2004 Legislative Report

For the week ending February 4, 2005

Political Overview

The decertification of the Vermont State Hospital took center stage in this week’s legislative activities. On Tuesday, state officials announced that the Vermont State Hospital (VSH) would once again be decertified by the Center for Medicare and Medicaid Services (CMS) because of patient supervisory concerns.

Governor Jim Douglas issued a harsh press release condemning the lapses in supervision and the failure to deliver its core mission, patient safety. According to Governor Douglas, CMS officials stated that the hospital failed to create a “culture of safety.” The Governor declared the hospital’s problems so severe that immediate steps be taken to close the hospital.

In addition to ordering Secretary Charlie Smith to accelerate the process of closure, the Governor also ordered the Secretary to carry out a plan of immediate corrective action, including a safety plan for each patient. The decertification of the state-run hospital creates an additional $1.4 million hole in this year’s budget and a $1.7 million hole in next year’s budget, adding to the State’s budget woes.

Secretary Smith still plans to release his report on the future of the Vermont State Hospital on Friday, February 4. The Secretary will likely propose replacing the State Hospital with a new 28-bed facility at an academic medical center and a number of short term programs run by community hospitals. Smith recommended that “…the state hospital, rather than being a state function, would become a function of a general hospital.” The new system proposed by Secretary Smith will annually cost approximately $22 million to operate.

The entire House spent Thursday afternoon and Friday on the House floor debating the Budget Adjustment Act. We do not expect any changes to the Office of Vermont Health Access budget adjustment numbers. The total adjustment before the debate began was $19,073,680. Also included in the Budget Adjustment is funding for the Vermont State Hospital of approximately $2.5 million. Discussion is taking place between the House and Senate on how the Senate will “fix” this particular adjustment.

Medicaid – The Douglas Administration held the first of what we expect to be weekly meetings to discuss the Medicaid deficit. The planned two-hour meeting ended after an hour in what most would describe as an “icy” atmosphere. Secretary of Administration, Mike Smith reiterated the Administration’s intention to prevent any cost-shifting of the proposed $21 million in planned provider reductions, while AHS Secretary Charlie Smith expressed optimism about working through the budget collaboratively. VAHHS, VMS and other providers expressed their grave concerns about any positive outcomes considering the magnitude of the proposed provider reductions in addition to the $29 million in proposed “program restraints and modifications.” Providers will also begin meeting weekly with House and Senate appropriations members as a group. Stay tuned!

VAHHS Issues

Mental Health:

Richard Palmisano, President and CEO of Retreat Healthcare, testified in a number of committees on the Retreat’s desire and willingness to treat patients currently served by the Vermont State Hospital. Palmisano described the Retreat’s capacities and stated they could immediately admit some of the patients currently cared for at VSH. The Department of Mental Health has reached out to all designated hospitals to gauge their ability to care for certain VSH patients. Given this week’s decertification, we expect operational and patient care decisions to materialize significantly over the next few weeks. VAHHS and member hospitals have expressed their willingness to help VSH and DMH during this crisis and expect many discussions to continue with the Secretary Charlie Smith and Health Commissioner Paul Jarris.

House Human Services
The House Human Services committee continued to take testimony on H. 58, Loan Forgiveness for Nursing Faculty. Carolyn Kehler from VSAC and Dr. Mimi Reardon from AHEC testified in support of the bill. Dr. Reardon did state that the appropriation of $200,000 could be reduced to $50,000, allowing $10,000 for each school of nursing. There was mixed reaction from committee members on this recommendation. The committee is expected to move on this bill shortly.

House Health Care
The House Health Care continued its work on the importation bill and passed the bill out of committee on an 11-0-0 vote. It is expected that the bill will be debated on the House floor early next week. Bea Grause testified on Thursday about general hospital and reform issues. The Committee plans to call in hospital CEOs to provide their perspective on hospital operations and reform strategies.

House Judiciary
House Judiciary took testimony on H. 163, - An Act Relating to Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults. Assistant Attorney General Linda Purdy testified before the committee and stated that the purpose of the bill is twofold -- (1) to move penalties for abuse of vulnerable adults from Title 33 to Title 13, which is the title more commonly used by law enforcement, and (2) to create a felony level of crime. Current law allow only for misdemeanors. In previous years, this bill to protect vulnerable adults from abuse including a definition of restraint was inconsistent with Title 33. H 163 has been re-drafted to be consistent with Title 33. In her testimony, Linda Purdy also suggested adding some language to the restraint section to make clear that leaving a patient in a position from which they cannot easily move (such as on a toilet with no assistance) constitutes restraint. VAHHS, the Health Care Association and Assembly of Home Health Agencies support the bill.

Senate Health & Welfare
The Senate Health & Welfare took department overview testimonies from Paulette Thabault, Deputy Commissioner of BISHCA, Commissioner Steve Gold of Corrections, and Commissioner Patrick Flood of Aging & Independent Living. Commissioner Flood stated that his department would be taking a huge hit on the Medicaid reductions.

This committee also heard from Richard Palmisano on the Retreat’s eagerness to assist the state with the VSH crisis. The committee also heard from Paul Harrington of the Vermont Medical Society on past universal access plans. For those of you who don’t remember, back in the early 90’s Paul was a board member of the Vermont Health Care Authority.

End of Life Care:
Also this week, Attorney General Bill Sorrel issued his report on end-of-life care. Sorrel convened two committees in 2003 to discuss and brainstorm on issues related to end-of-life care. One committee looked at advance directives and a registry accessible to doctors and hospitals. A bill was introduced last week on Advance Directives. The House Human Services committee plans to take testimony on this bill Wednesday and Thursday next week. (http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/intro/H-115.HTM H. 115) The other committee convened focused on pain management and recommendations on training on pain management for health care professionals.

Bills of interest introduced this week:

H. 139 - AN ACT RELATING TO LOWERING THE MINIMUM DRINKING AGE: This bill proposes to lower the minimum age for purchasing and consuming alcoholic beverages from 21 to 18.

H. 142 - AN ACT RELATING TO INFORMED CONSENT TO TEST FOR COMMUNICABLE DISEASE: This bill proposes to require informed consent in order to test for communicable and infectious diseases except in the case where a health care worker has been significantly exposed to the bodily fluids of a patient suspected of possible disease infection.

H. 143 - AN ACT RELATING TO FISCAL YEAR 2005 BUDGET ADJUSTMENTS: This bill proposes to make adjustments in the fiscal year 2005 omnibus appropriations act.

H. 150 - AN ACT RELATING TO INSURANCE FRAUD: This bill establishes the offense of insurance fraud and prescribes penalties and establishes requirements for insurers to file anti-fraud plans with the commissioner of banking, insurance, securities, and health care administration and to include fraud statements on certain documents.

H. 160 - AN ACT RELATING TO FULL REIMBURSEMENT FOR PHARMACISTS: This bill proposes to allow pharmacists to be reimbursed for services provided to state pharmacy program beneficiaries.

H. 163 - AN ACT RELATING TO CRIMINAL ABUSE, NEGLECT, AND EXPLOITATION OF VULNERABLE ADULTS: This bill proposes to revise and expand existing criminal law regarding abuse, neglect, and exploitation of vulnerable adults.

H. 165 - AN ACT RELATING TO THE STUDY OF HEALTH CARE ADMINISTRATIVE COSTS: This bill proposes to authorize a study of administrative costs in both the public and private sectors of Vermont’s health care system.

H. 168 - AN ACT RELATING TO DEATH WITH DIGNITY: This bill proposes to allow a mentally competent patient who is expected to die within six months to end his or her life in a humane and dignified manner by prescription medication.

H. 174 - AN ACT RELATING TO INCLUSION OF MEDICAID REIMBURSEMENTS AND EXPENDITURES IN ANNUAL SCHOOL DISTRICT BUDGETS: This bill proposes to require school districts to show revenues from Medicaid reimbursements and a proposal for expenditure of those reimbursements in their annual budgets.

H. 176 - AN ACT RELATING TO USE OF EDUCATION MEDICAID RECEIPTS: This bill proposes to have Medicaid reimbursements paid to schools instead of supervisory unions and remove provisions in law regarding use of the reimbursed funds.

There were no Senate bills introduced this week affecting health care.

Other items of importance

There will be a joint hearing of the Mental Health Oversight Committee, House Human Services and Senate Health & Welfare on Tuesday, February 8, 2005 at 3 p.m. in Room 11.

Joint Public Hearing on Fiscal Year 2006 Budget on Vermont Interactive Television - Appropriations Committees: Monday, February 14, 2005, 5:00 to 7:00 p.m. - The House and Senate Appropriations Committees will hold a joint public hearing on Vermont Interactive Television (V.I.T.) to give Vermonters throughout the state an opportunity to express their views about the State’s budget for fiscal year 2006. All VIT sites will be available for the hearing: Bennington, Brattleboro, Canaan, Castleton, Colchester, Johnson, Lyndonville, Middlebury, Newport, Randolph Center, Rutland, Springfield, St. Albans, Waterbury and White River Junction. VIT’s web site has an up-to-date location listing, including driving directions and telephone numbers: www:vitlink.org

For further information about the format of this event, call the House Appropriations Committee office at 802/828-2251. Requests for interpreters should be made to the office no later than 4:00 p.m. on Friday, February 4.

Joshua Slen, Commissioner of the Office of Vermont Health Access, is currently scheduled in front of House Appropriations for the entire day on Friday, February 18, 2005, to discuss the FY 2006 Medicaid budget.

Introduction of Senate Bills: Drafting requests for introduction of bills must be in by Wednesday, February 16, 2005.