VAHHS Legislative Report

Final 2006 Report

The Vermont General Assembly adjourned on Wednesday, May 10, 2006. As this is the second year of the biennium, any bill that had not passed both the House and Senate before the May 10th adjournment is dead. Because this is an election year in Vermont, the composition of the Legislature will be different when they begin the next biennium in January 2007. (A detailed political overview is set out below.)

VAHHS Issues

Medicaid/Budget (H.881)
The General Assembly passed a $1.13 billion state general fund budget ($4.5 billion total budget). Reimbursement for hospitals and physicians are included in the health care reform bill (H. 861) instead of the budget bill. A number of provisions of the Common Sense Initiatives bill (S. 310) are included in the budget bill.

The following budget bill provisions (by section number) of interest to VAHHS are as follows:

Section 64: Public Safety - Homeland Security: Up to $5 million in federal homeland security grant funds from maybe be used for planning, management, and initial development of the Vermont communications (VCOMM) statewide public safety communications system.

Section 70 (g)(7): General Fund Waterfall: Effective for fiscal year 2007 only, the division of rate setting shall amend the rules effective for establishing Medicaid rates for nursing homes services to lower the minimum occupancy used in setting the Medicaid rate to 90 percent, excluding nursing costs.

Section 75a and 75b. Victims’ Compensation Fund – Reimbursement to Providers: These sections set reimbursement levels to hospitals from the Victims’ Compensation Fund for uninsured crime victims at 70% of billed charges, and prohibit hospitals from billing any balances to the victims. Acceptance of payments from the Fund at this level also becomes a condition of hospital licensure.

Section 87. Banking, Insurance, Securities and Health Care Administration (BISHCA): $700,000 is appropriated to the BISHCA for the continuation of the Vermont Information Technology Leaders (VITL) project. This funding will not be made available until funding provided under last year’s budget is fully expended. Availability of the $700,000 is contingent on:

§ Approval by the Secretary of Administration of a plan from VITL for coordinating its activities with the Blueprint for Health’s chronic care initiative and other health care-related statewide information technology projects; and

§ A commitment by VITL to use its best efforts to secure a non-state match for the funds.

§ If at any point VITL no longer demonstrates its ability to deliver the work described, the State will have the right to assume ownership of all of VITL’s licenses, intellectual property and work product developed for the State.

From BISHCA’s total appropriation of $4,920,898 budget, $400,000 will be used by BISHCA for the development of the “consumer health care price and quality information system” under Section 57 of H. 861.

Section 107a. Medicaid Generic Reimbursement Reduction and Dispensing Fee Study: The Office of Vermont Health Access (OVHA) is required to study the impact of the federal Deficit Reduction Act of 2005 on pharmacists and the Vermont pharmacy benefits program, with specific reference to:

§ The impact of the generic drugs provision on Vermont pharmacists and on Medicaid program participants; and

§ The State’s potential for savings.

A preliminary report is due on September 1, 2006, with the final report due on November 15, 2006.

Section 112. Medicaid Deficit and Reimbursement Study: The Health Access Oversight Committee will study options for and develop a plan to eliminate the Medicaid deficit. This committee will study the reimbursement rates paid by Medicaid, VHAP and Dr. Dynasaur and the effects of the rates on Vermont’s health care system. The Committee will consider:

§ Opportunities in the Global Commitment waiver;

§ Methods to streamline administration and regulation in Medicaid, VHAP and Dr. Dynasaur;

§ The fastest growing expenses in the programs and determine whether there are efficiencies or other methods available to control costs; and

§ Other strategies for reducing the deficit.

§ The Committee’s report and plan will be due to the legislature by January 15, 2007.

Sections 115a and 115b. Vermont Department of Health (VDH) – Blueprint for Health: These sections contain the total appropriations ($6.3 million) for the Blueprint for Health. They also require that from those funds, VDH will provide incentive grants and stipends to physician practices participating in the pilot projects developed under the Blueprint.

Section 116. VDH – Chronic Fatigue Syndrome: VDH is to establish a statewide network of educational resources relating to Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), including developing informational packets on CFIDS with the assistance of the Vermont CFIDS Association and health care providers. The packet will be distributed to all primary care physicians in Vermont as well as available on the Department’s web site.

Section 119. VDH – Adverse Event Reporting: $160,000 is appropriated for the development and implementation of a patient safety surveillance and improvement system (see Sections 323 – 324 of the budget bill, below). The remaining $40,000 needed for this system will be collected by VDH and BISHCA from hospitals.

Section 122. VDH – Mental Health: Subsection (b) of this section appropriates $70,000 to Burlington’s “Downtown Outreach Program” to develop a model program for expansion to other parts of the state.

Section 149 a: Task Force on the Future Sustainability of Nursing Homes: The Department of Disabilities, Aging, and Independent Living (DAIL), will collaborate with nursing homes, residential care homes, assisted living residences, home health agencies, area agencies on aging and adult day providers to develop a long-range plan to address the sustainability of Vermont’s long term care system. Recommendations shall address the transition issues for nursing homes as more individuals use home and community-based long term care services, how nursing homes can covert the services offered to provide long term care services differently, unmet need for nursing homes for individuals, accessibility for individuals with disabilities in nursing , an annual project of the number of nursing home beds to meet the projected need over the next 10 years reported by region, the development of adequate home and community-based services to support increased numbers of Vermonters receiving that type of care, whether indexing is an appropriate method of sustainable funding for home and community based services, and the method which nursing homes can use to become resident-centered in the provision of long term care. A second task force will be convened by DAIL to analyze Medicaid reimbursement for 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 in order to meet the protocols and objectives of the Choices for Care Medicaid Waiver. $25,000 in general funds will be appropriated with funds matched by the Vermont Health Care Association.

Section 271: FY2006 General Fund Appropriations and Transfers: Appropriates $1 million to the Department of Buildings and General Services (BGS) for the Agency of Human Services (AHS) for continued planning, design and permitting associated with creating a new inpatient facility to replace the current Vermont State Hospital (VSH). (see details below on Capital Bill)

Section 293. State Hospital Futures Planning Advisory Group: This section amends Act 122 (2004) to extend the existence of the VSH Futures Planning Advisory Group through July 1, 2009 (original sunset date of July 1, 2006).

Section 293a. The Mental Health Oversight Committee (MHOC): This section amends Act 122 (2004) to extend the MHOC’s existence through July 1, 2009 (original sunset of July 2006).

Sections 294, 294a and 294b. Health Access Oversight Committee (HAOC): This section codifies the existence of the HAOC, which was first created in 1995.

Section 295. Commission on Health Care Reform: This section authorizes the Commission to carry forward any unexpended amounts from its 2006 appropriation, and directs the Commission to:

§ Research support for state health care reform efforts and Medicaid program reviews; and

§ Monitor state health information technology activities, including reviewing State government health information technology (HIT) systems; continued review of HIT systems used by health care providers, and continued review of HIT activities by the Blueprint for Health and by VITL.

Section 295a. Health Care Reform – Economic, Financing and Administrative Studies: This section updates the required health care study sections of last year’s budget bill. The Commission on Health Care Reform, in consultation with BISHCA, is directed to complete an economic impact study by January 15, 2007, that will:

§ Review alternative ways of financing universal health care coverage based on either private insurance or a single payer, including employer assessments, payroll taxes, income taxes, premiums (either employment-based or independent of employment) or other revenue options;

§ Identify the macroeconomic consequences of choices in health care financing, such as changes in the number of employed individuals, the average wage, distribution of wages, rate of growth of gross state product, rate of growth of personal income, attractiveness of the state for relocating businesses and the mix of employment types;

§ Identify relationships between financing mechanisms and the macroeconomic consequences if quantifiable; and

§ Apply the policy analysis and indicators above to the specific health reform proposals considered in the 2006 legislative session.

Section 321. Coordinated Health and Wellness Programs: Under this section, the Coalition for Health Activity, Motivation and Preventions Programs (CHAMPPS) initiative of VDH is to serve as the foundation for all community wellness initiatives within the Department. The Agency of Human Services is also required to compile an inventory of all existing state programs and initiatives involving health, recreation, and wellness and report on it to the Legislature by December 15, 2006.

Section 322. Community Health and Wellness Grants: This section requires the Commissioner of Health to establish a program for awarding competitive, substantial, multi-year grants to comprehensive community health and wellness projects. The intention is to coordinate the grants, to ensure they are consistent with other State efforts (such as the Blueprint), and that grant recipients will be accountable for showing progress in meeting their goals. The Commissioner is also required to provide technical assistance to community projects. VDH must establish grant committees by September 1, 2006, which will review and score grant applications for grant funding to begin no later than July 1, 2007. [$1.09 million is appropriated to VDH in Section 119(i) of the budget to support these grants in FY 2007.]

Sections 323 – 326. Patient Safety Surveillance and Improvement System (Adverse Event Reporting): These sections establish a new adverse event reporting system administered by the VDH. The intent is to set up a system for monitoring each hospital’s adverse event reporting to ensure that the systems identify and act on those events in a timely way. The system administered by the Department will:

§ Collect data concerning the occurrence of reportable adverse events;

§ Aggregate and analyze the date for the purpose of developing and implementing strategies to target and eliminate specific adverse events;

§ For reportable adverse events, verify that hospitals are conducting causal analysis and developing corrective action plans consistent with standards set by the department, current patient safety science and relevant clinical standards;

§ Provide technical assistance or assist hospitals in locating technical assistance resources for analyzing adverse events and near misses and developing and implementing corrective action plans; and

§ Encourage hospitals to use anonymous in-hospital reporting when possible.

Under this system, all Vermont hospitals will be required to maintain adverse event reporting systems that allow them to identify, track, and act on a broad array of adverse events. In addition, hospitals will be required to report to the Department events identified through rulemaking, which will initially include the so-called “never events” identified by the National Quality Forum.

Hospitals will also be required to notify the Department of “intentional unsafe acts” by providers that affect patients, defined to include criminal acts, purposefully unsafe acts, alcohol or substance abuse, or patient abuse.

Hospitals will be required to give access to the Department to otherwise confidential or protected records for purposes of ensuring adherence to this section’s requirements, but those records will generally not be otherwise available to other agencies or for any other purpose than the State’s oversight function.

The Commissioner is also required to consult with BISHCA and to make recommendations concerning how adverse events should be included in the hospital community reports required under Act 53.

This system is funded initially by a $160,000 appropriation (see Section 119, above) and $40,000 to be collected from hospitals. Beginning July 1, 2007, expenses incurred for development and implementation of the safety system will be shared 50-50 between the state and hospitals.

An interim report will be due to the legislature by January 15, 2008 with a final report one year later.

Section 327. Hospital Infection Rate Reporting: This section amends the Act 53 reporting requirements in Title 18 to add hospital-acquired infection measurements into hospital’s annual reports. This section also adds members of the public to the existing BISHCA Act 53 Work Group, which helps develop measures to be included in the Act 53 reports.

Sections 328 – 330. Health Information Technology: These sections focus on coordinating various HIT efforts, with the Secretary of Human Services as the point person for State-related initiatives (including the Blueprint for Health, OVHA’s global clinical record, and the statewide health information technology plan being developed by VITL). It also adds the Commissioner of Health to the VITL board, changes the report due from VITL on January 1, 2007 to a preliminary report, and establishes a July 1, 2007, deadline for filing the final statewide HIT plan. Section 330 also requires BISHCA to establish a loan and grant program to help capitalize the implementation of electronic medical records (EMRs) at primary care practices.

Section 331. Loan Repayment for Health Care Providers and Health Care Educator Fund: This section establishes a new loan repayment fund to help ensure a stable and adequate supply of health care providers and health care educators to meet the needs of Vermonters, with a focus on recruiting and retaining providers and health care educators in underserved geographic specialty areas. The fund is to be administered by VDH, which in turn will use AHEC to administer the loan repayment awards. [$880,000 is appropriated to the Department of Health in Section 119(f) of the budget to support the new loan repayment fund.]

Section 332 – 340. Advance Directives: These sections make a number of changes to Vermont’s advance directive laws to clarify them, particularly with respect to organ donation programs. These sections also extend the VDH’s timeline for promulgating regulations for new Advance Directive forms to July 1, 2006, and extend their time to develop the Advance Directive Registry authorized last year to September 1, 2006. [$50,000 is appropriated to the Department of Health in Section 118(g) of the budget to support the development of the Registry.]

Section 341. FQHC Look-Alikes and Uncompensated Care Pool: Additional uncompensated care pool funds will be made available to primary care practices meeting conditions for serving a disproportionate share of the uninsured and Medicaid populations comparable to the federal expectations for federally qualified health centers and look-alikes. [$200,000 is appropriated to VDH in Section 119(h) of the budget to support the uncompensated care pool.]

Section 342. Medicaid Outreach: The Bi-State Primary Care Association is to research outreach efforts in other states intended to expand Medicaid enrollment and will report its findings to the Legislature and the Agency of Human Services by November 15, 2006.

To view the entire Appropriations Bill as passed by the House and Senate please view the link below. This bill has been signed by the Governor, but has not been given an Act number:

http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/H-881.HTM

Health Care Reform (H. 861/H. 895/Act 191)

The Governor signed into law on May 25, An Act Related to Health Care Affordability for Vermonters. This bill establishes a new state-subsidized insurance program for the uninsured and requires employers to pay assessments if they do not offer health coverage to their employees. A detailed summary is below.

Catamount Health: The centerpiece of this legislation seeks to create a private market solution to covering uninsured Vermont residents. The Catamount Health benefit would cover preventive, acute, hospital and chronic care services. Catamount Health would be offered as a preferred provider organization plan, with out of pocket payments specifically defined in statute. Co-payments and deductibles must be waived for chronic care management and preventive care. The carrier may use financial or other incentives to encourage healthy lifestyles and patient self-management. Any willing provider shall receive payment for covered services or conditions, with individuals responsible for increased payments only if the treatment is related to the efficacy or cost-effectiveness of the type of service. Limited pre-existing condition provisions apply, except for chronic conditions if the patient is participating in a chronic care management program.

Catamount Health plans shall constitute a separate market and shall be rated as a distinct pool, separate from other individual or group insurance products. The State will offer premium assistance to uninsured Vermonters under 300% of the federal poverty level (FPL) sufficient to keep an individual’s contribution for the lowest cost plan as outlined in the statute. Uninsured individuals at 300% FPL or above can purchase Catamount Health at cost. Increases in these contributions shall be indexed to the overall growth in the spending per enrollee. Enrollment caps or caps on premium subsidies can be imposed if it is determined that enrollment levels threaten to exceed the amounts available to pay for Catamount Health.

Payments to physicians and other individual providers are to be made at Medicare rates plus 10%, with hospital payments set initially at cost plus 10%. Insurance contracts will be renegotiated as necessary to include these rates. Funding for Catamount Health will come from increased cigarette taxes, individual premiums, and federal funds available through the Global Commitment and a new assessment on employers with uninsured employees.

The employer assessment will be $365 per FTE in the first year, and is targeted at employers who do not offer insurance, who have employees who are ineligible for their insurance (for example, work too few hours to qualify), or whose employees are eligible for but decline insurance, and are not insured through other means. To protect small businesses, a specified number of FTEs is exempt from the assessment, as follows: 8 FTEs (FY 2007 and 2008); 6 FTEs (FY 2009); and 4 FTEs (FY 2010 and thereafter). After 2008, the assessment will be adjusted to reflect the percentage change in premiums for Catamount Health for each succeeding fiscal year.

In the event no private carriers elect to offer Catamount Health plans or the market is not a cost-effective method of providing coverage, the Commissioner can require health plans to offer Catamount Health as a condition of doing business. By October 2009 an independent consultant shall conduct an evaluation of whether Catamount Health can be most effectively offered on the commercial market. If not, then the state can opt to run Catamount Health. Plans cannot enroll residents in Catamount Health plans until October 1, 2007.

Health System Reform and Chronic Care: The Secretary of Administration will coordinate all major health reform efforts, including Catamount Health and the Vermont Blueprint for Health. The Secretary shall create a five year strategic plan outlining how these various efforts shall remain aligned and moving forward. Within this effort, the public-private chronic care program, the Vermont Blueprint for Health will be managed by the commissioner of health. The Blueprint will also produce a separate five year strategic plan.

The Secretary of Administration will contract with a private entity to create a chronic care management program. This program will identify and manage persons with chronic conditions in Medicaid, Dr. Dynasaur and the Vermont Health Access Plan (VHAP). Dual-eligible’s (Medicare and Medicaid) will not initially be eligible for this management program. The Commission on Health Care reform must review and approve the Administration’s request for proposal prior to issuance. The commissioner of human resources shall work with the Secretary to determine how and when to align the state employees’ health benefit plan with the goals of the Vermont Blueprint.

VHAP and Dr. Dynasaur Changes: Premiums are reduced by approximately one-third for VHAP and one-half for Dr. Dynasaur. VHAP beneficiaries and uninsured individuals eligible for Catamount Health who also have access to approved employer-sponsored insurance (ESI), will receive premium assistance so they can take advantage of their employer’s insurance. Moving these individuals onto ESI is premised on a finding that this initiative will be cost-effective to the State.

Employer Sponsored Insurance (ESI): The Agency of Human Services shall establish a premium assistance program to assist individuals eligible for or enrolled in VHAP and uninsured employed individuals with incomes under 300 percent of the federal poverty guidelines. The benefits covered by the plan must be substantially similar to the benefits covered under the certificates of coverage offered by the typical benefit plans issued by the four health insurers with the greatest number of covered lives in the small group and association market in Vermont. The agency will determine whether it is cost-effective to the state to enroll an individual in an approved ESI plan with premium assistance compared to enrolling the individual in VHAP. If the agency determines that it is cost-effective, the individual will be required to enroll in the approved ESI as a condition of continued assistance under VHAP. In consultation with BISHCA, the agency will develop criteria for approving ESI plans to ensure the plans provide comprehensive and affordable insurance. An approved ESI plan will include: covered benefits similar to those covered by Catamount Health; appropriate coverage of chronic conditions that are consistent with the Vermont Blueprint for Health. The Agency shall issue a report on the viability of this program to the joint fiscal and health access oversight committees prior to implementing this program.

Medicaid Reimbursement: Medicaid payments will be increased in FY 2007 on January 1, 2007, by providing $2.5 million for increased payments for physicians and other professionals, focusing on enhancing primary care services (E&M codes), promoting participation the chronic care management program, increasing CPT code payments at greatest disparity from Medicare payment levels, and increasing dental rates and caps. Hospitals will receive $1.0 million. These payment increases shall be adjusted as outlined at the beginning of FY 2008 and thereafter (July 1).

Other Provisions:

§ Immunizations will be made available to Vermonters at no cost, subject to rules to be developed and to the appropriations made to support this program.

§ BISHCA will establish a task force to help it ensure that any increases in payments or reductions in the number of uninsured are reflected in reduced hospital or insurance premiums, or in smaller increases in rates and premiums.

§ BISHCA is also charged with developing recommendations for uniform hospital charity care policies, with input from a variety of stakeholders, by January 15, 2007. The bill recognizes that there may be some instances in which variations to those policies are appropriate.

§ The “Non-group Market Security Trust” is established to help the non-group (individual) market by having the State pay for 5% of actual costs paid in this market, with the goal of reducing the premiums paid by the participating individuals.

§ Finally, the bill incorporates a number of provisions from S. 310 (the “Common Sense Initiatives” bill), including insurance discounts for healthy lifestyles, the development of common claims forms, the adoption of uniform credentialing forms, the development of a consumer health care price and quality information system, and the development of a Master Provider Index. Other portions of S. 310 were incorporated into H. 881, the budget bill, including adverse event reporting, increased funding for Vermont Information Technology Leaders ($700,000) and the health professionals loan repayment program (see details above in H. 881).
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT191.HTM

Bills of interest to VAHHS that were enacted into law (or are awaiting the Governor’s signature) in 2006:

Safe Staffing and Quality Patient Care (H. 227/Act 153)
This law adds a requirement that Act 53 public report cards will include information on staffing levels, measures to be determined by the Act 53 BISHCA subcommittee. Section 2 amends the Patient Bill of Rights such that patients have a right to know the “maximum patient census and full-time equivalent numbers” of registered nurses (RNs), Licensed Practical Nurses (LPNs) and Licensed Nurses Assistants (LNAs) on each shift, each day. Section 3 requires daily posting on each unit of maximum patient census and full-time equivalent numbers of RNs, LPNs and LNAs. Postings would be once a day, at the end of the last shift, but the posting would break out the information by shift. Seven consecutive days of postings are required. This section also requires that hospitals make available a telephone number to the public (not just patients on the unit) to access the information. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT153.HTM

Hospital Infection Reporting (H. 258)
Language incorporated into the FY 2007 Appropriations bill.

Access to Mental Health an Substance Abuse Practitioners (H. 404/Act 129)
This law prohibits health insurance plans from excluding from their networks or provider listings any licensed mental health or substance abuse practitioner located within their coverage area of the health benefit plan. Mental health practitioners must be willing to meet the terms and conditions for participation established by the health insurer.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT129.HTM

Fiscal Year 2006 Budget Adjustments (H. 617/Act 93)
The law exempts psychiatric hospitals from the reductions in the Medicaid reimbursement rates from the FY2006 reductions to hospitals (payments to hospitals were reduced by $16.5 million in the 2006 Appropriations Bill and the language passed in the Budget Adjustment Act exempts psychiatric facilities from these reductions).
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT093.HTM

Mental Health Oversight Committee (H. 644)
Language incorporated into the FY 2007 Appropriations bill.

Health Access Oversight Committee (H. 674)
Language incorporated into the FY 2007 Appropriations bill.

Eradication of Cervical Cancer (H. 715/Act 110)
This law creates a 12-15 member task force to study the eradication of cervical cancer in Vermont. The task force will consider public awareness of the causes, prevention and early detection of cervical cancer and health providers’ awareness of screening and prevention options, recommended protocols and new technology. The task force will also consider recommended protocols and schedules for testing for cervical cancer, issues of cost, health insurance coverage and potential sources for funding of education, screening and treatment programs.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT110.HTM

Home and Community-Based Care Workforce Issues (H. 723)
Language incorporated into the FY 2007 Appropriations bill.

Capital Construction and State Bonding (H. 864/Act 147)
It appropriates $1,000,000 to the Agency of Human Services for continued planning, design, and permitting associated with the reaction of a new inpatient facility to replace the current Vermont State Hospital. The funds must be used solely for costs incurred in connection with work required by the Vermont State Hospital Futures Plan as approved by the joint mental health oversight (JMHOC) committee and the joint fiscal committee (JFC) to include: application of a certificate of need, detailed itemization of the specific manner in which the funds will be spent to and approved by the JMHOC and JFC. The Department of Buildings and General Services and the Agency of Human Services must report to the JMHOC, JFC, House Human Services and the Senate Health & Welfare Committee on the progress made on the planning, design and site and permitting of a new hospital facility and the status of negotiations, if any, with a non-state partner regarding the resolution of outstanding issues, including building ownership, staffing and administrative responsibilities. Staffing will include demonstrated due diligence in support of the statement in the Vermont Futures Strategic Implementation Plan that the expertise and experience of the current VSH staff is a valuable resource by identifying potential avenues that would enable current qualified staff to maintain their status and contractual benefits as Vermont state employees. It also includes an appropriation of $100,000 for the AHS for safety enhancements for patients and staff at VSH with a target date of completion of July 1, 2007.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/H-864.HTM

Public Safety and Emergency Management (H. 890)
This bill updates the Public Safety law in Vermont, formerly known as the Civil Defense Law. The bill covers planning and emergency management for all hazards, including natural, terrorist or radiological incidents. The bill authorizes the Vermont Department of Health to plan, develop and implement a comprehensive medical program to protect and assist Vermonters in the event of an emergency. The bill provides medical professions who volunteer for state agencies access to workers’ compensation coverage in the event they were injured during the time they serve. Individuals involved in emergency activities, including medical and health services, would be immune from liability absent willful misconduct or gross negligence. The bill also provides medical personnel protection under state tort claims. To be eligible for this protection volunteers must be deployed at the request of state agency and may not receive compensation from either the state or another source. Hospitals will also have a voting seat at the State Emergency Response Commission. Any Medical Reserve Corps created in the state will be considered a mobile support unit when signing a Memorandum of Understanding with Vermont Emergency Management and the protections afforded to this designation.

This bill has been signed by the Governor, but has not been assigned an Act number.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/H-890.HTM

Off-Label Use of Prescription Drugs for Cancer (S. 22/Act 139)
This bill requires health insurance plans to cover the use of off-label drugs for cancer treatment, if the drugs prescribed by the patient’s treating oncologist are supported by appropriate medical or scientific evidence. In addition, health plans will not be permitted to deny coverage based on Federal Drug Administration (FDA) approval status or any medical necessity requirement related to the FDA status of the drug. Denials of coverage for cancer drugs would be subject to review through the process operating by BISHCA, once plan internal appeals were completed. The bill would require a feasibility study to determine whether licensed facilities, drug distributors and drug manufacturers could donate unused, unopened prescription drugs to pharmacies, hospitals and clinics for distribution to income-eligible and uninsured patients.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT139.HTM

Safe Haven Defense to the Crime of Abandoning a Baby (S. 27/Act 124)
This law provides a procedure which ensures the safety and well-being of newborns and infants. A person who abandons or exposes a child under 2 years of age shall be imprisoned not more than 10 years or fined not more than $10,000 or both. If an individual voluntarily delivers a child at a health care facility, fire station, police station, place of worship, adoption agency, or calls 911 to arrange a location for pickup, distraught mothers can leave them at a location above without fear of prosecution.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT124.HTM

Prescription Drug Monitoring (S. 90)
The bill authorizes the Vermont Department of Health (VDH) to create a prescription monitoring program for controlled substances on Schedules II, III, and IV. Pharmacies and other dispensers will report prescriptions of controlled substances to VDH, including patient names, the name and quantity of the drug dispenses, the date of dispensing, and the name of the prescriber or dispenser. Access to information in the database would be limited. Physicians and pharmacists will be able to obtain information from the database about their patients for treatment purposes. Licensing boards will be able to access data pertaining to specific licensees who are under investigation. VDH will be authorized to inform physicians when information in the database raises quality of care questions about a particular drug or dosage that a patient was receiving. VDH may also inform a licensing board if the commissioner suspects fraudulent or illegal activity on the part of a prescriber or pharmacist. The commissioner of health may communicate directly with the commissioner of public safety, after consultation with a patient’s health care provider, if the health commissioner believes that disclosure is necessary to avert a serious and imminent threat to an individual or the public. An advisory committee will assist the health commissioner with implementation and evaluation of the database. With passage of the bill, VDH will now be able to draw down a $350,000 grant to get the database running.

This bill has been signed by the Governor, but has not been assigned an Act number.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/S-090.HTM

Safe Apology and “Sorry Works” (S.198/Act 142)
The law establishes a “safe apology” statute in Vermont in order to encourage greater communication between physicians and their patients about possible medical errors without fear of the discussion being used against the physician in a future civil proceeding. It provides that an oral expression of regret or apology, made by or on behalf of a health care provider or health care facility, that is provided within 30 days of when the provider or facility knew or should have known of the consequences of the errors, does not constitute a legal admission of liability for any purpose and shall be inadmissible in any civil or administrative proceeding again the health care provider or health care facility, including any arbitration or mediation proceeding. The bill also establishes a voluntary “Sorry Works!” pilot program under the oversight of the commissioner of BISHCA. The program would be open to one or more hospitals that voluntarily choose to participate beginning on January 1, 2007. Hospitals may participate only with the approval of the hospital administration and the hospitals’ medical staff. Under the program, hospitals and physicians would promptly acknowledge and apologize for mistakes in patient care that result in harm and promptly offer fair settlements. If the settlement is accepted, further litigation with respect to the mistake would be prohibited.
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT142.HTM

Hospital Rates for Victims of Violence (S. 288)
Language was incorporated into the FY 2007 Appropriations bill.

Workers Compensation
The Vermont Department of Labor implemented Rule 40.000, the workers compensation medical fee schedule. For procedures having no code listed in Appendix I of the fee schedule, payment shall not exceed 83% of the charge for the service. The percentage will be adjusted annually to consider any increase or decrease in the total operating expense of all hospitals based on hospital budget submissions to BISHCA. The change shall be calculated using the ratio of the new cost-to-charge ratio to the prior year cost-to-charge ratio.

Political Overview

With final adjournment of the Vermont General Assembly on the evening of May 10, 2006, public officials who must get voter approval next November to keep their seats will soon be turning to the business of politics.

All statewide offices and all 180 seats in the General Assembly will be up for grabs on November 7, 2006. With the passage of health care reform this year, incumbents will claim victory for leading the nation on protecting the uninsured and bending the curve on rising health care costs.

With Senator James Jeffords’ resignation, there will be new changes on the federal level. Congressman Bernie Sanders will be running for this seat and will be running against Republican Richard Tarrant. On the House side, Senate President Pro Tempore Peter Welch will be challenged by the winner of the Republican primary on September 12 with either Martha Rainville or Mark Shepard. At the Republican Convention held in Barre a few weeks ago, Martha Rainville won the party nomination overwhelming.

State Treasurer Jeb Spaulding, Secretary of State Deb Markowitz, Attorney General Bill Sorrell and State Auditor Randy Brock all are expected to seek re-election and none are expected to face serious opposition.

Lt. Governor Brian Dubie will be challenged by the winner of the Democratic primary in September, a race between Rep. John Tracy, D – Chittenden, chair of the House Health Care Committee and Senator Matt Dunne, D – Windsor.

The race for governor will be between incumbent Jim Douglas and challenger Scudder Parker. Political observers feel Douglas will easily win a third term as governor. Again, with agreement reached on health care reform and other major accomplishments including mandatory minimums, groundwater, renewable energy, and Vermont Yankee, Governor Douglas will claim victory to a very successful legislative session in a year where partisanship was prominently displayed day-to-day.

The General Assembly

Democrats now control the Vermont Senate by a 19 to 11 margin. With Senators Peter Welch, Mark Shepard and Matt Dunne running for federal or statewide office these seats will now be open. Other Senators not seeking re-election include Rod Gander, D-Windham and Jim Leddy, D-Chittenden. Senator Leddy, Chair of the Senate Health & Welfare Committee, was instrumental in passing many valuable health care bills in the last 8 years and was a lead in negotiations the last two years on health care reform.

The strength of Democratic incumbents and the political makeup of the remaining senate districts will make it difficult for Republicans to pick up seats.

Democrats currently control the Vermont House by a significant margin, holding 83 seats to 60 Republicans, 6 Progressives and 1 Independent holding the remaining.

In Vermont’s small House districts (each member represents about 2500 – 4000 residents) it is the local stature of the candidates rather than political party affiliation that usually determines the winners. This fact makes the recruiting of candidates done by party leaders in the first year of every biennium very important in determining control of the House of Representatives. Approximately the same numbers of Republican and Democratic House members have announced their retirements to date. These numbers will change between now and the July17, 2006 filing deadline for candidates, but it appears the Democrats will have significantly more vacant seats to fill than Republicans.