Senate have continued to migrate toward final drafts of their major reform bills and are still on target for the legislative season to come to a swift close at the end of this month. With bills near final drafts, the legislature is preparing to expedite approval of the FY2007 budget over several weeks and end the session by the end of April.

Both, H. 861- Healthcare Affordability for Vermonters and S. 310- Common Sense Initiatives have garnered much of the legislative committee focus in healthcare reform. The Senate announced new changes today to their version of the Catamount Health benefits. Ken Thorpe, Consultant to the Health Reform Commission, was in town mid-week to discuss updates and impetus for the bill components, raising questions about this year’s end game strategy. It remains anyone’s guess how these reform proposals will fare at the end of this session.

VAHHS Issues

Health Care Reform

H. 861

The Senate announced significant changes to their version of Catamount Health. Essentially, the Senate proposal moved to include additional “financial restraints” and modeled the bill more like the original House version. The benefit package was trimmed, reducing reliance on Global Commitment funding and limiting Catamount Health to the individual market. To this new version, publicly funded reinsurance and the Governor’s Employer Sponsored Insurance proposal were also added. Funding remains unclear, but legislators voiced their intent to secure hospital support for this new draft.

Various stakeholders could potentially rally around this final draft. VAHHS believes these reforms have kept the torch of reform through compromise alive at least for now. The Governor issued several press releases during the course of the week expressing his concern around the burden on taxpayers, but with optimism around finding middle ground. On Friday the Senate Health and Welfare Committee continued review of the bill. Next week will likely trigger release of projections identifying financial impact of recent changes to the bill. All Senate Committees will be returning to regular am/pm committee meeting schedules.

Senate Finance: Hospital Charity Policy and Responses to bill

On Thursday morning, representatives from VAHHS including several hospital and financial administrators testified before the committee on issues around hospital charity care/bad debt policies. Information was distributed to educate legislators on the reality of how charity care is provided, how hospitals make those determinations and then conduct their financial accounting in response. Questions from committee members followed.

S. 310 - Common Sense Initiatives

The House Health Care Committee continued discussion and revisions to the bill during the course of the week. Minor language changes were made to clarify several issues around data collection and information sharing. Herb Olson and Linda Cohen, BISHCA, testified on issues of information sharing and utility and also brought forth concerns from the PBMs on duplicative reporting. BISHCA requested bill language to remain as is with provisions to be included in the rule-making process to address these issues.

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

House Judiciary took up S 198 which focuses on Safe Apology and Sorry Works. They heard testimony in support of the language that passed the Senate from a diverse group of stakeholders including the health care ombudsman, the Vermont Medical Society, the Vermont Trial Lawyers Association and VAHHS. Based on questions from the committee, some of the concerns that individual stakeholders expressed when the bill was under consideration by the Senate were described. These included concerns about the 30 day time limit for Safe Apology expressed by VAHHS and VMS and concerns about protecting “explanations” expressed by the Vermont Trial Lawyers Association. However, all parties said that despite their lingering concerns, they supported the compromise language as passed by the Senate. The committee raised questions about whether the Sorry Works section of the bill includes adequate protection against settlements offered by hospitals being admissible in a litigation proceeding. BISHCA staff agreed that the protection might be inadequate. The committee also heard testimony on the general issue of malpractice insurance, including extensive testimony from Representative Harry Chen who provided context for the discussion.

Emergency Preparedness

A joint committee from House Agriculture and House Fish, Wildlife and Water Resources convened to hear testimony on Avian Influenza. Various stakeholders including Wayne LaRoche, Commissioner of Dept. of Fish and Wildlife, Dave Cote, Public Health Preparedness, Dr. Cort Lohff, State Epidemiologist provided testimony on risk of the epidemic in the Vermont and the state’s preparedness activities. In the unlikely event that such an infectious strain of the disease comes to Vermont, it could kill more than 3,700 Vermonters and send more than 18,000 others to the hospital, according to state estimates released in the joint hearing. Even if Vermont never sees a strain of the illness severe enough to pose a human health threat, state officials warned, the disease could still severely impact the state's poultry and wild birds.

Title 20 An Act Relating to Emergency Management and Public Safety - The House Government Operations did one last review of the revisions to Title 20 on Thursday afternoon. The Committee passed the bill out of committee on Friday. The bill will be on notice next Wednesday and on the floor Thursday. The committee will be conducting a public hearing at Brattleboro High School on Wednesday, April 5, 2006 at 6:30 p.m. Any comments/revisions will be done by 3rd reading. VAHHS supports the bill as passed the committee.

Senate Appropriations

Budget - Yesterday afternoon the Senate Appropriations Committee heard from various advocates regarding funding requests and programs including the Dept. of Health. The committee heard testimony from Dr. Paul Jarris, Commissioner of Health, Sharon Moffett, Deputy Commissioner, regarding oral health; Barbara Cimaglio, Deputy Commissioner Alcohol and Drug Abuse Programs, and Paul Blake, Deputy Commissioner Mental Health Services. Dr. Jarris commented that he will be presenting on the Blueprint to the CDC later this week. He expects pandemic Influenza to enter the U.S. by summer. Currently, it is only in birds and not humans, but believes this is a credible threat and likened the possibility to the 1918 pandemic. Currently, there are no federal guidelines regarding the use of antiviral's; at the same time antiviral's may not be the best use of the money (other uses might be more appropriate) i.e. not the panacea. They are planning the state's largest response drill this summer.

Mental Health Services requested $1.3 million that was in last year's waterfall to be put into this year's base. Staffing levels were sustained with this $1.3 million in FY2006. FY2007 staff increases include: adding 13 positions to nursing to meet a 1:4 ratio in addition to a records specialists, administrative support, an executive level director, project leader, a risk manager, attorney, medical director in addition to other clinical staff.

The House concurred with the Governor's recommendation for $100,000 to the Oral Health Initiative - this money is available for federal match and would help fix the larger more expensive issues (prevention). The money works to set up the system, identifies the kids and works within the system to get these kids to the limited number of dentists that are in the state.

There is also $100,000 in the budget for specific community grants including Fit N’ Healthy Kids and Run Girls Run. The Governor's budget contains $100,000 for a media campaign targeting alcohol abuse. This funding was cut by the House, so the Dept. of Health requested the Senate to include it. Drug and Alcohol Programs will be adding 50 opiate treatment slots focusing on adolescent treatment services as well as transitional housing mainly for women getting out of prison.

DAIL

Testimony was also heard this week from Commissioner Patrick Flood of the Department of Aging and Independent Living. Commissioner Flood gave an overview of Department’s budget and their new 1115 Waiver, Choices for Care. Commissioner Flood testified that the following areas are being recommended for increases: Area Agencies on Aging (AAA) of $250,000; $244,000 for four additional slots in traumatic brain injury slots; $150,000 for home health administrative staff to address licensing activities, one for quality assurance and one for financial review; $100,000 for adult protective services to improve the APS system including crisis response, coordination with law enforcement and prevention; $100,000 for healthy aging to assist elders to stay physically active; and $10,076,713 to cover projected caseload as well as provide the designated agencies with a 4% cost of living adjustment.

The House Appropriations made the following changes: increased the funding to the AAA to $500,000; $65,000 to adult day, $100,000 for assistive community care services, $36,000 for home delivered meals for the disabled, $50,000 for services to the blind and $75,000 for HomeShare Vemont. Within the OVHA budget are long term care funds of $10.7 million. The $10.7 includes approximately $7 million for nursing home inflation, case mix rate adjustment and extraordinary relief contingency funds. The remainder $3.75 million is to support the home based care system.

In regards to nursing homes, the bill requires that the commissioner of the Department of Aging and Independent Living convene a task force to analyze Medicaid reimbursement rates for nursing homes and coordinate their work with the task force on the future sustainability of nursing homes. The task force will make recommendations on changes to the rules, methods, standards, and principles for establishing Medicaid payment rates for long term care facilities.

Blueprint

Wednesday afternoon, Ken Thorpe, Consultant to the Health Care Commission, presented a status report on the Senate Floor outlining the impetus for the major provisions of H. 861 including the Blueprint/Chronic Care Management and Catamount Health including administration by a private entity and inclusion of reinsurance. He emphasized implications of affordability and access, highlighting that the purpose is to not only provide coverage, but to decrease cost for those already insured in the private market.

State Hospital

The Senate Appropriations committee reviewed the FY2007 budget where they approved funding of $1,350,000 to the State Hospital futures project; an increase from the $1,000,000 allocated by House Appropriations. Also included was an additional $100,000 for safety enhancements as recommended by Senate Institutions.

House Commerce

On Thursday afternoon, additional testimony was heard around H. 511 – An Act Relating to Medical Discount Plans. Additional draft language was brought forth, but the committee will continue to discuss and determine bill provisions through next week.

House Human Services

House Human Services considered testimony from the Division about Mental Health about their concern that the CON requirements for the new state hospital may be duplicative of, and even contradictory to, other obligations through the Futures Advisory Committee and the Mental Health Oversight Committee. The Division also expressed concern that the construction of a new state hospital would be delayed by the CON process. Representatives for the Division testified the primary functions of the CON process to assess need and contain costs were being addressed through the regulatory, legislative and appropriation processes and were not necessary. The committee took additional testimony from the Vermont Association for Mental Health, the Vermont State Employees Association and the Public Oversight Commission.

House Human Services considered S.90, a bill to establish an electronic prescription drug monitoring program in order to identify possible abuses of prescription drugs and support the legitimate medical use of controlled substances. The committee took testimony from Barbara Cimaglio, Deputy Commissioner of Drug and Alcohol Abuse at the Department of Health. Some stated desired outcomes of the legislation include providing for patient privacy and public safety, a focus upon prevention and intervention and making the Health Department (and not law enforcement) the lead agency in operation and enforcement. Ms. Cimaglio testified that any database would be fully HIPPA compliant and noted that grant money had already been approved for Vermont to develop such a program through the Department of Justice. Vermont would need to enact legislation authorizing the project to pull down the grant however. The VT program would be developed in context with federal guidelines and with the help of Maine, which has successfully implemented a monitoring program