VAHHS Legislative Report

For the week ending February 2, 2007

Political Overview

Speaker of the House Gaye Symington (D-Jericho) and Senate President Pro Tempore Peter Shumlin (D-Windham) announced that James Hester has been selected to be the Director of the Health Care Commission. Hester currently is Vice President for Vermont MVP Health Care. The Health Care Commission unanimously recommended Hester for the post. Hester will begin his new position the first week of March.R 8HHRH

The House deadline dates for new bills have been set. All requests for introduction of bills drafted to be submitted to Legislative Council by Wednesday, January 31, 2007. During the first year of the biennium, a member may request introduction of a bill drafted in short form (without bill language) and submitted to the Legislative Council anytime during the session. Except with prior consent of the Committee on Rules, all bills drafted in standard form, shall be introduced by February 28, 2007. During the first year of the biennium Committee bills may be introduced at anytime.

A day after pledging to work together on property tax reform and a month into the session, Democratic leaders and Governor Douglas are locked in a partisan battle. The House Agriculture committee passed a bill that will create a one year temporary surcharge on commercial property transfers to help raise funds to aid farmers. The Governor is adamantly opposed to raising taxes and would like to find the $4 million dollars within the existing budget. This comes a day after the two sides found agreement on property tax reform. The framework for containing property tax increases includes examining proposals to modify how Vermont delivers and funds education in Vermont. The major areas of focus will be: consolidating the existing 283 school districts to 63; examining ways to fully engage voters in their spending decisions; identifying ways to modify current education tax policy to improve efficiency and reduce extreme variations caused by property value fluctuations; studying the current structure of authority over school spending and effectiveness; working to understand the major cost drivers in public schools and discussing ways the state can alleviate cost pressures or assist schools to address this effectively. As specific proposals emerge, the Legislature and Administration will consult each other regarding the merits of the proposals. Despite the collaborative approach, this issue is far from resolved.

Health Care Reform
The House Health Care spent most of the week reviewing technical amendments to Catamount Health and voted the bill out of committee on an 11 to 0 vote. A tremendous amount of time was spent on the definition of “Uninsured” and when does one become eligible for Catamount Health. Deputy Commissioner of the Banking, Insurance, Securities and Health Care Administration (BISHCA) Christine Oliver presented language that would amend the provider reimbursement section of the bill. The draft bill now states that payments for hospital services shall be calculated using a hospital-specific-cost-to-charge ratio approved by the Commissioner, adjusted for each hospital to ensure payments are at 110 percent of the hospital’s actual cost for services. The commissioner may use individual hospital budgets to determine approved ratios. The commissioner may approve adjustments to the amounts paid in accordance with a carrier’s pay for performance or quality improvement program. The bill also states that carriers shall pay health care professionals, such as physicians, using the Medicare fee schedule, at an amount ten percent greater than fee schedule amounts paid under the Medicare program in 2006. These payments will be indexed to the Medicare economic index developed annually by the Centers for Medicare and Medicaid Services.

The bill also amends the section on the Vermont Information Technology Leaders (VITL). The bill moves VITL oversight from the Commissioner of BISHCA to the Commissioner of the Department of Innovation and Information (DII). VITL, BISHCA and DII all agree with the change. Language was added that would designate VITL as the exclusive statewide health information exchange network for the state.

The committee clarified the definition of full-time equivalent (FTE) and seasonal employees. FTE does not include any employee hours attributable to a seasonal employee of an employer who offers health care coverage to all of its regular full-time employees, provided that the seasonal employee has health coverage under a private or public plan. The definition of seasonal employee means an employee who works for an employer for fewer than 20 weeks in a calendar year and works in a job scheduled to last 20 weeks or less.

The committee had extensive discussion on the prohibition of health coverage status discrimination. The language approved by the committee states that no employer or employment agency shall inquire about the health coverage status of a job applicant or discriminate among applicants on the basis of health coverage status. The employer may inform an applicant about the employer’s health coverage benefits. Employers may inquire about the health coverage status of an employee to enable the employer to determine the number of uncovered employees. The section also allows an aggrieved applicant to bring action in the superior court of the county where the violation occurred. If the court finds the employer has violated this section, the court can order any of the following: payment of lost wages, benefits, and other remuneration; any appropriate injunctive relief; compensatory damages; punitive damages; attorney fees; or any other appropriate relief.

VAHHS President Bea Grause and Vice President of Operations and Policy Jill Olson testified on VAHHS’ recommendations for legislative fixes. Olson gave the committee background on the legislation passed last year that required BISHCA to select a single credentialing form to be used by insurers and hospitals. The Council for Affordable Quality Healthcare (CAQH) is the only system in place nationally. CAQH has only recently begun working with hospitals and there are many technical issues that need to be resolved. The committee, as well as BISHCA, supported our amendment on the uniform provider credentialing form section of statute that would allow a hospital to request an extension from BISHCA for the full implementation of the CAQH form for up to one year from the January 1, 2007 implementation date.

The Committee deferred VAHHS’ four other legislative fixes because they were not directly related to Catamount Health. The Chair stated the committee will address the issues in a future bill. VAHHS will be asking for: 1) Elimination of the community needs assessments and strategic planning. Our rationale is that they are costly and have not proved to be useful because most of the data is available elsewhere and most Vermont hospitals do not have the expertise to conduct them. 2) Eliminate the provision calling for biannual updates to the health resource allocation plan (HRAP). Instead, the HRAP should be revised every four years or as needed at the discretion of the Commissioner of BISHCA in consultation with the Public Oversight Commission. 3) Suspend the Certificate of Need “Gap” Jurisdiction through June 30, 2007. As part of their annual budget reviews, hospitals have been required to report any projects that otherwise would have required a letter of intent to the commissioner of BISHCA. This section should be eliminated since reinstatement would create additional expenses and regulation with no benefit.

VAHHS’ final request on nurse staffing will be handled by the Human Services Committee and a bill placeholder has been requested by the Committee Chair on our behalf.

Home Health
The Vermont Assembly of Home Health Agencies testified in the House Human Services committee on Thursday. The home care agencies lost $4.4 million providing home care services to state-run programs. The home health agency has requested $810,000 in budget adjustment and a FY08 budget request of $442,000 above the Governor’s recommended budget. The committee was sympathetic, but made no commitments to assist.

Fee Bill
The House Ways and Means Committee continues it work on the $2.3 million fee bill. The proposed fee increases for the health department remain as stated in the January 19 VAHHS report. The X-ray fee will be a triennial registration fee of $300 per entity. Therefore, a hospital will pay a flat rate of $300. The nursing home per bed tax will increase to $4322.90 starting on July 1 to bring the tax to the 6% allowable limit through December 31, 2007. Beginning on January 1, 2008, the per-bed tax will decrease to $3,962.66 to bring the tax to the 5.5% of gross revenues. The committee supported Vermont Health Care Association Director Mary Shriver on deferring the first payment of the first installment until August 07 to allow nursing homes time to fund the additional burden. OVHA Director Joshua Slen supported that.

Bills of interest that were introduced this week:

H. 148 –AN ACT RELATING TO THE CHILD ABUSE REGISTRY: This bill proposes a number of measures related to child abuse reporting and the child abuse registry. The bill proposes to: 1) make confidential any identifying information about a person who makes a report of child abuse or about any person mentioned in a report; (2) gives the department for children and families discretion to provide services to a child who is the subject of a child abuse report or to the child’s family or caretaker; (3) requires the department to begin an investigation within 72 hours after it has sufficient information to accept a report of child abuse; (4) requires, if the abuse occurred outside the home, the department’s investigation to include the names of other children living outside the home who may be at risk; (5) permits child abuse registry records to be disclosed to law enforcement agencies; and (6) requires the department to adopt rules for the child abuse registry which define what a “registry record” is, specify time frames and other criteria for inclusion of a person’s name in the registry, and establish processes through which a person may challenge his or her inclusion in the registry and seek to remove his or her name from it. (NOTE: Requires health care providers licensed, certified, or registered, resident physician, intern, or any hospital administrator in any hospital in this state, whether or not so registered, the clergy who has reasonable cause to believe that any child has been abused or neglected shall report or cause a report to be made in accordance with the provisions of section 4914 of this title within 24 hours. This is current law.)

H. 153 – AN ACT RELATING TO ELIMINATION OF THE RULE PROHIBITING SMALL BUSINESSES FROM BUYING HEALTH INSURANCE UNLESS 75 percent OF EMPLOYEES ENROLL: This bill proposes to allow small businesses that offer health insurance to all full-time and part-time employees to purchase small group insurance even if less than 75 percent of the employees enroll in the employer’s plan.

H. 164 - AN ACT RELATING TO EXPANDING EMERGENCY PLANNING TO ADDRESS LAND USE ISSUES, INCLUDING FOOD SUPPLY PLANNING, DISTRIBUTED POWER PLANNING, AND WATER SUPPLY PLANNING: This bill proposes to require the secretary of agriculture, food and markets to develop guidelines for use in establishing local and regional food supply plans and to develop a state food supply plan. It proposes to require the director of emergency management to coordinate emergency planning efforts with long-range land use initiatives, including food supply planning efforts, drinking water supply planning efforts, and power planning efforts that would assure distributed renewable power facilities are located so as to provide service for critical local facilities. It proposes to allow municipalities to establish local food supply districts and to adopt local food supply plans, which may include: completion of an inventory of soils within the municipality; the creation of a program to assure soils are sufficient to feed the local population with locally grown food; and a program of inducements for obtaining landowner commitments to make specified tillable land available for local food production purposes in time of extended shortages of petroleum and other nonrenewable sources of energy. It proposes to establish the powers and duties of local food supply commissions. The bill proposes to require regional planning commissions to develop regional food supply plans and coordinate with others working on food supply planning. It proposes to require regional planning commissions to inventory fire and safety facilities, hospitals, and other critical local facilities, assure establishment of emergency shelters, and work with others to see that these facilities are served by distributed, renewable power facilities. It proposes to require the regional plans to facilitate development and implementation of food supply planning and to indicate areas proposed for the siting of facilities to provide locally generated renewable power to critical regional service providers. It proposes, effective July 1, 2009, to prohibit regional plans from providing for the conversion of primary agricultural soils until the region has adopted a regional food supply plan and has determined that the soils planned for conversion will not be needed for those purposes. The bill proposes to require the department of public service, in developing the state electric energy plan, to take into account the siting of distributed power facilities so as to serve critical local facilities and to consult with the regional planning commissions. It proposes to require the department, in developing the state energy plan, to make recommendations for replacement of oil‑based fuels with biofuels produced within the state and recommendations for how the state energy plan may support food supply planning. (NOTE: It proposes to require regional planning commissions to inventory fire and safety facilities, hospitals, and other critical local facilities, assure establishment of emergency shelters, and work with others to see that these facilities are served by distributed, renewable power facilities.)

H. 198 - AN ACT RELATING TO ENHANCING MENTAL HEALTH PARITY: This bill proposes to: (1) establish the goal of fully integrating mental health and substance abuse services with other health services, while establishing interim steps toward that goal; (2) prohibit the imposition of any type of greater burden in accessing mental health services, instead of prohibiting only financial burdens; (3) require deductible or out-of-pocket limits to be comprehensive for all services; (4) require that administrative and clinical protocols for provision of mental health and substance abuse services do not differ from those for other health services or create burdens to access; (5) require rulemaking to ensure consistency in requiring co-payments for routine and primary mental health care; (6) prohibit mental health carve out margins in excess of those for physical health; (7) require health plans to engage in mental health quality improvement projects, including one joint venture between all managed care plans and mental health review agents; (8) require health plans to demonstrate how collected data is being used to inform practices, policies, and future direction of integration of services; (9) require health plans to demonstrate how quality improvement projects relate to the blueprint for health and chronic care initiative; and (10) support the priorities of the report of the Institute of Medicine, “Crossing the Quality Chasm (2006).”

H. 201 - AN ACT RELATING TO ADMISSION TO DESIGNATED MENTAL HEALTH HOSPITALS: This bill proposes to clarify the limited ability of children under 14 years of age to consent to voluntary admission into a designated mental health facility, to establish a clear process for voluntary admissions for children under 14, and to provide for the child a representative who is authorized to compel court review of the hospitalization upon a finding of probable cause that the hospitalization is unnecessary.

H. 202 - AN ACT RELATING TO ADMISSION PROCEDURES FOR INVOLUNTARY HOSPITALIZATION FOR MENTAL HEALTH TREATMENT: This bill proposes to require a preliminary hearing before a district court judge within 72 hours of the filing of an application for emergency examination for mental health treatment.

H. 207 - AN ACT RELATING TO THE DISCHARGE OF VOLUNTARILY ADMITTED PSYCHIATRIC INPATIENTS: This bill proposes to repeal the Vermont law relating to the discharge or detention of patients who voluntarily admit themselves for inpatient psychiatric care.

H. 214 – AN ACT RELATING TO PURCHASE OF HEALTH INSURANCE FROM OTHER STATE MARKETS: This bill proposes to allow Vermonters to purchase health insurance policies sold in other states, provided certain requirements of Vermont law are met, including minimum capital, surplus, and reserve requirements; disclosure and reporting requirements; and grievance procedures. This bill would also require that prospective Vermont enrollees be provided full disclosure, in a format approved by the commissioner of banking, insurance, securities, and health care administration, of how the out-of-state health insurance plans may differ from Vermont health insurance plans.

Public Hearing: Fiscal Year 2008 state budget by Vermont Interactive Television Monday, February 5, 2007 from 4:15 p.m. – 5:45 p.m.