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For the week ending March 23, 2007
Political Overview
Action in the State House moved to the floor with both the House and Senate spending time in their respective chambers deliberating bills passed during crossover week. Political battles occurred on two fronts this week between Legislative leadership and the Governor related to part-time and seasonal employee exemption from the Catamount Health assessment and the Governor’s threat of a veto on the Budget Adjustment Act due to its exclusion of money for college scholarships and loan repayment. Legislative leaders are concerned that the Governor has diverted $5.7 million from the Catamount Health Plan to support provider increases, funding for the Blueprint for Health, and the individual insurance market study. Legislative leadership stated exemptions for seasonal and part-time workers could not be funded unless the administration reversed it decision on the diversion of $5.7 million.
The House unanimously approved the Next Generation bill, which aims to improve
FY 2008 Budget Bill
The House Appropriations Committee has slowed its work on the FY 2008 Appropriations bill at the request of the Democratic leadership. The committee had stated their intention of having the budget bill out by the end of this week and instead spent the week looking at bills with appropriations attached. The Governor has also threatened to veto the 2007 budget adjustment bill unless an additional $1.9 million is included for college scholarships. He has been warning lawmakers for weeks that he would veto the budget unless he gets his scholarship money.
Health Care Reform
On Friday the House passed H. 380, An Act Relating to the Regulation of Health Care Facilities, more commonly known as the Certificate of Need (CON). Provisions of the bill include: elimination of gap jurisdiction, more clarity on the application process, changes to the community needs assessments, requirements on reporting of nurse
On Wednesday, the House Health Care committee passed H. 531, An Act Relating to Ensuring Success in Health Care Reform on an 11-0-0 vote. Provisions of the bill include: outreach and enrollment for Catamount Health and state benefits programs to achieve the goal of 96% of Vermonters with health insurance by 2010; requires the Agency of Human Services to adopt a simplified application form to enable individuals to assess their potential eligibility for any of the state health benefits programs; enables health care professionals to assist individuals apply for health benefit programs; limits premium assistance for Catamount Health plans to the amount of assistance for the lowest priced plan, such that individuals receive the same dollar amount of premium assistance, regardless of the cost of the higher cost plans.
Related to the Blueprint it creates a position in the department of health titled principal assistant to the commissioner (titled the director of the blueprint for health) to lead the blueprint; adds a representative of the state employees’ health plan to the blueprint for health executive committee and the director of the health care reform commission as a nonvoting member; establishes principles and benchmarks to guide development and implementation of the blueprint for health, and requires the department of health to facilitate participation in the blueprint; establishes a project for integrated early implementation of the blueprint programs by the department of health, including a medical home project, a chronic care payment reform project, and a community‑based care coordination team development project. It directs the commissioner of BISHCA to prepare an implementation plan, including recommendations for enhanced authority, outlining the steps necessary to ensure that health insurers will successfully implement the Blueprint by January 1, 2009; appropriates $75,831.00 in general funds plus the federal matching funds ($185,000.00 total) to the department of health for use by the Vermont Rural Health Alliance for early integration of the blueprint projects, upon receipt of matching funds by the alliance.
Related to information technology, it moves the oversight of the Vermont Information Technology Leaders (VITL) from BISHCA to the Department of Information and Innovation; and requires VITL to establish both a permanent and an interim loan and grant fund (goal is to raise $1 million for pilot projects) to provide for the capitalization of electronic health records systems in Blueprint communities and at other primary care practices serving low and moderate income Vermonters (enable providers, especially primary care providers, to create and share electronic health records). VAHHS opposed language that set a specific dollar amount on how much had to be contributed by VAHHS to VITL. We successfully changed this fundraising language to a voluntary effort by VITL without specific fundraising targets mandated by any stakeholder.
Other provisions of the bill include: a requirement for the commissioner of health, the director of the office of professional regulation and board of health to study eliminating the requirement that advance practice nurses have a collaborative practice with a physician; adds the department of human resources to the list of state agencies with which provider bargaining groups can negotiate; requires BISHCA to annually survey health insurers to determine the reimbursement paid for the ten most common billing codes for primary care health services and to report back to the House Health Care and Senate Health & Welfare committees; and requires an annual report on the alignment of the state employees’ health plan with the blueprint for health and the adequacy of networks and reimbursements for that plan.
The committee also removed language that would appropriate $880,000 to the Area Health Education Centers for the loan repayment program. The House Appropriations committee will combine a number of loan repayment initiatives and will allocate just under $2 million for the health care workforce.
The bill will be referred to the House Appropriations committee for review and be debated on the floor next week.
H. 44, An Act Relating to Patient Choice and Control at End of Life
After nearly 4 hours of debate, the House defeated H. 44 on a vote of 82-63. More commonly known as the death with dignity bill, the defeat in the House ends the debate for this biennium. If the bill had become law it would have allowed terminally ill patients, who had less than six months to live and were mentally sound, to receive a prescription from a doctor that would be fatal when self-administered.
H. 112 – An Act Relating to Protection of Health Care and Public Safety Personnel from Communicable Disease
The House Human Services Committee took testimony on H. 112 this week. The committee heard from the lead sponsor of the bill, Dr. Harry Chen (D-Mendon), on why the bill is needed. The bill as introduced proposes to require informed consent in order to test for communicable and infectious diseases except in the case in which health care workers or public safety personnel have been significantly exposed to the bodily fluids of an individual suspected of possible disease infection.
Dr. Chen believes that the bill will facilitate rapid decision-making and appropriate care in the event of occupational exposure to communicable diseases. It will allow practitioners and their patients to make clinical decisions based on hard data rather than supposition. He believes the legislation will save exposed health care and emergency workers a great deal of anxiety, the need to take a costly and possibly toxic drug regimen, and worry about the potential of exposing their spouses or partners to blood borne disease. H.112 will treat the results of the tests as confidential. He further stated that the bill does not discriminate against individuals infected with blood borne diseases as every person is at risk and would be tested if a health care or public safety worker had a significant exposure. The bill will facilitate non-discriminatory treatment of all individuals as it provides an evidence based treatment pathway in the event of an exposure.
The committee will take testimony on Friday, March 30. The committee would like to hear from hospital representatives on the bill (see attached proposed amendment by Dr. Chen to the bill as introduced).
S. 124 – An Act Relating to Planning and Evaluating Options for
The House Human Services took testimony on S. 124 this week. The bill provides for an independent evaluation by the general assembly of the options available to the state regarding the provision of inpatient psychiatric services now provided at the
David Anderson, Acting Chair of the Public Oversight Commission (POC), briefed the Human Services committee on the POC recommendations to BISHCA on the Vermont Department of Health conceptual Certificate of Need (CON). The POC recommended approval of the application with a number of conditions. The conditions included: the CON must explore and consider alternative solutions for an inpatient psychiatric facility which provide a satisfactory and appropriate balance of the priorities of the Health Resource Allocation Plan; it must review the need and include in the CON proposal appropriate consideration for adequate inpatient mental health treatment for inmates of the correctional systems; it must provide a long range perspective to include adequate funding sources for the inpatient facility; it must include sufficient research and analysis of systems in place or planned in other sates; a governance structure; it must have a transition plan from the current to the planned facilities; it must address or show alternate plans to address the issues of community impact; it must comply with the schedule established by BISHCA with agreed upon timetables and planning benchmarks (inclusion of an interim objective for recertification of the current VSH could be part of this plan in order to address quality of care issues for the extended period before completion of a new VSH); and interested parties should be permitted open, transparent and meaningful access to the CON planning process to include their perspectives on the needs of their members, constituents, or those who utilize mental health services.
Public Hearing: The Senate Appropriations Committee will hearing from advocate on the FY 2008 Budget on Monday afternoon, March 26 beginning at 3:00 pm, in Room 10 of the State House.
Bills of interest that were introduced this week:
H. 531 - AN ACT RELATING TO ENSURING SUCCESS IN HEALTH CARE REFORM: This bill proposes to (1) establish outreach and enrollment principles for Catamount Health and state benefit programs; (2) require the agency of human services to adopt a simplified application form for state health benefit programs, enable health care professionals and community volunteers to assist individuals to apply for health benefit programs, and provide coverage for state benefit programs beginning on the date the agency received the application; (3) limit premium assistance for Catamount Health plans to the amount of assistance for the lowest priced plan, such that individuals receive the same dollar amount of premium assistance, regardless of the cost of the higher cost plans; (4) create a position in the department of health titled principal assistant to the commissioner to lead the blueprint; (5) add the director of the health care reform commission and a representative of the state employees’ health plan to the blueprint for health executive committee; (6) establish principles and benchmarks to guide development and implementation of the blueprint for health, and require the department of health to facilitate participation in the blueprint; (7) establish a project for integrated early implementation of the blueprint programs by the department of health, including a medical home project, a chronic care payment reform project, and a community‑based care coordination team development project; (8) appropriate $75,831.00 in general funds plus the federal matching funds ($185,000.00 total) to the department of health for use by the Vermont Rural Health Alliance for early integration of the blueprint projects, upon receipt of matching funds by the alliance; (9) require the board of nursing and board of health to study elimination of the requirement that advance practice nurses have a collaborative practice with a physician; (10) add the department of human resources to the list of state agencies with which provider bargaining groups can negotiate; (11) require BISHCA to annually survey and report on the costs of the most common health services; (12) require an annual report on the alignment of the state employees’ health plan with the blueprint for health and the adequacy of networks and reimbursements for that plan; (13) move the oversight of the Vermont Information Technology Leaders (VITL) from BISHCA to the department of information and innovation; and (14) require VITL to establish both a permanent and an interim loan and grant fund for enabling providers, especially primary care providers, to create and share electronic health records.
S. 192 - AN ACT RELATING TO HIV NAME‑BASED REPORTING: This bill proposes to: (1) remove hospital administrators, town health officers, and non-medical community‑based organizations from the list of persons who must report cases of listed diseases to the department of health; (2) allow anonymous HIV testing; (3) require health care providers to report HIV cases to the department of health using the patient’s name, rather than through use of a unique identifier code; (4) require the department of health to adopt rules to ensure enhanced computer security and protection of information collected concerning reportable diseases; (5) prohibit the department from disclosing identifying information about a person with a reportable disease, even to other state agencies or to the federal government, unless the individual has authorized the disclosure; (6) prohibit use of identifying HIV information for any purpose other than public health surveillance; (7) prohibit the department from storing identifying HIV information on a laptop or networked computer; (8) establish a private right of action for malicious disclosure of identifying information; (9) require the department to perform a computer security audit and evaluate the adequacy of penalties for disclosure of identifying information by state personnel and health care providers; and (10) require 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.