VAHHS Legislative Report

Final Report, 2007 Session

The Vermont General Assembly adjourned on Saturday, May 12, 2007 and will plan to return on Tuesday, January 8, 2008 for the 2008 session. Because this is the first year of the biennium, any bill that was introduced this session is still in play next January. We expect next year’s priorities will continue to focus on property tax and education reform. It is an election year so lawmakers will be mindful of the promises made when they were elected in November 2006.

Political Overview

Ideology predominated over policy in the 2007 session of the Vermont General Assembly. Democrats control the Senate by a 23 to 7 margin. Democrats control the House by a large margin holding 93 seats to 49 for the Republicans, 6 Progressives and 2 Independents. With such large Democratic majorities in both chambers, Speaker Symington and Senate President Pro Tempore Peter Shumlin, were challenged in keeping the caucus together and in line on certain issues. Lawmakers are likely to return to Montpelier on July 11, 2007 for a veto session on the energy bill (H. 520). This bill establishes an energy efficiency utility and offers incentives for renewable energy. At issue is funding. Lawmakers ultimately decided to raise the taxes paid by Vermont Yankee by $25 million through 2012. The Governor remains adamantly opposed to this.

With Catamount Health now painfully in the regulatory arena, VAHHS focused on improvements to hospital regulations and relationship building. Grassroots advocacy made all the difference. Board members consistently had a presence at the State House, an important strategy with the rapid pace of health care changes.

FY 2008 Budget Bill (H. 537)

Lawmakers sent the Governor a $4.7 billion budget to run state government starting on July 1, 2007. The budget pays for existing programs that include prisons and public safety, environmental protection, health care, human services and economic development. Analysts have projected that Medicaid costs will increase faster than revenues and the shortfall could be as much as $40 million for next year.

The budget bill appropriates an increase of $1 million for hospitals ($400,000 general funds and $600,000 federal matching funds). The proposed $1 million increase will go into effect on January 1, 2008, a six month delay, last’s year’s strategy. The bill increases physician fees effective on July 1, 2007, which will result in a $2 million increase for physicians.

The budget contains $3.9 million to implement some of the recommendations of the Nursing Home Medicaid Reimbursement Study. The key points are to make the 90% occupancy threshold permanent; institute biennial rebasing of nursing costs; increase, at a minimum, the nursing home market basket inflation index for nursing care by 1% in non-rebase years; and move the Minimum Data Set Coordinator costs from the indirect category to the nursing category. These recommendations will almost take nursing homes back to where they were when the major Medicaid cuts happened in 2005.

The inflation rate for nursing homes will become effective on July 1 and there is approximately $4 million in the budget to cover this. Residential Care and Assisted Living Homes that accept Enhanced Residential Care residents (nursing home eligible) will benefit from the 3.75% inflation increase for most Choices for Care providers. This increase is applicable to all tiers. Residential Care Homes that accept Assistive Community Care Services will see a $1 per day increase in their rates.

The budget bill also contains a repeal of a special rate that The Manor Nursing Home received in 2004 when it was still part of Copley Hospital. This repeal is necessary in light of the probability of The Manor applying for a Certificate of Need (CON) to increase bed size due to the closure of Morrisville Center last January.

The Department of Aging and Independent Living (DAIL) will also be required to submit quarterly reports to the legislature showing the utilization and expenditures under Choices for Care. The report shall include a comparison of actual expenditures to estimated and projected expenditures for the year.

The Home Health increase is $410,000.

The following budget bill provisions (by section number) of interest to VAHHS are as follows:

Section 9(a): Appropriates $726,664 to the Vermont Information Technology Leaders (VITL). Availability of the funds is contingent on the Secretary of Administration’s approval of the annual plan to coordinate activities with the Vermont Blueprint for Health and other health care-related information technology projects. Funds are also contingent on the delivery of an updated sustainable business plan and VITL’s commitment to secure non-state match for funds. If VITL is unable to demonstrate the ability to deliver the work, the state has the right to assume ownership of all licenses, intellectual property, and work product of VITL.

Section 37(a), 39 (b), 91(a), 106(a & B, and 277(e)(2): These sections relate to the Health Care Reform Commission:

Section 37 (a): Appropriates $450,000 for the Health Care Reform Commission. It includes language that states the health care information technology consultant will be jointly selected and supervised by the commission and the chairs of the House and Senate Appropriations Committee.

Section 39 (b): Effective June 24, 2007, the interim Medicaid analyst position currently in the Joint Fiscal Office is transferred to the Health Care Commission as a full-time exempt position.

Section 91 (a) & 277 (e) (2): Section 277 appropriates $2.5 million to the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) for the non-group market security trust. This appropriation will not be expended until the Health Care Commission approves the department’s plan for operating the trust, a description of how the plan conforms to the federal grant requirements from the Centers for Medicare and Medicaid Services (CMS), the statutory changes necessary to conform, and any other information requested by the commission.

Section 106 (a) & (b): These sections state that if CMS has not responded to the Global Commitment for Health waiver amendment request to fund Catamount Health Assistance with Medicaid funds, does not approve the requests or lowers the income eligibility limit by July 31, 2007, the commission will recommend to the emergency board the following options: 1) to proceed with implementation of Catamount Health, Catamount Health Assistance, and ESI or a combination thereof, 2) delay implementation of some or all of the programs; or 3) exercise the option to suspend new enrollment or restrict enrollment to eligible lower income individuals. After receiving a recommendation from the commission, the emergency board will make a determination by August 30, 2007, on which of the three options to move forward with.

Section 110(f & g): These sections require the Office of Vermont Health Access (OVHA) to review the fee schedule for Vermont Medicaid provider types that rely on the procedure codes other than the evaluation and management codes. A report will be prepared that compares, where possible, the Medicaid fee to the Medicare fee and include the estimated cost to close the gap between the two. The report will be submitted to the House and Senate Appropriations Committees on or before June 30, 2008. It also requires OVHA to conduct an analysis of the impact of the federal final rule revising the federal upper limits for prescription payment from the third party for medical services for which the agency has made payment.

Section 111: This section includes the provider increases listed above for hospitals and physicians.

Section 112 (a): This section requires the Department of Aging and Independent Living to submit quarterly reports to the General Assembly or the Health Access Oversight Committee about the utilization of services and expenses under the Choices for Care waiver. The report will include a comparison of actual expenditures to estimated expenditures and projected expenditures for the remainder of the fiscal year.

Sections 115, 116, 117, 120 (a, b, c, d, e, f, g, i, j, k), and 122: These sections relate to the Vermont Department of Health (VDH):

Section 115: This section calls for the Secretary of the Agency of Human Services and the Commissioner of Budget and Finance to receive approval from the Joint Fiscal Committee on the plan to realign the Department of Health and include the changes with the passage of H. 137, the establishment of a Department of Mental Health. If the plan is approved, it authorizes the Commissioner of Budget and Finance to adjust the FY 08 budget between the two departments in a budget neutral fashion

Section 116: This section raises the salary for the Commissioner of Health to no more than $150,000.

Section 117: This section establishes the budget for the Blueprint for Health at $4.8 million of which $1.8 million is from the Catamount Fund. It also requires VDH to provide incentive grants and stipends to physician practices participating in the Blueprint pilot projects.

Section 120 (e): This section appropriates $160,000 for the development and implementation of the adverse event reporting system. Of this appropriation, $40,000 will be bill-backed to hospitals licensed in Vermont.

Section 120 (a, c, d, f, g): These sections relate to health professional loan repayment. It allows for the carry forward of any unspent portion of the funds. It appropriates $450,000 to the Area Health Education Center (AHEC) to support the infrastructure of the AHECs. It allocates $1.4 million of Global Commitment Funds to the Vermont Educational Loan Repayment Fund and is allocated as follows: $700,000 to primary care physicians and health care professionals, $175,000 for dentists, $400,000 for nurses, $75,000 for nurse educators, and $50,000 for disciplines based on emerging health care needs and workforce shortages. An additional $80,000 is allocated for the Vermont Student Assistance Corporation loan forgiveness program for health care providers through the dental hygienist and nursing incentive loan programs.

Section 120 (b, i): These sections relate to tobacco funding. $1.05 million in Global Commitment funds will be distributed as follows: $1,023,624 in community based programs, $1,007,799 in media and public education, and $1,400,211 in tobacco cessation programs. It includes language that if the master tobacco settlement exceeds $13 million in FYO8 then $500,000 will be appropriated to VDH to be spent on the recommendation of the tobacco control board.

Section 120 (j, k): These sections provide $440,000 in Global Commitment funds to the Coalition of Clinics for the Uninsured and dental services provided by the clinics. An additional $200,000 of Global Commitment funds will be used for federally qualified health center (FQHC) look-alike uncompensated care pool funds.

Section 122: This section creates a public inebriate program study committee to look at existing inebriate statutes, funding, program policies, resources and availability of services to individuals. Hospitals will be represented on committee.

Sections 124( a, c, d, e): These sections relate to the reestablishment of the Department of Mental Health and Commissioner of Mental Health.

Section 124 a: This section states that the commissioner is responsible for the implementation of a strategic plan for the delivery of services provided by the Vermont State Hospital (VSH) as part of a long range plan for comprehensive mental health services. The principles guiding implementation of the strategic plan include: an understanding of the role of active treatment within the goal of recovery; an understanding of the role of trauma in the lives of the individuals; accessibility to general medical care; minimal use of involuntary interventions such as seclusion, restraint, and involuntary interventions; staff training in the use of safe and appropriate alternatives to involuntary interventions; consumers’ participation in the development and implementation of their plans; consumers’ right to privacy and the right to have information regarding their care remain confidential, unless disclosure is authorized by the consumer or required under law; ongoing consumer and community input with regard to program oversight and development; and accountability for all components of the mental health care system.

Section 124 c & d: Section (c) repeals the creation of the VSH Futures Committee and section (d) creates the Advisory Council for Mental Health Services Transformation. The Advisory Council will be appointed by the Commissioner of Mental Health and the council will cease to exist as of July 1, 2009.

Section 124 e: This section amends last year’s Capitol Appropriation of $1 million for planning for a new state hospital. $100,000 of these funds is allocated to the General Assembly for bill S. 124. S. 124 allocates $100,000 to the General Assembly to do an independent evaluation of the options available to the state regarding the provision of inpatient psychiatric services now provided at the Vermont State Hospital. It also requires the Agency of Human Services to regularly report to the Mental Health Oversight Committee the expenditures made under this appropriation.

Section 148: This section relates to the Department of Aging and Independent Living (DAIL) budget. See update above related to nursing homes.

Status: This bill has not been sent to the Governor for his review.

Position: Support

Health Care Bills

H. 137/S.58 (Act 15) – An Act Relating to the Restoration of a Department of Mental Health and Commissioner of Mental Health

This law restores the Department of Mental Health based in VDH, with its own Commissioner reporting directly to the Secretary of the Agency of Human Services. It ensures the integration of physical health, mental health and substance abuse. The Commissioner of Mental Health must be a mental health care professional. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT015.HTM

Status: Signed by the Governor.

Position: Neutral

H. 148 – An Act Relating to the Child Abuse Registry

This bill proposes a number of measures related to child abuse reporting and the child abuse registry. Current law requires that any licensed, certified, or registered health care provider, resident physician, intern, or any hospital administrator in any hospital in the state, who has reasonable cause to believe that any child has been abused or neglected will report or cause a report to be made in accordance with current law within 24 hours. It states high risk offenders who leave prison after serving their maximum sentence, but without receiving treatment will be required to follow stricter registry requirements, including that they obtain treatment

Status: The bill has not been sent to the Governor for his review.

Position: Support

H. 229 – An Act Relating to Corrections and Clarifications to the Health Care Affordability Act of 2006 and Related Legislation

This bill is known as the Catamount Technical corrections bill and has a number of provisions. Payments for hospital services will be calculated using a hospital-specific-cost-to-charge ratio approved by the Commissioner and will be adjusted for each hospital to ensure payments are at 110 percent of the hospital’s actual cost for services. The Commissioner may use individual hospital budgets to determine approved ratios. The Commissioner may approve adjustments to the amounts paid in accordance with a carrier’s pay for performance or quality improvement program. It requires insurance carriers to pay health care professionals, such as physicians, using the Medicare fee schedule, at an amount ten percent greater than fee schedule amounts paid under the Medicare program in 2006. Payments will be indexed to the Medicare economic index developed annually by the Centers for Medicare and Medicaid Services.

Provisions related to the Vermont Information Technology Leaders (VITL) include: transfers oversight of VITL from the Commissioner of Banking, Insurance, Securities and Health Care Administration (BISHCA) to the Commissioner of the Department of Innovation and Information (DII); designates VITL to operate the exclusive statewide health information exchange network for the state when the health information technology (HIT) plan takes effect; establishes the framework for the HIT fund; and creates a $1 million voluntary fund with contributions from payers, VAHHS and others.

It includes language on the prohibition of health coverage status discrimination that no employer or employment agency will inquire about the health coverage status of a job applicant or discriminate among applicants on the basis of health coverage status. The employer may inform an applicant about the employer’s health coverage benefits. Employers may inquire about the health coverage status of an employee to enable the employer to determine the number of uncovered employees.

This section also allows an aggrieved applicant to bring action in the superior court of the county where the violation occurred. If the court finds the employer has violated this section, the court can order any of the following: payment of lost wages, benefits, and other remuneration; any appropriate injunctive relief; compensatory damages; punitive damages; attorney fees; or any other appropriate relief.

The bill includes language on the uniform provider credentialing form that would allow a hospital to request an extension from BISHCA for the full implementation of the Council for Affordable Quality Healthcare form for up to one year from the January 1, 2007 implementation date.

It provides for VDH to provide payments for any Vermont resident to receive immunizations without cost to the individual. State health programs will receive coverage under those programs.

The bill offers exemptions from the employer assessment for seasonal and part-time employees. To qualify for the exemption, an employer must offer health insurance to all full-time employees. Employers who offer coverage will not have to pay the $365 employer assessment on some seasonal and part time employees. Seasonal employees are those who work in a job for 20 weeks or less, and part time employees who work year-round but for less than 30 hours per week, will be exempt if those employees have health insurance through some other means. The Vermont Department of Labor has developed a form for employers to use in order to determine their employees’ insurance status. The exemptions are retroactive to April 1, 2007.

Status: Awaiting action by the Governor.

Position: Support

H. 294 – An Act Relating to Executive Branch Fees

The Executive Branch Fees bill addresses monetary charges by an agency for a service or product provided to, or the regulation of, specified classes of individuals or entities. Fees are created and set by the legislature and not by rule. The fees reviewed are done on a three year cycle. The following items related to health care are included in the fee 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. Payments will be spread over 11 months, with the first payment due in August instead of July. 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 licensing 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 Vermont practitioner recovery network that will monitor recovering chemically dependant licensees.

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 Vermont practitioner recovery network that will monitor recovering chemically dependant licensees.

o Limited temporary licenses – Current fee of $50 increased to $70

o Anesthesiologist Assistants certification fee – Current fee of $100 increased to $115

o Anesthesiologist Assistants biennial renewal fee – Current fee of $100 increased to $115

o Physician Assistants certification fee – Current fee of $100 increased to $115

o Physician Assistants biennial renewal fee – Current fee of $100 increased to $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 increase in fees will help support the Board of Medical Practice with their statutory requirements.

Status: The bill has not been sent to the Governor for his review.

Position: Neutral

H. 368 (Act 29) – An Act Relating to the Regulation of Professions and Occupations (OPR)

Every year an OPR bill is introduced that addresses the regulation of licensed professions. Language in the bill changes the name of the Board of Nursing Home Administrators from a “board” to an “advisor” profession. Statute requires boards to be self-sustaining and because of the limited number of nursing home administrators the board was running with a budget deficit of $87,000. By moving to an advisor profession, nursing home administrators will become part of approximately 5,000 other professionals whose license fees are pooled. The current license fee of $400 will remain until the Board is eliminated (probably two renewal cycles) at which time the license fee will be reduced to an estimated $200. Requirements will remain the same, as will sanctions and penalties.

Changes to the Board of Nursing include: granting authority to the Board of Nursing to adopt rules and removal of renewal language that was repealed. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT029.HTM

Status: Signed by the Governor.

Position: Support

H. 372 (Act 14) – An Act Relating to the Rendering of Nursing and Medical Services by Professional Corporations

The law authorizes nurses and physicians to render services as a professional corporation. It changes the licensing laws for nurses and physicians to allow them own shares together in a professional corporation to provide medical and nursing services. Before H. 372 passed, nurses could only own shares in professional nursing corporations with other nurses and physicians could only own shares in physician professional corporations with other physicians.

http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT014.HTM

Status: Signed by the Governor.

Position: Neutral

H. 380 (Act 27) – An Act Relating to the Regulation of Health Care Facilities

This law amends the Certificate of Need (CON) regulations. It amends the requirements for the posting of nurse staffing on hospital inpatient units so that staffing would be reported in the same way that hospitals are required to report staffing measures in their annual reports to BISHCA. It amends the community needs assessment requirement that was adopted as part of Act 53 in 2003 and removes some of the more detailed requirements as to how public input is obtained, while retaining the general requirement that all hospitals have meaningful public participation in their strategic planning processes. It amends the law creating a periodic Health Resource Allocation Plan (HRAP) to every four years or as needed. It removes the gap jurisdiction for certain types of health care projects that were created in Act 53. It raises the jurisdictional threshold for “conceptual CONs” from $20 million to $30 million, and clarifies that the Commissioner of BISHCA has the authority to determine by rule what kind of planning expenditures are covered by this requirement. It allows an applicant to spend up to the jurisdictional thresholds ($3 million for hospitals, and $1.5 million for other types of facilities) in preparation of a conceptual CON. It allows the Commissioner of BISHCA to expedite review of CON applications under certain circumstances, as well as to clarify the timelines for such reviews. It allows applicants to request expedited review and would allow, but not require, the Commissioner to agree to such a request if he or she determines, after public notice that there will be no competing CON applications and no interested parties opposing the proposal. It clarifies that applicants have an obligation to file “adequate” letters of intent, allows applicants to file amended letters of intent, and allows the Commissioner to extend the time limits within which a CON application can be filed if an applicant so requests. It includes a state immunity provision that gives BISHCA the authority to have conversations with hospitals about market share issues. It includes a provision that would give the Attorney General’s office, in consultation with the Commissioner of Health, the authority to investigate complaints or alleged irregularities by service providers of mobile diagnostic and screening services by companies that advertise to consumers without being referred by their health care professional. It includes expedited review of health information technology (HIT) CONs. HIT expedited review became effective upon passage. The remainder of the law is effective on July 1. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT027.HTM

Status: Status: Signed by the Governor

Position: Support

H. 433/S. 122 - An Act Relating to the Next Generation Initiative of Workforce Development Through Workforce Development Programs and Internships
A total of $12 million was appropriated for this bill. The bill directs the Commissioner of Labor to be responsible for the integration of the state’s economic development, workforce development and education delivery systems. It focuses on supporting workforce development and training; encourages internships with employers using existing grant programs and establishes new grant programs administered jointly by the Department of Labor and Economic Development with assistance from the Workforce Development Council. The allocation of funds is as follows:

Workforce Development- $5.4 million:

o $2.2 million to the Workforce Education and Training Fund (WETF) administered by the Department of Labor in consultation with the Workforce Development Council, Workforce Investment Boards and Department of Economic Development Commissioner for innovative training programs and student internships.

o $1.2 million to the Agency of Commerce and Community Development for the Vermont Training Program (VTP) which is connected to the creation of new jobs.

o $900,000 to the Department of Labor for Career and Alternative Workforce Education with the targeted population being out-of-school youth and youth at risk. Forty-five percent of this money is for grades 7-12 for career exploration and fifty-five percent is for grants to secondary schools and non-profit organizations for alternative and intensive vocational/academic programs to earn credits toward graduation.

o $900,000 for the Department of Labor for adult technical education to unemployed and underemployed Vermont adults.

o $200,000 is appropriated to the University of Vermont for patent development and commercialization of technology.

Loan Repayment- $500,000:

o This amount is appropriated to the Agency of Human Services for loan repayment for health care-related education or training owed by persons living and working in Vermont in this field. There is also an additional amount of $1.4 million in the General Fund for loan repayment (section 120 of 08’ budget)

Scholarships and Grants - $6.1 million:

o $1 million to Vermont Student Assistance Corporation (VSAC) for its non-degree grant program, which may include living stipends, not to exceed $3,000.

o $4.7 million for scholarships to be equally distributed to the VSAC, the University of Vermont and the Vermont State Colleges.

o The sum of $400,000 is appropriated to the Vermont State Colleges for scholarships enabling dual enrollment by high school students in college.

The legislation also appoints a committee to identify sources of long-term sustainable funding to support ongoing workforce development efforts.

Status: Awaiting action by the Governor.

Position: Support

H. 531: An Act Relating to Ensuring Success in Health Care Reform
This bill expands on the health care reform legislation passed last year. 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 benefit 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.

It addresses Catamount Health reimbursement for mid-level providers, such as mental health counselors, optometrists and physical therapists. It modifies the Catamount Health reimbursement requirements for health care professionals to allow carriers to pay them the lesser of Medicare +10%, billed charges, or contracted rates. Carriers that have a negotiated contract in place with individual health care professionals (or group practices) will not be required to raise those rates, if the negotiated amount is less than Medicare +10%.

Related to the Blueprint it creates a high level exempt position in the Agency of Administration; 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 VDH to facilitate participation in the Blueprint; it establishes a project for integrated early implementation of the Blueprint programs by VDH, 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 the 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; it appropriates $75,831.00 in general funds plus federal matching funds ($185,000.00 total) to VDH for use by the Vermont Rural Health Alliance for early integration of the Blueprint projects, upon receipt of matching funds by the Alliance.

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; health care provider bargaining groups language that 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; 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.

Status: The bill has not been sent to the Governor for his review.

Position: Support

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

This bill increases the amount of marijuana and the number of marijuana plants that a patient in the program may possess and broadens the range of medical conditions which may qualify a patient for the program. Participants will be allowed to possess two mature plants and seven immature plants. 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.

Status: Awaiting action by the Governor.

Position: Neutral

S. 115 – An Act Relating to Increasing Transparency of Prescription Drug Pricing and Information
This bill increases the transparency of prescription drug pricing and information and was one of the most contentious bills debated in the State House this year. Provisions of the bill include: the Office of Vermont Health Access (OVHA) best practices and cost control programs; prohibits the use of prescriber-identifiable data unless a health care provider explicitly agrees to such use; pharmaceutical marketer disclosures; price disclosure and certification; pharmacy benefit manager regulations; prescription drug cost containment; and consumer fraud provisions. If enacted, VDH will set up an evidence-based drug education program for health professionals and will provide vouchers for samples of generic drugs as funding allows.

Status: The bill has not been sent to the Governor for his review.

Position: Neutral

S. 124 (Act 9) – An Act Relating to Planning and Evaluating Options for Inpatient Psychiatric Hospital Services

This legislation allows legislative leaders to spend $100,000 to hire a consultant to do an independent evaluation of the options available to the state regarding the provision of inpatient psychiatric services now provided at the Vermont State Hospital. Reports and recommendations from the independent consultant are due in November. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT009.HTM

Status: The legislation became law without the Governor’s signature.

Position: Neutral

S. 128 (Act 22) - An Act Relating to Eliminating Certain Sunsets on Forensic Examinations at Designated Hospitals.

This law eliminates the sunset on allowing court-ordered forensic examinations of criminal defendants at designated hospitals. Lawmakers reviewed a report from the Forensic Mental Health Summer Work Group 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. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT022.HTM

Status: Signed by the Governor

Position: Neutral

S. 192 – An Act Relating to HIV Name-Based Reporting

This bill requires health care providers to report HIV cases to VDH using the patient’s name, rather than use of a unique identifier code. This is necessary in order for VDH to continue to receive Federal funding. VDH will develop procedures to ensure the confidentiality of the information.

Status: Awaiting action by the Governor.

Position: Support

Bills of interest still in play for next year:

H. 43 – An Act Relating to Assaulting a Health Care Provider or Employee of a Health Care Facility. A Senate-version of the bill will be introduced and the Senate Judiciary is committed to taking this bill up on the first day of the session.

H. 112 – An Act Relating to Protection of Health Care and Public Safety Personnel from Communicable Diseases. The Human Services Committee took testimony on this bill. This is a very controversial bill and it is unclear what the committee plans to do.

H. 198/S. 114 – An Act Relating to Enhancing Mental Health Parity

H. 201 – An Act Relating to Admission to Designated Mental Health Hospitals

H. 202 – An Act Relating to Admission Procedures for Involuntary Hospitalization for Mental Health Treatment.

H. 207 – An Act Relating to the Discharge of Voluntarily Admitted Psychiatric Patients

H. 221/H.227/S. 24 – An Act Relating to Procedures Involving Medical Malpractice Actions/An Act Relating to Screening Panels for Medical Injury Claims

H. 304 – An Act Relating to the Vermont Hospital Security Plan (hospital global budgets).

H. 421/S. 141 – An Act Relating to Safe Patient Handling

S. 166 – An Act Relating to Prohibiting Mandatory Overtime