2004 Legislative Report

For the week ending January 23, 2004

Political Overview

This week Governor Douglas presented his FY05 Budget Address to a joint assembly of the House and Senate. The budget proposes $1.5 billion in general fund spending. Health care and the environment were two areas that received the most attention. With respect to health care, the Governor's "Prescription for a Healthy Vermont" plan proposes four main areas:

Revisions to the health insurance market for small employers, including a reinsurance plan for small businesses and individuals that would provide premium relief (up to 10 percent) paid for by extending the existing premium tax on health insurance policies to all private health insurance companies in Vermont and a proposal to give refundable tax credits to small employers as an incentive to offer health insurance to their employees.

"Empowering the patient" by requiring price and quality information for a broad range of health care services and products be readily available to consumers via the Internet.

Increasing access to low-cost prescription drugs by continuing to pursue the multi-state prescription drug purchasing pool Vermont has with Michigan, purchasing drugs in Canada, drug price disclosure on the Internet and some regulation of pharmacy benefit managers (PBMs)

Encouraging healthy lifestyle choices by allowing health insurance companies to offer "healthy lifestyle discounts" and supporting a Fit and Healthy Kids program

The full text of the Governor's "Prescription for a Healthy Vermont" plan can be found at:

http://www.vermont.gov/governor/priorities/priorities.html

VAHHS Issues

Dialysis

Act 40 of last year directed the Department of Aging and Disabilities to conduct a statewide needs assessment of dialysis treatment, and make recommendations to address identified gaps in renal dialysis service. The report, delivered on January 15 to the General Assembly, identifies Orleans County as the most seriously underserved area of the state, based on a comparison of driving distances for dialysis patients. The report recommends a collaborative process among Fletcher Allen Health Care (FAHC), Dartmouth Hitchcock Medical Center (DHMC) and the community hospitals serving the area to address this need.

On Wednesday, January 21, the House Health and Welfare Committee heard from representatives of FAHC, DHMC, North Country Hospital in Newport and Northeastern Vermont Regional Hospital in St. Johnsbury about the status of their work to bring a dialysis center to the Northeast Kingdom. The testimony made two things clear: 1) This is a complex medical and social problem with no easy answers, and 2) the hospitals involved are working collaboratively to solve the problem in a timely and efficient way. As usual, money is a serious issue. Chairman Koch appointed another task force headed by BISHCA to take another look at this issue and report back to the House Health and Welfare by the end of March.

Respiratory Therapists

This week Rep. Harry Chen, D-Mendon, as lead sponsor, introduced H.609, a bill to license respiratory therapists. The bill is pending in the House Government Operations Committee, which will take the bill up on Wednesday, January, 28, 2004. VAHHS is one of the main proponents of the bill and we will be participating at the hearing. Here is a link to the text of the bill as introduced.

http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2004/bills/intro/H-609.HTM

Long Term Care

This week the House Health and Welfare Committee continued to take testimony on long term care. A number of long term care insurance carriers testified about the draft bill submitted by

Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) Commissioner John Crowley. Overall the carriers supported the draft bill because it brings Vermont law in line with the National Association of Insurance Commissioners (NAIC) model law on long term care insurance. The insurance carriers did ask for a few technical revisions, such as the scope of the commissioner's ability to apply Vermont's law to contracts entered into out of state (extraterritorial jurisdiction), among other things.

A new draft of a separate long term care bill the committee is working on was distributed late in the week. In addition to the provisions regarding the long term care 1115 waiver application mentioned last week, the bill now contains provisions to update Vermont's law with regard to advanced directives (living wills and durable powers of attorney) and a proposed new advisory commission on palliative care and pain management. VAHHS has concerns about one provision in the bill that requires that all patient assessments be done before a patient can be discharged from a hospital. A hospital discharge planner will testify before the committee on Wednesday, 1/28, regarding this issue.

S.279, Methadone

Substance abuse treatment continues to be an issue in the Senate Health and Welfare Committee. The direction by the Senate Health and Welfare Committee and the Douglas Administration is to liberalize where and when methadone can be offered. For example, the committee is considering take-home methadone and offering methadone at facilities other than hospitals, including mobile units.

S.247, BISHCA Housekeeping Bill

The Senate gave preliminary approval to S.247, a bill that contains miscellaneous housekeeping provisions related to BISCHA. One amendment of interest to hospitals is a change to last year's hospital regulation bill (Act 53) whereby the various CON thresholds for both hospital and non-hospital projects involving the purchase or lease of a single piece of "durable medical equipment" will be changed to the purchase or lease to a single piece of "diagnostic and therapeutic equipment." This is clarify the intent of Act 53 to ensure that these thresholds apply to diagnostic equipment such as MRIs and not just pieces of durable medical equipment such as wheelchairs. The bill states that this provision will apply retroactively to all health care projects on or after July 1, 2003. The bill will be up for final action in the Senate on Tuesday, Jan. 27.

Forum on the Economic Impact of Health Care Costs on Vermont Employers

On January 28, 2004, the Senate Health and Welfare Committee is sponsoring a forum on the economic impact of health care costs on Vermont businesses, from 3 to 6 pm in Room 11 at the State House.