VAHHS Legislative Report

For the week ending March 30, 2007

Political Overview
The House was in chaos Thursday afternoon when action on the Education Quality and Cost Control bill was postponed after the leadership learned that the votes to pass the legislation did not exist. For some, the bill did not go far enough to address the property tax burden issue, while for others, the proposal delved too deeply into local decisions. Lawmakers of all parties had mixed emotions about the bill and the delay puts the work of the House Education and Ways and Means Committees for the past three months in doubt as to whether any real “bending of education costs” will occur this session. The House plans to debate the bill on the floor Tuesday and there is a question whether the bill will pass.

FY 2008 Budget Bill

The House Appropriations Committee continued review of the FY08 bill this week and will meet on Monday for final review and vote on the bill. On Friday, the committee reviewed the Medicaid section of the bill and appropriated an increase of $1 million for hospitals ($400,000 general funds and $600,000 federal matching funds). The proposed $1 million increase would go into effect on January 1, 2008, this essentially represents a six month delay, a similar strategy that was utilized last year. The physician increase is also $1 million with the same allocation and effective date.

The Blueprint appropriation of $1.8 million will come from Catamount Health, but language will be included that states it will be paid back from “waterfall” funds or through the budget adjustment process for next year. The bill will also have language stating the committee does not feel this is an appropriate use of Catamount Funds.

Senate Appropriations heard from Jim Hester, Director of the Health Care Commission, on the commission’s budget. FY 08 estimates include a $500,000 appropriation, plus $191,722 carry -forward for a total budget of $691,722. Line item for expenses include: salaries, legislative counsel support, and community meetings. There is also a line item for continuation of consultants Dr. Kenneth Thorpe and Hans Kastensmith of $125,000. Hester stated that the commission is working with Joint Fiscal on updating the models for Catamount Health and Vermont Health Access Plan enrollment projections The House Appropriations committee allocated $450,000 in the Appropriations bill Friday afternoon for the Health Care Commission rather than the $500,000 presented by Hester.

Health Care Reform
On Wednesday, the Senate Health & Welfare committee did a walk thru of H. 531, An Act Relating to Ensuring Success in Health Care Reform. The committee heard from Chair of House Health Care Steve Maier on the provisions of the bill. The committee will take testimony next week on the bill. The bill will be debated on the House floor next week and will be officially sent over to the Senate.

The House Ways and Means passed H. 229, the technical amendments bill for the Health Care Affordability Act of 2006. The bill has been stalled for a number of weeks due to the exemption of part time employees. An amendment was passed that exempts from the Catamount Health employer assessment, seasonal and part-time employees who have health insurance through some other means. In addition to the exemptions, the amendment directs the Governor’s office to come back to the Legislature before December 2007 with a plan to address the budget shortfall the exemptions create in the Catamount Health Plan fund. There is also discussion of combining the technical amendments bill with H. 531, An Act Relating to Ensuring Success to Health Care Reform before sending on to the Senate.

H. 137 – An Act Relating to the Restoration of a Department of Mental Health and Commissioner of Mental Health

The Senate Government Operations committee did a walk thru of H. 137. The committee heard testimony from Deputy Secretary of the Agency of Human Services Steve Gold, Ken Libertoff from Vermont Association of Mental Health, Madeleine Mongan of the Vermont Medical Society, and former State Senator James Leddy. Support was given by all that testified for passage of the bill. Gold stated the Administration supports the language to have the Department of Mental Health within the Agency of Human Services. The committee will be taking additional testimony next week on two amendments. One amendment was offered by the Medical Society that would increase coordination and integration of physical health, mental health and substance abuse. Senator Jane Kitchel (D-Caledonia) will also be offering an amendment that calls for a review of existing government structure for the administration of health care.

Vermont State Hospital

The Senate Institutions Committee heard additional testimony from the Administration on the Vermont State Hospital. There continues to be frustration on the perceived lack of progress, and the reasons for delay, including the need for the conceptual Certificate of Need.

H. 112 – An Act Relating to Protection of Health Care and Public Safety Personnel from Communicable Disease

The House Human Services Committee heard additional testimony on H. 112 this week. The committee heard from Legislative Counsel and the director of the American Civil Liberties Union (ACLU). Legislative counsel gave the committee a brief overview of the Health Information Portability and Accountability Act (HIPAA) and the ACLU on search and seizure case law. The committee had a number of questions related to confidentiality and disclosure of results, who deems the blood test appropriate and timeframe for which a test can be done. The committee asked that VAHHS and the Vermont Medical Society review the bill, how HIPAA applies and to be sure that the language is HIPAA compliant. Over the next few weeks, VAHHS will be addressing a number of other detailed questions the committee raised.

S. 114 – An Act Relating to Enhancing Mental Health Parity

The Senate Health & Welfare Committee took testimony on S. 114 this week. The bill proposes to establish the goal of fully integrating mental health and substance abuse services with other health services. The bill prohibits the imposition of any type of greater burden in accessing mental health services, instead of prohibiting only financial burdens; require deductible or out-of-pocket limits to be comprehensive for all services. It requires rulemaking to ensure consistency in requiring co-payments for routine and primary mental health care and prohibits mental health carve‑out margins in excess of those for physical health. It requires a health plan to set rates with mental health providers in the same manner as it sets rates with physical health providers. The committee heard from a number of psychologists and psychiatrists in support of the bill.

Peter Albert from the Brattleboro Retreat shared with the committee some of work Retreat and MVP have been engaged in. It is a model developed on care management that would put into practice the theories of collaboration, quality and integration and do so in a respectful and financially viable manner. The Retreat created a non profit provider run Managed Service Organization called PrimariLink and entered into a venture MVP on a model based upon partnering with providers to make real the notions of best practice.

A number of initiatives have been underway such as psychiatric consultation, training, free computer programs, quality improvement projects, and coordination of disease management program for the early identification and care of depression.

Albert discussed the concept of real integration and parity and feels real integration is not simply about co-locating people in the same building. True integration and parity comes from managing to the outcomes we wish to see. It means developing measures to know your plans for integration are on track. Albert hopes the bill will provide the vehicle for serious conversations about how to further parity and integration of care while preserving some of the great work already taking place.

S. 124 – An Act Relating to Planning and Evaluating Options for Inpatient Psychiatric Hospital Services
The House Human Services took additional testimony on S. 124 this week and passed the bill out of committee on a 10-0-1 vote. 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 Vermont State Hospital. It authorizes the House and Senate leadership to retain one or more consultants to compile, analyze and review what has been done to date, and investigates the necessary steps to meet conditions of participation or waivers from the Centers for Medicare and Medicaid Services. The Leadership is authorized to spend up to $100,000 from the $1 million appropriated last year to Building and General Services to accomplish this work. The consultants will report preliminary progress on or before May 1, 2007 to the Appropriations and Institutions committee of both the House and Senate. A final report will be submitted the Chairs of Appropriations and Institutions committees, the Joint Fiscal Committee, the Mental Health Oversight Committee, the Secretary of Administration and Secretary of Human Services.

S. 166 – An Act Relating to Prohibiting Mandatory Overtime

Senate Health and Welfare took up S. 166, a ban on mandatory overtime. Committee Chairman Douglas Racine opened the hearing by commenting that the bill was not likely to make it through the full process for a vote this year but the committee might spend more time on it next year. Susan Lucas and Jennifer Henry from Justice for Healthcare Workers testified in favor of the bill, citing concerns about patient safety when staff works too many hours. Ann Jerman testified for the Vermont State Hospital and described situations such as the Valentine’s Day blizzard when mandatory overtime becomes the only option to cover units. Jill Olson testified in opposition to the bill on behalf of VAHHS, noting that mandatory overtime has been phased out of most Vermont hospitals and those that are still using it have collective bargaining agreements that allow for it, although even those hospitals would prefer to eliminate it. She noted that hospitals oppose the bill despite striving to reduce or eliminate mandatory overtime because there may be circumstances that require its use (storms, immediate patient care issues, public health emergencies) and we prefer to let nurse managers make the kinds of judgment calls they have the training and experience to make. Throughout the testimony, the committee raised a number of issues including (1) if mandatory overtime is dangerous how is voluntary overtime any safer? (2) what about significant emergencies such as snowstorms? (3) is this a significant issue in Vermont right now? How many hospitals are using mandatory overtime? (4) would a bill that limits hours that hospital workers can work whether voluntary or not (such as exist for truck drivers) be preferable to a bill that focuses only on mandatory overtime?