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For the week ending April 13, 2007
Political Overview
Senate morning committees will shut down after this week in order to allow afternoon committees more time to focus on must-pass legislation and the Appropriations bill may be voted out by the Senate Appropriations Committee by Friday, April 20th and to be debated on the Senate Floor the week of the 23rd.
The House turned up the heat on property taxes and how the State funds education. In a tri-partisan press conference this week, a group of lawmakers who have been working behind the scenes on a proposal to simplify the tax system unveiled an outline, entitled “A School Funding System Based Directly on Per Pupil Spending.” The proposal repeals the homestead property tax and the $15,000 homestead exemption, assesses an education tax based on income rather than the value of property, and sets the education tax rate in proportion to per pupil spending in each district to reinforce the connection between school spending and school taxes. The press release issued by the group listed five major issues to be resolved, including what the base would be for measuring wealth, establishing a limit to the amount of income that is subject to the education income tax and how to make up tax revenues by exempting more than the two acre house site. How this will resolve the unsustainable increase in providing educational services is yet to be determined.
FY 2008 Budget Bill
The Senate Health & Welfare took testimony this week from the Agency of Human Services, Office of Vermont Health Access (OVHA), Vermont Department of Health (VDH) and the Department of Aging and Independent Living (DAIL). The committee plans to vote the budget out of the Appropriations committee on Friday, April 20.
OVHA: Director of OVHA Joshua Slen gave an overview of the Medicaid budget. The testimony consisted of an explanation of the Medicaid program and the Governors' proposed budget of $749,342,679. Twenty five percent of Vermonters are covered by Medicaid. Slen reviewed his department’s role related to Catamount Health, clinical initiatives, the chronic care management program, Global Commitment, and information technology. Director Slen also told the committee that OVHA has selected APS Healthcare, Inc., as the vendor to administer its Chronic Care Management Program. APS will collaborate with OVHA, health care and social service providers throughout
The Governor’s budget proposed new money for hospital rate increases for SFY 2008 (July 1, 2007) of $2.0 million, physician increases of $2 million, and home health increases of $400,000. The House Appropriations Committee passed the budget last week with an appropriated 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 Home Health increase is $410,000.
VDH: VDH presented their 2008 budget in Senate Appropriations. Acting Commissioner Sharon Moffat presented the Department’s $277,575,428, a 9% increase over the 2007 budget. Moffat shared with the Committee a draft VDH realignment organizational chart. Key points are a new Medical Director position; current deputy commissioner Chris Finley’s department brings together many of the grant programs and includes the emergency preparedness unit as a central focus, has an Office of Local Health that includes the 12 district health offices, and an Office of Epidemiology and Environmental Health; and current deputy commissioner Barb Cimaglio’s department includes substance abuse prevention, treatment and workforce training. With the likely passage of H. 137, legislation which creates a department of Mental Health and Commissioner of Mental Health will remain within VDH. The two departments will share communications, administrative office sand information technology. The Commissioner of Mental Health will report to the Secretary of Agency of Human Services.
Moffat 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, a decrease of $600,000 to the Women, Infant and Children’s (WIC) program, eliminates a .5 FTE medical examiner position that is currently vacant and a number of other programs. New revenues from proposed fee increases (in the fee bill being reviewed by Senate Finance) for the department include: food and lodging, newborn screening, radiology, and the CRASH program.
Blueprint for Health: Budget increase of 48% - $4,807,708. The proposed budget adds a number of positions within the department to implement the Blueprint. The health care bill (H. 531) currently being reviewed by Senate Health & Welfare includes a principal assistant position. Under the Grants Implementation section, 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. Acting Commissioner Moffat stressed the $4.8 million in the Governor’s proposed budget is critically important in order to get providers on board, to develop the health information technology infrastructure and to continue the healthy living workshops.
Health Protection Division: The proposed budget eliminates the Radon Program and the Emergency Preparedness Chief position.
Health Surveillance Division: The proposed budget eliminates a .5 FTE medical examiners position that is vacant and eliminates an administrative assistant position in the HIV/AIDS program.
Health Improvement Division: 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
Community Public Health Division: The proposed budget eliminates the town health officer program and decreases funding to the WIC program by $600,000.
Alcohol and Drug Abuse Program Division: The proposed budget adds new federally funded positions for the prescription drug monitoring program, includes a 7.5% increase in general funds for the provider system, and annualizes 50 Methadone slots that were funded for 6 months in FY07.
Mental Health Division: 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.
DAIL: 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
Health Care Reform
H. 531: The Senate Health & Welfare continued to take testimony on H. 531, An Act Relating to Ensuring Success in Health Care Reform. The committee heard from Vermont Information Technology Leaders (VITL) President Greg Farnum and Chief Operating Officer
Forlenza stated that VITL is working with the Administration to raise $1 million on a voluntary basis from commercial insurers, self-insured employers and VAHHS for the interim fund for the electronic health record (EHR) pilot. They are to report back to the committees of jurisdiction by September 1, 2007 on their progress. Other timelines are: by October 1 VITL will issue the request for proposal to select vendors and implementation specialists; by November 1, 2007 they will publish the criteria for selecting pilot sites; and by January 1, 2008 they will award pilot sites with licenses for EHR systems.
Committee Chairman Doug Racine asked what happens if physicians don’t buy into this? Forlenza feels that physicians are very interested in EHRS because it allows for easier sharing and gathering of patient information, which leads to better treatment for patients.
Consultant to the Health Care Commission Hans Kastensmith stated he will be coordinating a “Vermont Health Care Day” in
Forlenza and Farnum discussed the issue of limitation on liability insurance. There is general support of limiting VITL’s liability regarding data services and exchange. The committee would like the appropriate individuals to come up with agreeable language.
The committee also heard testimony from
On Wednesday afternoon the committee heard from
Director of the Health Care Commission
Kenneth Thorpe, consultant to the Health Care Commission, presented options for expanding Catamount Health. Thorpe proposed having traditional Catamount Health and a higher deductible Catamount Health plan. Catamount Health expansions could be gradually opened to currently insured populations by firm size (first to enter would be self-employed and smaller firms), with required employer and worker contributions. Thorpe recommended that initially the risk pool be kept separate from traditional Catamount Health and the goal ultimately would be to merge the current Catamount Health pool and individual and small group pool, in the 2111/2112 time frame. Thorpe believes that employers would join the program because they will spend 3-5% less on health care insurance premiums. The reduced premiums would be a result of more Vermonters becoming insured, which would reduce bad debt and charity care for hospitals and other providers, resulting in a reduced cost shift. With providers not needing to shift as much to the insured, reimbursement rates 5% lower than current commercial rates would be acceptable, which would account for the 3-5% reduction in premiums.
House Health Care and Senate Health & Welfare will be having a public hearing on April 24, 2007 beginning at 6:30 p.m., Room 11 at the State House. The committee would like to receive ideas on how to expand health care reform initiatives.
H. 137 – An Act Relating to the Restoration of a Department of Mental Health and Commissioner of Mental Health
The Senate Government Operations voted out of committee H. 137 on a vote of 5-0 this week. An amendment proposed by the Vermont Medical Society on increased coordination and integration with physical health, mental health and substance abuse was accepted by the committee. The committee also accepted the House language on the qualifications of the Commissioner of Mental Health to be a mental health care professional.
H. 294 – An Act Relating to the Executive Branch Fee
Senate Finance began taking testimony this week on the different section of the Fee Bill. VDH Acting Commissioner Sharon Moffat and Director of OVHA Joshua Slen reviewed their sections of the 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.
S. 7 – An Act Relating to the Compassionate Use of Marijuana for Medical Purposes
House Human Services took testimony this week on S. 7, An Act Relating to the Compassionate Use of Marijuana for Medical Purposes. The committee heard from VDH, law enforcement, the ACLU, consumers and health care organizations. The Senate removed a provision that would allow a registered patient to possess or use medical marijuana in a nursing home or hospitals based on the fact that this would be in direction of Federal law. The Vermont Medical Society testified on their concern of broadening the range of medical conditions that quality for the program.
S. 128 – An Act Relating to Eliminating Certain Sunsets on Forensic Examinations at Designated Hospitals.
House Human Services took testimony on S. 128 this week. The committee heard from VDH, Vermont Legal Aid, and the Court Administrator. A report from the Forensic Mental Health Summer Work Group was reviewed. The workgroup was charged with reviewing transfers between hospitals, including standards, procedures and rights of patients; determination of the least restrictive setting for forensic evaluations; disposition of the defendant if it is determined after admission that the defendant does not meet the standards for hospitals; and legal representation of defendants and the state in hospitalization hearings. The committee will continue to take testimony next week.
VDH Conceptual Certificate of Need Decision
Deputy Commissioner of the Health Care Administration Christine Oliver reviewed the final Statement of Decision on the VDH conceptual CON to create new inpatient programs to enhance psychiatric inpatient care and replace the functions currently performed by the
CON law (18 V.S.A. §9440(d)(6)(B)) requires BISHCA to hold a hearing for the applicant and any interest parties after the Agency has issued a Notice of Proposed Decision that is different from the POC recommendation. This hearing was held on Monday, April 9. The applicant, the Department of Health, had no additional evidence to present, but asked for clarification on three issues. VDH requested a clarification on the type of services they would be obligated to provide to inmates. VDH’s assumption was their obligation is limited to inpatient services. VDH asked that BISHCA clarify their language on non-transferability of the application. They suggested that given potential re-organizations, BISHCA may want to consider language that recognizes any successor organization that may come into existence. VDH asked for clarification that project activities authorized by the conceptual CON are the architectural, engineering and other planning activities needed to prepare the phase II CON application, not the actual construction and development of the facility to replace VSH. BISHCA agreed to these clarifications in the final decision.
The Vermont State Employees Association (VSEA) and Vermont Protection and Advocacy (VPA) had a number of comments. VSEA suggested that BISCHA revisit the number of beds needed because of increased potential demand from corrections; specifically require VDH to work with our congressional delegation on obtaining an Institute of Medical Disease waiver; BISHCA include the Public Oversight Commission recommendations around the recognition of employee specialized training and experience and the development of a transition plan to ensure employee retention. BISHCA’s determination on these issues is this goes beyond the scope of the Commissioner of BISHCA jurisdiction.
VSEA, VPA and the Vermont Psychiatric Survivors requested that BISHCA include POC recommendation # 9 that called for “open, transparent and meaningful access” throughout the planning process. Herb Olson, the Commissioner’s designee did not make any conclusion in support of, or in opposition, but concluded that imposing such an obligation on the applicant, in the manner suggested by the Commission and interested parties, also goes beyond the Commissioner’s legal authority.
Legislative Committee on Administrative Rules
The Department of Aging and Independent Living reviewed a number of proposed rules by the department on the Choices for Care 1115 Waiver, regulations implementing the Developmental Disabilities Act of 1996, Global Commitment to Health Grievance and Appeals Rules, and the Attendant Services Program Regulations.
Choices for Care 1115 Waiver: The rule amends the appeal section of the existing Choices for Care Waiver regulations to give participants in the program a grievance and appeal process that is the same with other programs within the Agency of Human Services. The goal is to resolve disputes fairly, to provide expeditious resolution of disputes, to enhance beneficiary and public confidence in the equity and integrity of the service system, to ensure participant access to services for which they are eligible and to allow for the independent review of decisions concerning actions which can be appealed.
Developmental Disabilities Act of 1996, Global Commitment to Health Grievance and Appeals Rules and Attendant Services Programs: These rules implement the grievance and appeal process required under the federally-approved Global Commitment to Health 1115 Medicaid program as part of the managed care organization (MCO) of OVHA. Federal regulations require Medicaid MCOs to establish internal procedures under which Medicaid enrollees may challenge the denial of coverage of, or payment for, medical assistance. The rules amend the existing regulations to achieve this.