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For the week ending April 9, 2004
The big political news at the State House this week was the announcement by House Speaker Walter Freed, R-Dorset, that he would not seek re-election to his House seat and thereby give up the Speaker's post. Representative Richard Westman, R-Cambridge, quickly threw his name into the ring as the Republican candidate for Speaker when the General Assembly returns in January 2005. Rep. Westman is a moderate Republican who presumably could vie for some Democratic votes for Speaker and some say has earned the chance to run by chairing the powerful House Appropriations Committee for the past four years. Notwithstanding the advanced transition planning by the Republicans, this early announcement by Speaker Freed gives the House Democrats a psychological edge in recruiting for candidates for the fall elections. Both parties have been aggressively recruiting candidates and raising political contributions to gain control of the House and the Speakership next January. House Minority Leader Rep. Gaye Symington, D-Jericho, a key recruiter and Democratic strategist, is a possible Democratic candidate for Speaker but no formal announcement has been made yet. It is clear that whoever is in control of the General Assembly next session is going to face significant budget deficits in areas such as Medicaid, corrections and mental health, to name just a few.
H.759, Health Insurance Market Reform
This week the House Appropriations Committee started taking testimony on H.759, the Governor's health care "bucket bill." The committee focused primarily on the tax credit for small employers offering health savings accounts and paying a portion of the savings account deposits and deductibles. The tax credits are limited to $4 million starting in FY06. The House Commerce Committee will also review the bill and scheduled legislative counsel staff to walk them through the bill on Thursday, April 15th. It is unclear at this time if the House Commerce Committee will formally ask for the bill before the bill goes to the full House for a vote.
Respiratory Therapists (H.609)
This week the House Appropriations Committee advanced by a 9-0-2 vote H.609, a bill that proposes to license respiratory therapists. The committee reviewed the appropriations in the bill but made no changes to the bill. VAHHS supports this bill. The bill will be up for action on the House floor on Tuesday, April 13, 2004. Here is a link to the House Calendar for Tuesday, April 13, 2004, with the text of the bill as it was approved by the House Government Operations Committee, the House Ways and Means Committee and the House Appropriations Committee.
Capital Construction Bill (H.767)
This week the Capital Construction Bill, a bill that funds capital projects for state government, emerged from the Senate Institutions Committee. The bill contains a number of provisions of interest to hospitals and nursing homes. The Senate version of the bill includes a $485,000 appropriation to the Vermont Economic Development Authority (VEDA) for the North Country Hospital in Newport to assist with the creation of a nine-station hemodialysis center within the hospital (See Sec. 3). The appropriation requires the North Country Hospital to repay the funds to the state, without interest, in 20 equal annual payments commencing July 1, 2005. The bill also prohibits any portion of this appropriation to be disbursed until evidence is provided to VEDA that federal, community, or other non-state funds are available for this project in the amount of $840,000.
The bill also earmarks to the Vermont State Hospital a total of $625,000 ($25,000 for planning, $500,000 to create two specialized acute stabilization units and $100,000 to soundproof four existing seclusion rooms). Also $150,000 is appropriated for the Department of Corrections to make modifications to existing space to be used as a secure mental health and medical unit for women incarcerated in the Dale II facility (See Sec. 3). Finally, the bill includes language related to the history and corporate status of the Vermont Veteran's Home. (See. Secs. 76-79). The Senate Appropriations Committee will review the bill before it reaches the Senate floor for a vote. Here is a link to the bill as it was advanced by the Senate Institutions Committee.
Workers' Compensation (H.632)
The Senate Economic Development, Housing and General Affairs Committee voted unanimously to advance H.632, the Governor's bill to reduce the cost of workers' compensation insurance rates. The committee made significant changes to the section of the bill related to the implementation of a medical fee schedule for medical, hospital, pharmaceutical and durable medical equipment. The bill now requires the Commissioner of the Department of Labor and Industry, with assistance from the Commissioner of Banking, Insurance, Securities and Health Care Administration (BISHCA), to develop and implement mechanisms to control medical costs while assuring injured workers' access to medically necessary care by February 1, 2005. The bill now authorizes, but does not require, that the reimbursement for medical and hospital services (both inpatient and outpatient) and durable medical equipment be based on Medicare reimbursement methodologies for each area, but each area may have different base reimbursement rates. The rates may also be set as ratios to the base reimbursement rates. Currently, hospitals are reimbursed at 90 percent of the charge for the service. The two Departments must also investigate ways to lower prescription drug costs (See Secs. 14 &15). Here is a link to the Senate Calendar for April 8, 2004, with the text of H.632 as approved by the Senate Economic Development, Housing and General Affairs Committee.
Mental Health
The House Heath and Welfare Committee continued to take testimony from numerous interested parties this week regarding Vermont's mental health system. Susan Besio, Commissioner for the Department of Developmental and Mental Health Services, and Charles Smith, Secretary for the Agency of Human Services, testified Thursday on a draft bill that would enhance Vermont's mental health system. Commissioner Besio commented on a few key issues including: the proposal to establish a statewide advisory group to advise the secretary on all aspects of strategic planning, concern that the bill focuses on the entire mental health system and not the immediate issues surrounding the Vermont State Hospital (VSH) and the Legislative Oversight Committee. Regarding the advisory group, the Commissioner recommended that the current VSH Advisory Committee serve as the statewide advisory group.
Fee Bill - Hospital & Nursing Home Provider Tax/Hospital Licensing Fees (H.772)
The Senate Finance Committee took additional testimony on H.772, the fee bill. This week Department of Prevention, Assistance, Transition and Health Access (PATH) Commissioner John Michael Hall testified about the hospital and nursing home provider taxes. Hall proposed that the hospital provider tax be increased from 4.50 to 4.54 percent of net patient revenue (less chronic, skilled and swing bed revenues) starting July 1, 2004. There are two components of the 4.54 percent tax: (1) 3.59 percent is for the FY05 disproportionate share hospital (DSH) related assessment; and (2) .95 percent is the assessment related to the FY04 Medicaid reimbursement rates (reduced from 1.25 percent in the House-passed version of the bill). The proposed increase in the nursing home bed tax from $3,388.25 to $3,676.06 per bed starting July 1, 2004, in the House-passed version of the bill remained unchanged. Here is a link to the bill as it passed the House.
Civil Monetary Penalties (H.566)
H.566, a bill that proposes to impose civil monetary penalties for provider fraud, passed the Senate this week. The Senate-passed version of the bill covers provider fraud only when it is done with "actual knowledge." The House-passed version contains a section making "reckless disregard" (or unintentional acts) actionable. This is the key difference between the House and Senate-passed versions of the bill. The House rejected the Senate's amendment and asked for a conference committee. The House appointed Rep. Michael Kainen, R-Hartford, Rep. Richard Marek, D-Newfane, and Rep. Bill Lippert, D-Hinesburg, to serve on a conference committee. The Senate has yet to appoint its conferees.
Whistleblower (S.154)
Early this week all members of the House received a bottle of Vermont Pure water left on their committee room desks with a white piece of paper pasted on the front that read "Patient Safety It's In Your Hands Now Support S.154 Whistleblower Protection." The name of the person or group responsible for distributing the bottles did not appear on the label. The House Judiciary Committee is scheduled to take up S.154, the bill that provides whistleblower protections for hospital employees, on Thursday, April 15th, and Friday, April 16th. Here is a link to the text of the bill as it passed the Senate.
Pain Management/Advance Directives (H.752)
The Senate Rules Committee voted to be relieved of H.752, a bill related to pain management and advance directives this week. The bill was then referred to the Senate Health and Welfare Committee. Here is a link to the text of the bill as it passed the House.
Medical Marijuana (S.76)
Last week the House Health and Welfare Committee voted to take up S.76, a bill to legalize medical marijuana. The committee scheduled two days of hearings on the bill, April 14 and 15. Here is a link to the bill as it passed the Senate last year.
BISHCA Housekeeping Bill (S.247)
This week the House passed S.247, a bill that contains miscellaneous housekeeping provisions related to BISCHA. The House made one small amendment so the bill will have to go back over to the Senate. It is unclear at this time if the Senate will accept the House's revision or will ask for a conference committee on the bill. One provision 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 to 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. Here is a link to the text of the bill as passed by the House
Nursing Home Bed CON Exemption (H.768)
A provision exempting 10 nursing home beds from the Certificate of Need law under limited circumstances was in the Department of Aging and Disabilities section of the House-passed version of H.768, the FY05 budget bill. According to legislative staff, this provision is aimed at Copley Manor in Morrisville. Copley Manor is not associated with Copley Hospital. A similar provision was included in the budget bill in 2002 (for FY03). The Senate Appropriations Committee is looking carefully at this language. The language reads:
The conversion of 10 lower-level beds to nursing home level of care shall be deemed approved, notwithstanding the provisions of subchapter 5 of chapter 221 of Title 18, provided the nursing home was initially certified after January 1, 2001 and is not located in a hospital, and that the potential annual cost to the state, calculated by assuming that all converted beds will be funded by Medicaid, shall not exceed $250,000.00.