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For the week ending February 23, 2007
Political Overview
There was a flurry of activity in the committee rooms this week as each committee tried to wrap up work on bills to send out on the floor or to other committees of jurisdiction before the Town Meeting break. Although “crossover” is not until March 16, lawmakers feel a duty to have a list of bills that have had action. On Wednesday, legislative leadership and the Governor publicly sparred over the
The Governor continues to voice his displeasure at the lack of work accomplished in the first 8 weeks of the session.
FY 08 Budget
The Vermont Department of Health presented their 2008 budget in House Appropriations this week. Acting Commissioner Sharon Moffat presented the Department’s $277,575,428, a 9% increase over the 2007 budget. Moffatt stated that difficult decisions needed to be made during the budgeting process. Programs negatively impacted include: elimination of the workforce development unit, radon program, emergency preparedness chief, town health officer program, Women, Infant and Children’s (WIC) program, part time medical examiner and a number of other programs. There also is a reduction in lab equipment and supplies. New revenues for the department include: food and lodging, newborn screening, radiology, and the CRASH program. The department also receives income from hospital licensing and medical practice board. All divisions account for a wage and benefits increase in accordance with the State/VSEA contract and reflect the annualization of the cost of the FY 2007 Pay Act.
A highlight of each division/program of interest to VAHHS is listed below:
Blueprint for Health: Budget increase of 48% - $4,807,708. The Blueprint and health planning program works to improve the health of Vermonters by developing systematic and coordinated approaches to health disparities, self-management, provider practice, health care systems, communities and public policy. The proposed budget adds a number of positions within the department to implement the Blueprint. Under Grants Implementation increases include: increasing the number of sites from 6 to 7; expands self-management coordination statewide from 6 to 12 sites; increases payment for local manager by 3%; increases average practice stipend from $6,000 to $7,000; increases number of practices participating from 65 to 100; and adds start up costs for education/outreach to encourage better self management and behavior changes. Under the Grants/Direct Support to Communities increases include: average allotment per community from $15,000 to $30,000 to expand beyond walking programs to include community planning and implementation to address all risk factors; assumes coordination with Coordinated Healthy Activity, Motivation & Prevention Programs (CHAMPPS) in 2 or 3 communities; and adds small grants for non-geographic communities such as church groups, worksites, or minority organizations. Contracts and information system includes: $25,000 budgeted in 2007 for transferring Vermont Health Record files to the permanent registry to maintain the system for another year with implementation of the new registry in FY2008. Other costs associated with the Blueprint include: increase in the purchase of materials for the self management class with increase in number of participants; development and implementation of a web-based self management program for people unable or unwilling to participate in a class or workshop environment; and day-to-day operations of the Blueprint.
Health Protection Division: Budget increase of 10% - $6,332,601: The programs within the division include: emergency medical services, emergency preparedness, radiological health, food and lodging and environmental health. The proposed budget eliminates the Radon Program and the Emergency Preparedness Chief position.
Health Surveillance Division: Budget decrease of 2% - $14,706,150: The programs within this division include: Public health statistics, epidemiology, HIV/AIDS, public health laboratory and the office of the Chief Medical Examiner. The proposed budget eliminates a half-time assistant chief medical examiners, eliminates 1 FTE in the HIV/AIDS program, and reduces lab equipment and supplies.
Health Improvement Division: Budget increase of 3% - $20,291,585: This division includes programs that address chronic disease and health promotion, oral health, maternal child health and children with special health needs, rural health and primary care. Some notable changes in this division include moving hospital licensing to the medical practice board and an increase in the healthy aging initiative of $100,000. The loan forgiveness program is level funded.
Community Public Health Division: Budget increase of 10% - $38,158,180: This is the division that supports the 12 Health Department district offices. The district offices are active participants in planning, implementation and evaluation of community-based public health programs. District office
Alcohol and Drug Abuse Program Division: Budget increase of 1% - $31,101,881. This alcohol and drug abuse program coordinates programs and services, from prevention to treatment to recovery, as close to home as possible. The proposed budget adds new federally funded positions for the prescription drug monitoring program. Under the grants it adds 7.5% increase for the provider system, annualizes 50 Methadone slots that were funded for 6 months in FY07, adds 3 student assistance program counselors, realizes savings from Valley Vista rates, and increases CRASH revenues.
Mental Health Division: Budget increase of 11% - $132,247,704. This division is responsible for the public mental health for community rehabilitation and treatment, adult outpatient services, emergency services and inpatient hospitals at the Vermont State Hospital (VSH) and designated hospitals. The division directly operates VSH and manages all psychiatric hospitalizations. The division operates the child, adolescent and family services program. There is an increase of 7.5% in general funds for children and adults programs, creates wrap around services for long term VSH residents moving into the community, increase in the residential recovery program of 6 beds for six months, reduction in Second Spring from 16 beds to 11 beds, creates crisis beds, and adds 6 secure residential beds.
Medical Practice Board: Budget increase of 31% - $1,025,009. The proposed budget moves hospital licensing from Health Improvement division and additional fee income from hospital licenses.
Legislative leaders announced this week they will play a bigger role in resolving operational problems at VHS and speed up the process to replace the antiquated institution. The legislature will put a hold on the use of $1 million previously approved for planning for a new inpatient psychiatric hospital while the Legislature hires experts to answer the many questions they have about operating and replacing the state hospital. Governor Douglas was clear at his weekly press conference that the legislature set forth the Futures process, which was slow but comprehensive and he plans to adhere to their recommendation to site the facility adjacent to Fletcher Allen Health Care unless President Pro Tempore Peter Shumlin can present him with viable alternatives by the end of the month. The Governor cited federal funding and sign off from the oversight committees as the main reasons for backing the Fletcher Allen Health Care site. He doubts that VSH will regain certification without integration with a general hospital, especially since the “free standing” waiver has expired and the Federal government has expressed no desire to renew it. He also referred to an uproar from the advocate community several years ago when Fletcher Allen Heath Care considered moving their psychiatric unit to
Health Care Reform/Health Care Commission
Blue Cross Blue Shield of Vermont Vice President Don George and Medical Director Dr. Stephen Perkins were invited to testify on Blue HealthSolutions, its pay for quality provider reimbursement strategy. Blue HealthSolutions programs help members with chronic or catastrophic illnesses get the special attention they need. Blue HealthSolutions help mitigate spending on high-dollar cases while actually improving the care to individuals from their providers. Blue HealthSolutions services include: Care Management, Healthcare Advisory, Pharmacy Management, Disease Management and Member Decision Support. George and Dr. Perkins focused their discussion on care management and disease management. Doctors and nurses give members support and assist in coordinating the medical care that's most appropriate for their needs. The specialty case managers work as advocates, reviewing patients' conditions, providing assessments of patients' knowledge, behavior and clinical status to optimize health care outcomes and identify other services and support systems available regionally. Blue HealthSolutions disease management programs offer targeted individualized intervention, coaching, education and 24-hour access to program nurses, helps the behavioral and lifestyle changes critical for short- and long-term health improvement. They described the pilot project in
The House Health Care committee is considering several non-controversial Certificate of Need provisions. These changes include: elimination of gap jurisdiction, more clarity on the application process, changes to the community needs assessments, requirements on reporting of nurse
Rutland Regional Medical Center President Thomas Huebner testified on CIGNA reimbursement and the Common Claims Committee created in Act 191. Huebner stated that CIGNA is the hospital’s most difficult payer from a claims processing point of view. The hospital spends a significant amount of time trying to get claims paid. Huebner’s solution to dealing with the CIGNA issues is to continue to build a relationship with them. Huebner also stated that government payers make up approximately 65% of his book of business. Because they do not pay their fair share, the costs are shifted on to the private payers. The Governor did put provider reimbursements in his budget, but with Medicaid paying only 50 cents on the dollar this still exacerbates the cost shift. The state is also proposing to move hospital payments from a per diem system to a Diagnostic Related Group (DRG) system in October. A committee has been working with state and discussions continue on how best to implement the change. An unanticipated consequence of the proposal is the affect on hospitals that operate psychiatric units. DRGs do not work well on the psychiatric side and there is an approximate 20 to 50% difference on current payment to hospitals with psychiatric units.
Huebner updated the committee on the current status of the Common Claims workgroup. The group meets on a monthly basis and has established six workgroups with an established goal statement and work plan. Three groups are doing extremely well and three are struggling. The workgroups are: 1) maximization of electronic process, 2) simplification of explanation of benefits and patient bills, 3) pre-authorization pilot project, 4) credentialing, 5) improving the efficiency of claims adjudication, and 6) consider ways to simplify claims processing for workers.
Acting Commissioner of Health Sharon Moffatt discussed the alignment of the Blueprint for Health and Catamount Health. Moffatt stated that the elements of the Blueprint alignments used for the review the state employee health plan selection include: chronic care management program (knowledge in the investments in effective chronic care management, use and understanding and the chronic care model and commitment to chronic care management), systemic supports for physician and patient relationship (ID and risk stratification, health risk assessment, network management and provider education, coordinated feedback to patients and providers), patient self-care programs, supports and empowerment strategies, measurement of outcomes and use of common outcome measures, data reporting, payment methodologies (experience with incentive programs; effectiveness of incentive programs and willingness to implement incentive programs; and best practice protocols and evidence-based practice guidelines.
HIV Name Reporting
The Senate Health & Welfare committee continued to take testimony on the HIV name reporting draft bill. The bill purposes has been expanded to clarify enhanced computer security and protection of information collected concerning reportable diseases and forbids the department from disclosing identifying information about a person with a reportable disease to other state agencies or the federal government unless the individual has authorized the disclosure. It also requires the department to plan and implement a public campaign to educate the public about the value of obtaining an HIV test as part of a regular medical examination. The Committee asked VAHHS for clarifying language on the section of the bill that requires hospital administrators to report cases to VDH.
Medical Marijuana
The Senate Health & Welfare committee took testimony this week on S. 7, An Act Relating to the Compassionate Use of Marijuana for Medical Purposes. VAHHS and the Vermont Health Care Association (VHCA) were asked to testify on a proposed amendment being offered by the committee that would allow a registered patient to possess or use medical marijuana in a nursing home or hospital. Both VHCA and VAHHS testified that this would be in direct violation of Federal law. The committee decided not to include this provision in the bill and passed the bill out of committee. The bill was referred to the Senate Finance committee due to the revenue piece of the legislation.
PUBLIC HEARINGS: Tuesday, February 27, 2007 – Well of the House – 6:30 – 9:30 PM –House Committee on Human Services and other relevant committees will have a public hearing on H. 44, An Act Relating to Patient Choice and Control at End of Life.
HOUSE DEADLINES: Introduction Deadline - 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.
Bills of interest that were introduced this week:
S. 95 - AN ACT RELATING TO SMALL BUSINESS ELIGIBILITY FOR CATAMOUNT HEALTH AND VHAP: This bill proposes to allow access to Catamount Health and the
S. 115 - AN ACT RELATING TO INCREASING TRANSPARENCY OF PRESCRIPTION DRUG PRICING AND INFORMATION: This bill proposes to increase transparency in prescription drug information and pricing by limiting fraudulent advertising of prescription drugs to consumers and health care professionals, requiring notice to clients by pharmacy benefit managers that certain types of contracts are available, strengthening the Medicaid preferred drug list, establishing an evidence-based education program, providing additional pricing information to the Medicaid program from drug manufacturers, requiring disclosure of education programs funded by drug manufacturers, and providing enforcement for prescription drug provisions under the Consumer Fraud Act.