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For the week ending February 16, 2007
Political Overview
The Speaker announced March 16, 2007 as the “crossover” date. This is the date on which bills must move from one body to the other in order to pass this session. There are exceptions for some money bills, including the budget and the miscellaneous tax and fee bills and committee bills. The Legislature will be on break Town Meeting week. The Speaker also announced her target date for adjournment of May 5, 2007.
The House spent more time on the floor this week on several pieces of legislation including the 2007 Budget Adjustment, adjustment to the education property-tax rate (proposed at $1.38 for non-residential and $.89 for homesteads), the Fee Bill and appointments to the UVM Board of Trustees. As of this writing the Budget Adjustment bill passed the House and will move on to the Senate. The Fee Bill is certain to pass third reading and will also move to the Senate.
The House Education and Ways and Means Committees have been directed by the House leadership to come up with a bill that will begin to address the containment of property-tax increases. Speaker Symington asked the committees to address governance, regional school contracts, special education, budget caps and penalties, as well as more transparency on the connection between what people spend for education in their tax bill, as items to be considered. Administration Secretary Michael Smith has been presenting a proposal to cap education spending to various House and Senate Committees. The proposed cap for school budgets in the first year would allow for schools to have 104 percent of the previous year’s budget and 103.5 percent of their previous year’s budget for each year thereafter. The proposed caps are “soft caps,” meaning that they may be overruled by voters if a super-majority of 60 percent or more approve.
FY 08 Budget
Secretary of the Agency of Human Services Cynthia LaWare gave an overview of her agency departments. Individual commissioners will be presenting their detailed presentations to the House Appropriations Committee over the next two weeks. Secretary LaWare stated that the proposed budget is in balance and has no Medicaid deficit, primarily due to the Global Commitment Waiver. The following Governor’s 08’ initiatives are: Healthy Aging - $100,000; Aging out of Foster Care - $741,000; Mentoring Initiative - $250,000; Dental Hygiene Initiative - 1,090,861 ($275,000 for administration; $816,000 for programs, $647,000 related to increased dental reimbursement rates, increased provider/site options for children - $98,000, $80,000 grant type programs; Civil Confinement - $187,500; and Blueprint for Health - $1,528,136. Secretary LaWare stated that the budget will fund the Vermont State Hospital Futures estimated expenditures, continues the Governor's 7.5% General Fund commitment to support the developmental and mental health provider system; funds the key recommendations of the Nursing Home Reimbursement Report; funds the Choices for Care Waiver programs budgeted at estimated growth rate of 5.77%, and fully funds the implementation of Catamount Health.
House Appropriations chair Rep. Martha Health and Medicaid lead Rep. Mark Larson both questioned the Administration's hospital increase in light of next year's Medicaid deficit. Both asked, “Why give them an increase this year, when we're just going to cut them next year?”
Vermont Department of Disabilities, Aging and Independent Living (DAIL) Commissioner
o $100,000 Grant to the
o Reduction in the Homemaker program by $400,000 in state funds. Flood stated that $200,000 was used to generate $487,924 in developmental services grant for an adjustment to reflect the impact of Education Property Tax changes on developmental home providers. An additional $200,000 was moved to the long term care appropriation to generate $500,000 of homemaker services for moderate needs people.
o $3.8 Million for the Choices for Care program.
n Governor’s budget includes $15.2 million in new funding for long term care. Of that amount $4 million is targeted for nursing home inflation; $3.8 million for rebasing of nursing home rates; $1.6 million for a 3.75% inflationary for providers (not all providers will get a 3.75% increase); and allocated funds for new individuals added to the Waiver. Flood stated the department anticipates approximately $2 million in savings from reduced nursing home use.
n $500,000 increase by moving some of the Homemaker funding to the Choices for Care Waiver (this will net approximately $100,000 in new funding after replacing the state funds used in the developmental services and long term care appropriation.)
o Funds Nursing Home Reimbursement Study Recommendations with the following key recommendations:
n Maintain Occupancy levels for reimbursement at 2007 levels - 90%
n Change schedule of rebasing of Nursing Costs to Bi-annual reviews from
the current 3 years cycle
n Add a 1% premium over Nursing Market Basket rates in off years to reflect actual regional experience
n Include MDS (Minimum Data Set) Coordinators in Director of Nursing cost centers
The Vermont Department of Health’s (VDH) testimony was postponed due to weather. VDH will present their budget the week of the February 26.
On Tuesday, February 20, 2:30 p.m. – 4:30 pm., Room 11 and Friday February 23, 9 a.m. to Noon, Room 10, the House Appropriations Committee will hear from
Health Care Reform/Health Care Commission
The House Health Care Committee heard from Heath Care Commission consultants Dr. Kenneth Thorpe and Hans Kastensmith. Dr. Thorpe’s presentation was similar to two weeks ago discussing the Blueprint Implementation Plan and outreach and enrollment efforts. Dr. Thorpe met with Joint Fiscal and the Administration to try to gain consensus on the number of individuals eligible for VHAP and Catamount Health. The goal is to get 35,000 uninsured individuals covered to get us to the 96% stated in legislation by 2011.
Both the House Health Care Committee and the Health Care Commission are focused on the progress of the Vermont Blueprint for Health. Of particular focus is the Chronic Care Information System - the chronic care registry that physicians and other providers will use to assist them in their care for chronically ill patients. Another focus is the Blueprint efforts on changing how providers are paid. Legislators are anxious to provide the right incentives for physicians to provide evidence-based care to patients with chronic disease and want all payers to align their payment incentives so that physicians and other providers will receive sufficient reimbursement for their efforts. Kastensmith testified that insurance companies in
The committee is working on legislation that will somehow expand Catamount Health, would fund Health Information Technology development through the creation of a "Technology fund", create a communications plan for all providers, loan repayment and support for physicians. The bill will also hopefully include Association supported statutory changes to Certificate of Need and the Health Resource Allocation Plan.
The Health Care Commission also heard from incoming director
Director of Health Care Reform Implementation
Cost Shift Task Force Report and
Mike Davis, Director of Cost Containment at the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA), gave an update on the Cost Shift Task Force Report and the Vermont Health Care Expenditure Analysis.
Choices for Care
The Senate Health & Welfare Committee heard testimony from DAIL Commissioner
Catamount Technical Corrections Bill (H. 229)
The Catamount Technical Corrections bill was referred to the House Ways & Means committee this week to review the portion of the bill that addresses seasonal employees. The committee heard from the reporter of the bill, Rep. Lucy LeRiche.
HIV Name Reporting
Dr. Donald Schwarz, Medical Director at VDH and Rob Lunn, testified on draft legislation that will require health care providers to report HIV cases to VDH using the patient’s name, rather than through the use of a unique identifier code. The Federal government is requiring name-based reporting to continue receiving federal funding. The state receives funding from the Health Resource Services Administration and Centers for Disease Control at a tune of approximately $2.4 million. Not all funds would be in jeopardy, but VDH is not clear how much would be.
Fee Bill
The House took up the Fee Bill (H. 294) on the floor Friday. As of this writing the bill is being debated and is certain to pass. The following items related to health care are included in the fee bill:
Nursing homes: Beginning on July 1, 2007, the nursing home per bed assessment will be $4322.90 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. This is due to the passage of HR 6111, which caps nursing home provider taxes at 5.5% until federal fiscal year 2011. There is also a provision to amend the current law to allow the Office of Vermont Health Access (OVHA) the option to secure payment from claims paid to the provider in default.
Vermont Department of Health:
Ø X-ray fee will be a triennial registration fee of $300 per entity. A hospital will pay a flat rate of $300.
Ø Language included to continue the current hospital baseline fee of $7,667, unless a hospital is accredited by the Joint Commission on Accreditation of Health Care Organization, which reduces the fee to $2,750
Ø Hospital per bed fee of $25 through FY 2010
Ø Increase in fees for the following providers:
o Podiatrists and physicians: License fee of $565 in fiscal year 2008, $600 in fiscal year 2009 and fiscal year 2010 and thereafter $625. $25 of the fee will support the costs of the creation and maintenance of a
o There will be a biennial renewal fee for podiatrist and physicians of $450 and in fiscal year 2009 and thereafter will be $500. $25 of the fee will support the costs of the creation and maintenance of a
o Limited temporary licenses – Current fee of $50 to proposed fee of $70
o Anesthesiologist Assistants certification fee – Current fee of $100 to proposed fee of $115
o Anesthesiologist Assistants biennial renewal fee – Current fee of $100 to proposed fee of $115
o Physician Assistants certification fee – Current fee of $100 to proposed fee of $115
o Physician Assistants biennial renewal fee – Current fee of $100 to proposed fee of $115
The Board of Medical Practice issues licenses and certificates to physicians, podiatrists, physician assistants, anesthesiologist assistants and physicians in training. The Board also issues license verifications, investigates complaints and takes disciplinary action when needed. The Board is required by law to create and maintain individual profiles on all health care professionals licenses, registered or certified by VDH, and make the profiles available to the public. The proposed increase in fees will help support the Board of Medical Practice will their statutory requirements.
Restoration of the Commissioner of Mental Health
The House on Friday passed H. 137, An Act Relating to the Restoration of a Department of Mental Health and Commissioner of Mental Health. 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. It now moves to the Senate.
Bills of interest that were introduced this week:
H. 235 - AN ACT RELATING TO THE ADMINISTRATION OF COURT-ORDERED FORENSIC EVALUATIONS OF CRIMINAL DEFENDANTS WHO ASSERT INSANITY AS A DEFENSE TO CRIMINAL CHARGES: This bill proposes to amend the hospitalization processes for criminal defendants who, before their criminal trial, are ordered by the court to receive inpatient mental health treatment and who must, in connection with a plea of insanity, undergo a court-ordered forensic psychiatric examination at a designated hospital.
H. 248 - AN ACT RELATING TO ESTABLISHING THE VERMONT TELECOMMUNICATIONS AUTHORITY TO ADVANCE BROADBAND AND WIRELESS COMMUNICATIONS INFRASTRUCTURE THROUGHOUT THE STATE: This bill would establish a
H. 250 - AN ACT RELATING TO POST-APPEAL REVIEW PANEL FOR WORKERS’ COMPENSATION CLAIMS: This bill proposes to create a process whereby a panel composed of two attorneys familiar with workers’ compensation claims and a physician experienced in the cause and treatment of the alleged work injury review a workers’ compensation claim after the claimant has exhausted all available appeals, upon request of the claimant. The panel will issue an evaluation of the claim and a determination regarding its merits.
H. 264 - AN ACT RELATING TO THE VERMONT HEALTH CARE PLAN: This bill proposes to establish the
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.
H. 294 - AN ACT RELATING TO EXECUTIVE BRANCH FEES (Fee Bill): This bill proposes to adjust executive branch fees.
H. 302 - AN ACT RELATING TO FISCAL YEAR 2007 BUDGET ADJUSTMENTS: This bill proposes to make adjustments in the fiscal year 2006 omnibus appropriations act.
H. 304 - AN ACT RELATING TO THE VERMONT HOSPITAL SECURITY PLAN: This bill would provide access to and coverage for health services provided in hospitals, build on Catamount Health, and offer opportunities for premium relief to all Vermonters. The bill would establish a global hospital budget for the state and an individual hospital budget for each hospital in the state. It would establish a
H. 314 - AN ACT RELATING TO MEDICAID COVERAGE FOR CIRCUMCISIONS OF MALE CHILDREN: This bill proposes to prohibit Medicaid coverage for circumcisions of male children if the procedure is not medically necessary.
H. 315 - AN ACT RELATING TO HEALTH CARE RIGHTS OF CONSCIENCE: This bill proposes to respect and protect the fundamental rights of conscience of all individuals who provide health care services.
H. 316 - AN ACT RELATING TO NURSING PRACTICE AT THE VERMONT STATE HOSPITAL: This bill proposes to require nurses in the Vermont state hospital to meet the same standards as nurses in other facilities by repealing 26 V.S.A. § 1583(6), which exempts the work and duties of psychiatric technicians and other care attendants employed at the Vermont state hospital from the regulation of nursing practice.
H. 322 - AN ACT RELATING TO CHIROPRACTIC SERVICES FOR MEDICAID BENEFICIARIES: This bill proposes to ensure that Medicaid beneficiaries may receive medically necessary chiropractic services.
H. 328 - AN ACT RELATING TO EDUCATION AND SCREENING FOR POSTPARTUM DEPRESSION: This bill would require licensed health care professionals providing prenatal care to educate women and their families about postpartum depression, and require licensed health care professionals providing postnatal care to screen new mothers for the disorder.
S. 84 - AN ACT RELATING TO PROMPT PAYMENT OF ELECTRONIC PRESCRIPTION DRUG CLAIMS: This bill proposes to require a health plan to pay by electronic funds transfer within eight days any prescription drug claim submitted electronically.
S. 87 - AN ACT RELATING TO GIVING CONSUMERS NOTICE OF THE RIGHT TO BUY PRESCRIPTIONS FROM RETAIL PHARMACIES FOR THE SAME CO-PAY AS FROM MAIL-ORDER PHARMACIES: This bill proposes to: (1) require health insurers and pharmacy benefit managers to give notice to consumers that the consumer can obtain a prescription from a community retail pharmacy for the same co-payment as from a mail-order pharmacy; (2) prohibit an insurer or pharmacy benefit manager from telling a customer that a community retail pharmacy may be unwilling or unable to fill the prescription with the same co-pay; and (3) make a violation of these provisions a violation of the Consumer Fraud Act.
S. 91 – AN ACT RELATING TO THE DEPARTMENT OF BANKING, INSURANCE, SECURITIES, AND HEALTH CARE ADMINISTRATION (BISHCA Housekeeping Bill – does not include health care): This bill proposes to: (1) to permit the banking division to request and receive any criminal records of any applicant for a banking division examiner; (2) to change the due date for money service licensees to file their annual report with the department of banking, insurance, securities and health care administration; (3) to allow a domestic insurer credit for reinsurance secured by letters of credit issued on or before the due date for the insurer's annual report; (4) to establish consistent annual filing dates for reinsurers; (5) to revise and update audit standards for certified public accountants consistent with the accreditation standards of the National Association of Insurance Commissioners (NAIC); (6) to eliminate a requirement that the commissioner expressly approve employee pension plans offered by domestic insurers; (7) to repeal the requirement of an annual NAIC report to the legislature; (8) to establish consistent filing and fee payment dates for surplus lines companies; (9) to authorize an industrial insured captive insurance company to insure the controlled unaffiliated business of its participating industrial insured entities; (10) to clarify that an association captive insurance company may insure its sponsoring association along with the association's members; (11) to correct the reference to the law applicable to captive insurance company supervision, rehabilitation, and liquidation proceedings; (12) to include rules regarding taxation of sponsored captive insurance companies and captive insurance companies formed as limited liability companies that are under common ownership and control with one or more other captive insurance companies; (13) to correct statutory cross-references made in the enactment of Vermont's Revised. Uniform Securities Act; (14) to restore the securities regulation and supervision fund; (15) to restore the commissioner's general authority regarding recovery of investigation and examination expenses; (16) to reinstate Vermont's exemption from the federal Philanthropy Protection Act; (17) to restore the commissioner's registrant exemption authority with respect to broker-dealers; (18) to restore the fee imposed for processing registration exemptions; and (19) to restate the commissioner's ability to impose notice filing and notice filing fees with respect to federal covered securities.