VAHHS Legislative Report

For the week ending April 20, 2007

Political Overview

Senate Leader Peter Shumlin reiterated several times this week that his goal is to adjourn the session by May 5. Some Senators were skeptical that this timeline could be achieved because several major pieces of legislation, such as the budget, capital budget, telecommunications, workforce development and climate change/energy bills, had not yet been finalized and passed by their respective bodies to enable conference committee negotiations. Shumlin wants all bills out of committee by Friday, April 27.

Senator Shumlin presented and defended the Governor’s proposal to require approval of a school budget by 60 percent or more of those voting if the proposed amount of spending exceeds 104 percent of the prior year’s authorization. The Senate was deadlocked on this proposal, and therefore, Lieutenant Governor Brian Dubie broke a tie vote and supported the Governor’s spending cap proposal. This action means the possibility of a legislative remedy for cost containment is in doubt, as the House did not support this cost containment method and the House and Senate bills are very different.

On Friday, Senator Shumlin unexpectedly decided to take up a resolution calling for the impeachment of President Bush and Vice President Dick Cheney. The Senate adopted the resolution on a 16-9 vote. The resolution says they have exercised their authority "in ways that raise serious questions of constitutionality, statutory legality, and abuse of the public trust." Senators cited the war in Iraq and issues relating to individual privacy and personal liberty as reasons for supporting the resolution. A similar Resolution has been held up in the House Judiciary Committee for weeks.

The House gave final passage to the public transit bill. The bill originally included a surcharge on low-mileage vehicles as a funding source for transit, that provision was removed with an amendment on the floor that changed Vermont’s seatbelt law to a primary offense in order to qualify for one-time, $3.7 million federal highway safety grant to help provide $20.7 million for public transportation next year.

FY 2008 Budget Bill

The Senate Appropriations continued to work on the FY2008 Appropriations Bill. The committee will meet on Monday to do markup on the human services portion of the bill.

Health Care Reform/Health Care Commission
H. 531: The Senate Health & Welfare continued to take testimony on H. 531, An Act Relating to Ensuring Success in Health Care Reform. On Thursday afternoon the committee reviewed a number of amendments for consideration. The committee approved consensus language on health care provider bargaining groups. It states upon publication of the requests for proposals, health care professional and trade associations may register with the Secretary of Administration to be provided a list of bidders and submit information about the business practices of these bidders to the Secretary of Administration to consider when evaluating bids. The committee also approved an amendment related to the Blueprint, which creates a high level leadership position in the Office of Secretary of Administration. The remaining Blueprint staff will remain at the Vermont Department of Health (VDH). Because of the number of changes to the House bill, the committee will offer a “strike all” amendment to the House bill to make it easier and cleaner when reporting the bill on the floor next week.

H. 229: The Senate Health & Welfare passed the technical amendments bill this week. The bill includes language to move oversight of the Vermont Information Technology Leaders (VITL) from the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) to the Department of Innovation and Information (DII). It also has the voluntary health information technology fund. The Vermont Grocers Association successfully offered an amendment to define part time employees as employees who work for fewer than 30 hours a week. The bill was referred to the Senate Finance Committee to review the employer assessment, insurance and premium sections of the bill.

Health Care Commission Meeting: Acting Commissioner of the VDH Sharon Moffat and Director of Health Care Reform Implementation Susan Besio gave an update on the staffing of the Blueprint for Health. The Administration recognizes the need for a more visible point person to speak with authority and is now proposing the individual report directly to the Secretary of Administration. It will be an exempt position with salary of approximately $150,000. The remaining Blueprint staff will remain at VDH. The chronic care information system team will be lead by the VDH chief of information technology and will add two additional staff in this area. Moffat feels progress is being made with GE and VITL and will look to hire an information technology expert. VDH has disseminated the bid proposal for a communications strategist and hopes to have the person or form on the ground by mid-May. Moffat also stated that they are searching for a national expert on payment reform. The commission asked the Administration to bring language for the new director position to the committee as soon as possible.

Director of the Health Care Commission Jim Hester presented themes for assessing the long term strategy for health reform. They include: expanding affordable coverage to more Vermonters; reduce the rate of increase in costs while improving quality; using information technology as a catalyst for reform; ensure the right size and right type of capacity in the health care delivery system; and the capability of the system to implement rapid change. Hester is advocating workgroups be established to address each strategy, commission members pick one or two workgroups to participate on, and that commission members “adopt” a Blueprint community.

Office of Vermont Health Access (OVHA) Director Joshua Slen told the commission 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 Vermont to advance evidence-based practice and help Medicaid patients self-manage their chronic health conditions.

Kevin Veller, Director of Health Care Reform Outreach and Enrollment, stated OVHA selected GMMB as the vendor to lead Vermont’s health care reform outreach and enrollment activities, pending the successful outcome of contract negotiations. The final contract is anticipated to be completed within the next couple of weeks. GMMB will collaborate with the Agency of Human Services/OVHA, the Director of Health Care Reform Implementation, health insurers, businesses and other interested parties to research groups of uninsured Vermonters, and develop and implement outreach activities to target these groups for enrollment. GMMB has helped the uninsured secure health insurance coverage through national and state-level efforts. GMMB specializes in integrated outreach campaigns and has a long record of successfully motivating behavioral change among hard-to-reach groups.

Betsy Forest reviewed policy issues in Employer Sponsored Insurance Catamount Premium Assistance rules. Representatives from the Administration met with several members of the Commission to reach consensus on issues before the Administration files its proposed premium assistance rules with the Legislative Committee on Administrative Rules. These issues include:

Issue 1: The Administration’s recommendation for approving plans with cost-sharing amounts that differ from Catamount Health will propose ESI plans with deductibles of $1000 or less be deemed substantially similar to Catamount Health. Catamount Health plans has more comprehensive coverage and less cost-sharing requirements than most plans available on the market. The administration and lawmakers agreed the phrase “substantially similar” to acknowledge this discrepancy and provide room for reasonable ESI plans to be approved. Approved ESI plans will cover physician visits, inpatient care, outpatient services, prescription drugs, emergency room visits, ambulance services, mental health and substance abuse treatment, medical equipment and supplies, as well as maternity care.

Issue 2: Methodology for cost effectiveness test will use the actual cost of an individual’s ESI plan compared to an average per-member-per-month for the individual’s age/gender cohort.

Issue 3: Statutory language should be revised to clarify that the cost-sharing wrap for ESI chronic care is not intended for all possible chronic care, but for those chronic care services that are related to evidence-based guidelines for ongoing clinical prevention and management of the chronic conditions specified in the Blueprint for Health. The administration will revise the proposed rule to state that OVHA will consult with the Blueprint for Health in determining the diagnosis and procedure codes that will be eligible for the chronic care wrap.

Issue 4: The Administration will reimburse wrap-around claims at the Medicaid payment rate rather than the ESI commercial rate. Payment at the Medicaid rate is consistent with OVHA’s practice for Medicaid and Dr. Dynasaur beneficiaries who have other insurance. Beneficiaries will not be harmed by this since providers who agree to accept Medicaid may not balance bill beneficiaries. Providers with patients who enroll in the ESI premium assistance will receive payment for some services at a higher rate than they currently receive, since claims paid by the ESI plans will be at a higher rate than would be the case if the beneficiary were enrolled only in VHAP. OVHA will discuss this with the Vermont Medical Society.

Deputy Commissioner of BISHCA Christine Oliver gave an update on the review of Catamount Health filings. MVP’s rates were approved last week and Blue Cross/Blue Shield of Vermont’s rate was denied on Monday. The department will meet with the carriers to discuss changes that need to be made.

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

House Human Services took testimony on H. 112 from Dr. Don Swartz, Medical Director for the Vermont Department of Health (VDH) and Dr. Christopher Grace, Infectious Diseases Department at Fletcher Allen Health Care/University of Vermont College of Medicine. Both physicians testified that infection from two blood borne pathogens (Hepatitis B and HIV ) that first responders and health care workers may be exposed to from "source patients" can potentially be prevented if treatment is begun immediately. Dr. Grace further noted that the treatment to prevent HIV infection carries many side effects and should not be started unless the source patient is known to be infected. Dr. Swartz expressed concern with language in the current draft of the bill under which source patients known to be infected would be reported to the new health department HIV reporting program. He suggested that a better strategy would instead be a modification to the health department's anonymous testing mechanism.

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

The Senate passed on the floor this week H. 137. The bill restores the Department of Mental Health within VDH, with its own Commissioner reporting directly to the Secretary of the Agency of Human Services.

S. 7 – An Act Relating to the Compassionate Use of Marijuana for Medical Purposes

The House Human Services committee passed S. 7, An Act Relating to the Compassionate Use of Marijuana for Medical Purposes this week and referred the bill to the House Judiciary committee for their review. The definition of physician now includes physicians, surgeons, or osteopathic physicians licensed to practice medicine and prescribe drugs under comparable provisions in New Hampshire, Massachusetts or New York. The Department of Public Safety is required to verify the physician is in good standing through that state’s medical practice board. The possession amount between the registered patient and the patient’s registered caregiver to no more than two mature plants, four immature plants, and two ounces of usable marijuana.