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For the week ending February 9, 2007

Political Overview
On Friday, United Stated Department of Health and Human Services Secretary Michael Leavitt was in Vermont asking business leaders to play a pivotal role in the movement toward transparency and value-driven health care purchasing.  Secretary Leavitt asked leaders to support the four cornerstone actions of the Executive Order signed by President Bush on interoperable health information technology; transparency of quality; transparency of price; and incentives for high value health care. This work has been going on for years in Vermont with the private sector, public sector, health insurance plans and providers.  Secretary Leavitt stated that these four steps are the foundation for a value-driven health care system.   That foundation has been cemented in Vermont. 

Several legislative committees are diligently at work on various elements on the framework for containing property taxes.   The caucus meetings focused on which committees would handle what aspects of the plan and committees very quickly added these aspects to their agendas this week. Education will handle the consolidation of school districts, House Ways and Means will tackle the complexities of the Common Level of Appraisals and income sensitivity thresholds and the Senate Education will focus on the Next Generation Commission recommendations and the Stafford School initiative.

The Governor and legislative leaders agreed to provide emergency aid for the farm industry. Farmers will receive $3.2 million in aid immediately. To finance the assistance, cuts were made to the low-income heating assistance program among others programs. Some lawmakers on the Appropriations committee are concerned about taking funds from one area to help another.

Health Care Reform            
The House Health Care spent this week discussing primary care issues.  The committee heard from the Vermont Medical Society, Bi-State Primary Care, independent providers, and the Area Health Education Centers.   The message to lawmakers is there continues to be a physician shortage, the Vermont demographics are an aging population, older adults suffer more chronic illnesses, and even if we had enough physicians now, it would be not be enough to meet the needs of our aging population.  What needs to happen in Vermont to help the physician shortage are:   increased Medicaid payments, medical malpractice reform, evaluation of the current supply of physicians and future needs, examine the impact of demographic factors, increase loan repayment funding and additional scholarship programs.  

The Area Health Education Centers gave an overview of their program.   They are requesting $175,000 for each of the four sites to maintain their work in strengthening Vermont’s community-based health care system and workforce development.   They also will be requesting continued funding for education loan repayment for health care professionals.

Hunt Blair of Bi-State Primary Care gave an update on the Vermont Rural Health Alliance.  This is a collaborative of Federally Qualified Healthcare Center (FQHC) and FQHC Look-Alike, Critical Access Hospitals, Rural Health Clinics and other primary care providers.  The goal is to improve access and quality through system integration.

Vermont State Hospital (VSH)
The Senate Health & Welfare and House Human Services Committee held a joint hearing on the results of the Department of Justice report on the VSH.  Members of the committees were very disturbed and voiced their frustration on the lack of progress in the last 18 months by the Administration and their failure to meet many of the standards related to patient care and treatment.   Specific areas highlighted by committees members included:  inadequate treatment plans for individuals, inappropriate use of high risk medications, insufficient treatment of behavioral problems and policies and procedures have not yet been finalized and implemented.   Although not discussed in great length, some positive feedback was given related to the reduced use of seclusion and restraint and the development of new options for patients who no longer require the level of care provided at VSH.  

Senate Resolution 10/House Resolution 10
The House and Senate delegation of Franklin County and Senators Claire Ayer and Harold Giard of Addison County, offered a resolution in opposition to the issuance of a certificate of need for a proposed ambulatory surgical center in the Burlington area.   The resolution was referred to the Senate Health & Welfare and House Health Care committees respectfully for review.

Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISHCA)
BISHCA Commissioner Paulette Thabault presented the agencies FY 08 budget request for each of the departments within the agency.   The Health Care Administration budget will increase $5.47 million of which $4.75 million is related to Catamount Health and the health care reform efforts passed last year.   Deputy Commissioner Christine Oliver stated the Common Claims committee continues to meet and that the uniform credentialing is in effect.   Oliver stated that the Health Care Committee added language in the technical amendments bill (H. 229) on credentialing which will allow a hospital to request an extension from BISHCA for the full implementation of the Council for Affordable Quality Healthcare (CAQH) form for up to one year from the January 1, 2007 implementation date. 

Restoration of the Commissioner of Mental Health
The House Government Operations Committee passed out an amended version of H. 137, An Act Relating to the Restoration of a Department of Mental Health and Commissioner of Mental Health, on a vote of 11-0.   The bill intends that the department of health and the department of mental health continue the coordination and integration of physical and mental health.  The bill also requires that on or before January 15, 2008, the secretary of human services, the commissioner of health, and the commissioner of mental health will jointly report to the general assembly describing their relationship and the effectiveness of the relationship.  

Office of Professional Regulation

The House Government Operations did a walk through of the yearly Office of Professional Regulation bill.  The office is requesting that the Board of Nursing Home Administrators change from a “board” to an “advisor” profession. Because nursing home administrators are a small constituency (73), the board as it is currently administered has a budget deficit of $87,000. Because statute requires boards to be self-sustaining, keeping the board concept would mean a license increase from $400 to $1,100. By moving to an advisor profession, nursing home administrators will become part of approximately 5,000 other professionals whose license fees are pooled. The current license fee of $400 will remain until the dept is eliminated (probably two renewal cycles) at which time the license fee will be reduced to an estimated $200.  Requirements will remain the same, as will sanctions and penalties.   The Vermont Health Care Association supports the change from a board to an advisor profession.

Changes to the Board of Nursing include:  granting authority to the Board of Nursing to adopt rules, removal of renewal language that was repealed, and statute states that appeals of board decisions should be made to the Supreme Court. This is inconsistent with language in Title 3 which governs all appeals be first made to an appellate officer and then to the Superior Court of Washington County.

Budget Adjustment

The Senate Appropriations committee heard from the Vermont Department of Health (VDH), the Office of Vermont Health Access (OVHA) and the Department of Aging and Independent Living (DAIL) on their FY 07 Budget Adjustment request.  

Related to VDH, portions of the adjustment have to do with Global Commitment changes and moving programs in or out, depending on approved expenditures.   A few areas to note are:  

• Health Surveillance:  An adjustment of $962,000 is requested for the purchase of anti-virals in the event of a pandemic flu.   The state share is $562,400 with the expectation that hospitals and insurance companies will come up with the additional $399,600.   The goal is to have an anti-viral stockpile in the state for immediate use.  VDH has adopted the category of anti-viral recipients developed by the Centers for Disease Control.  
• Blueprint for Health:  Decrease of $292,866.   This eliminates the FY06 carry forward that was intended for the Vermont Information of Technology Leaders and ORION contracts.  Due to the delay in the program this expense was eliminated.
•  Mental Health:   A transfer of $401,753 to the State Hospital because of savings on the Williamstown project.   The funds will be used for additional staffing needs, food, prescription drugs and supply needs.

Joshua Slen, Director of the OVHA, is requesting a budget adjustment of approximately $8.7 million in administration and a decrease in programs of just over $5 million.  Slen stated that there are many issues impacting the SFY 07 administrative budget adjustment request.  OVHA has a $5.6 million carry forward need and $3 million of new SFY 07 needs due to:  the National Provider Identifier mandate, outstanding payables on SFY 06 contracts, increased call volume to member services related to the citizenship requirement under the Medicare Modernization Act and the ability for Coordination of Benefits unit to data match with commercial carriers, administrative movement of funds within the agency, and marketing and outreach for Catamount Health and Employer Sponsored Insurance.  Related to programs Slen stated that when comparing OVHA’s spending pattern for services to the original budget request, it became apparent that trends in certain major categories was dropping.   Significant dollar decreases are occurring in hospital inpatient service and nursing homes   Inpatient services is decreasing 14.9 percent resulting in an expenditure impact of $9.7 million and nursing home decrease of 4.3% resulting in an expenditure impact of $4.89 million.  Other areas include an increase in cost settlements from hospitals of $4.272 million.

Patrick Flood, Commissioner of DAIL, explained the $4.5 million in savings in the FY07 budget adjustment act. Several corrections to the FY07 budget include moving $119,000 for Meals on Wheels from the Development Disabilities budget line, moving $150,000 from the administration budget line for the long term care ombudsman to the global commitment budget, and two other global commitment budget transfers (relating to mental health and the jobs program).  The major discussion item was the $4.5 million reduction in the Choices for Care budget.   Based on spending to the date, the Department is requesting that amount be reduced to $147.5 million from $152 million.  Commissioner Flood stated the $2 million was saved because the plan of care “creep” that was anticipated did not occur. Another $2 million was saved because of the 15% growth in consumer directed care that is less expensive than home health agency rates. These were assumptions that could not be made when the FY07 budget was debated. The question for the committee to answer is are these savings or are these efficiencies?   Commissioner Flood said that only the funds that aren’t used for nursing home care are considered savings. He assured the committee that the $2 million in reduced nursing home use was indeed reinvested in Choices for Care programs. As of February 2, there were no people on the “high needs” waiting list, home health agencies providers received an increase and more than twice as many as anticipated were being served in the “moderate needs” group. He pointed out that the moderate needs group is not part of the “entitled” or “eligible” population under Choices for Care.  Senator Susan Bartlett (D-Lamoille) expressed conflict between what the waiver really does and what people think it is supposed to do. She suggested a protocol to define and monitor any future savings. 

Health Insurance Market Study

BISHCA Commissioner Paulette Thabault reviewed the Health Insurance Market Study conducted by Health Management Associates.  The report states the individual market in Vermont is performing badly.   The number of individuals buying coverage is falling drastically, coverage is unaffordable, and the coverage available is very expensive.  The small employer group is also not good with the community-rated portion of the small group declining, prices in the market are rising relative to the association plan market; and community rating is not a reality in the small-group market.   Proposed solutions to help the individual market are:   longer waiting periods for pre-existing conditions, limiting enrollment to a short period during the year, age-rating for all insurers, lowering the price of coverage through subsidies, reinsurance, establishing a high risk pool, combining the individual and small group markets, combining the safety net with the individual market, and requiring everyone to buy coverage.  The state will need to decide if it is committed to community rating or not.

Vermont Program for Quality in Health Care (VPQHC)
The Senate Appropriations Committee had an overview on VPQHC from Helen Riehle, Executive Director and Dr. Cy Jordan, Medical Director, on the organization that brings together all the stakeholders to focus on quality analysis and improvement.  The strategic goals of the organization are:  to provide expertise and assistance to provider community on quality improvement projects; produce data analysis that illustrates and directs improvements in patient safety and health care quality, and guides policy changes; serve as the state’s premier organization dedicated to quality improvement; and have adequate financial resources and staffing capacity to achieve external goals.   

Bills of interest that were introduced this week:

H. 221 – AN ACT RELATING TO PROCEDURES INVOLVING MEDICAL MALPRACTICE ACTIONS:  This bill proposes a number of changes related to medical malpractice actions.  The bill:  (1)  requires the Vermont property and casualty guaranty association to pay medical malpractice claims which were timely filed against insolvent insurers; (2)  provides for public inspection of all rate filings; (3)  shortens the time period within which minors may bring medical malpractice actions; (4)  sets standards for the qualification of physician expert witnesses; (5)  limits damages for pain and suffering in medical malpractice actions to $250,000.00, adjusted every other year beginning in 2009 based on the Consumer Price Index; (6)  provides limited immunity to health care practitioners providing volunteer or public health services; and (7)  establishes a mandatory arbitration process for medical malpractice actions.

H. 226 - AN ACT RELATING TO ORGAN AND TISSUE DONATIONS:  This bill proposes to honor a decedent's wishes regarding organ and tissue donations.

H. 227 - AN ACT RELATING TO SCREENING PANELS FOR MEDICAL INJURY CLAIMS:   This bill proposes to establish screening panels for medical injury claims.

H. 229 - AN ACT RELATING TO CORRECTIONS AND CLARIFICATIONS TO THE HEALTH CARE AFFORDABILITY ACT OF 2006 AND RELATED LEGISLATION:  This bill proposes to make corrections and clarifications to the 2006 Health Care Affordability Act and related legislation.

H. 256 - AN ACT RELATING TO REQUIRING VACCINATION AGAINST CERVICAL CANCER: Statement of purpose:  This bill proposes to (1) require girls entering grade 6 to show evidence of HPV vaccination; (2) require those parents objecting on religious or moral grounds to sign a statement acknowledging receipt of information explaining the connection between the human papillomavirus and cervical cancer; and (3) appropriate funds to the Vermont department of health for purchase of HPV vaccines.

H. 264 – AN ACT RELATING TO THE VERMONT HEALTH CARE PLAN:  This bill proposes to establish the Vermont health care plan as a universally accessible, comprehensive, publicly administered health benefit plan offering care and treatment to all Vermont residents.

H. 273 – AN ACT RELATING TO SERVICES FOR INDIVIDUALS WITH TRAUMATIC BRAIN INJURY:  This bill proposes to increase services for individuals with traumatic brain injury by increasing vehicle registrations by $1.00 and establishing a fund.

S. 81 - AN ACT RELATING TO PROHIBITING USE OF MERCURY‑CONTAINING FLU VACCINeS and phasing out the use of mercury in dental fillings:  This bill proposes to:  (1) require that dental patients are notified of alternatives to mercury amalgam dental fillings, using brochures and posters the department of health must produce; (2) phase out the use of mercury amalgam fillings, beginning with a ban on the use of mercury amalgam fillings for pregnant women and children commencing in 2008 and then applying it to the rest of the general public by 2011; and (3) prohibit the use of mercury in flu vaccines except in the case of a shortage or public health emergency.