VAHHS Legislative Report

For the week ending April 8, 2005

Political Overview

The House Republicans once again called a news conference to the dismay of House Democrats. The news conference was an attempt to hold the Democrats’ feet to fire as it relates to protecting the public from known sex offenders and criminals. The problem is that the Administration’s bill is still being drafted. The “draft” bill would create civil commitments for violent individuals and sex offenders who their maximum sentence without treatment. Other states that have civil commitment laws have focused on sex offenders, but Vermont would be the first state to extend the provision to violent offenders. The House Judiciary Committee will have jurisdiction over the bill. Another wrinkle and source of frustration is the fact that a recent special sex–offender study established by the legislature recommended against civil commitments. Additionally, with the impending closure of the Vermont State Hospital, where will these individuals be placed?

After weeks of heated debate in committee discussions, the full Senate passed a bill that would make seed manufacturers liable for damages when genetically modified seeds drift into other crops. The heart of the controversy concerned farmers who do not choose to use genetically altered seeds. The goal of advocates was to protect those farmers from liability if such modified seeds ended up on the farmers' property. For the legislature, the issue of greatest concern involved the concept of "strict liability," which means seed manufacturers would be responsible for damages their products caused even if the manufacturer was found not to be at fault and even if the user did not follow the manufacturer's instructions on the label. Although the bill passed the Senate 26-1, many senators still have concerns with the bill. The bill now moves to the House where the battle will continue.

VAHHS Issues

Medicaid:
Earlier this week the Administration called a press briefing to announce the preliminary nod of approval from the federal government on the Global Commitment. The revised plan outlined Monday shows savings of $180 million, not the $300 million in the original Global Commitment proposal that was rejected in part by the federal government. As in the original Douglas FY 2006 budget proposal, providers are still being asked to cut a total of $31 million over the course of the budget year. On Thursday, the Medicaid Advisory Committee formally came out in opposition of the global commitment stating that the plan has too many unknowns and is being crafted under an "unrealistic" time frame. A motion was made at the end of the Advisory Committee to gain information on how large the deficit would be if the Health Access Trust Fund was funded at General Fund growth rates.

As drafted, if agreement is reached the federal government would agree to a cap on Medicaid spending every year for the next five years, and allow the state to manage all of the Medicaid spending through a Managed Care Organization. The Office of Vermont Health Access would assume that responsibility.

If the state exceeds the caps, the state would have to kick in 100 percent of all additional spending or find ways to cut benefits. Vermont would have the flexibility to decide which route to take. The other caveat to the cap issue is the drop in federal match rate that is expected to hit Vermont next year. It is expected that the rate will drop to about 56 percent, resulting in a $17 million loss for next year. The Agency of Human Services Secretary Mike Smith would like to put together a group of experts to study how best to persuade the federal government to change its mind in dropping the reimbursement rate. A laudable, but unrealistic goal.

The joint House/Senate Medicaid working group did not meet this week. The House Appropriations Committee starting looking at the Medicaid budget and asked providers to come in to educate the committee on what these cuts will mean. Thomas Huebner, CEO of Rutland Regional Medical Center and Michael Del Trecco, Vice President of Finance at VAHHS, testified on the Medicaid cuts. Mr. Huebner stated that if these cuts went through as proposed, the hospital would have to determine what programmatic cuts the hospital would need to implement in order to maintain a viable margin. Mr. Del Trecco provided information what the aggregate impacts to the hospitals will be if the cuts when through as proposed by the Administration. Additional discussion items included: implications surrounding cost shift, hospital reform efforts and “do no harm.”

Health Care Reform
Representatives from VAHHS testified in a number of committees this week. Daria Mason, President and CEO of Central Vermont Medical Center, testified in Senate Health & Welfare on Tuesday. Ms. Mason educated the committee about CVMC, CVMC’s physician practice organization and CVMC’s nursing home. The Committee seemed focused on billing and administrative simplification issues. Richard Slusky, Administrator at Mt. Ascutney Hospital and Health Center, testified in Senate Committees of Health & Welfare and Finance. Slusky briefly reviewed the VAHHS 5-year reform plan and continued on with some of his own ideas on health care reform. His remarks focused on provider payment reductions, the need for structural reform, , simplified and standardized forms for all payers, incentives for providers to follow accepted clinical protocols, incentives for consumers to adopt healthy behaviors and long-term care reform. He also expressed his concerns that a Medicaid global budget will not produce savings, since other payers need to be involved.

Tom Huebner, VAHHS Board Chair and President of Rutland Regional Medical Center, and Bea Grause, President and CEO of VAHHS, addressed the Association’s five-year plan for health care form. Huebner’s points were first do no harm. Mr. Huebner and Ms. Grause went through details of VAHHS’ Five Year Plan. The committee discuss also focused on next steps for the Association in the areas of: Administrative Simplification, Health Information Technology, payment reform (Blueprint), Insurance Redesign (WellPRO), Malpractice reform and Long-term care insurance. Ms. Grause also agreed to keep the committee regularly informed of the Association’s reform progress and efforts.

The House Health Care committee has spent the week marking up their latest version of the health care reform bill. There have been many ups and downs through out the week. It was the hope of the committee to vote the bill out this Friday, but by mid-afternoon it became apparent that this would not be the case. At the 11th-hour the trial lawyers came to testify in opposition of the medical malpractice study addressed in the bill. Some committee members felt blind-sided by the health community.

H. 227 - An Act Relating To Safe Staffing and Quality Patient Care

The House General, Housing & Military Affairs committee took brief testimony on H. 227. VAHHS went into the hearing expecting that the bill as introduced would be the basis for testimony. Gail Zatz, lobbyist for the nursing unions, began her testimony by stating that they would be offering a strike-all amendment that would require health care facilities as defined in Title 18, Chapter 121, Subsection 9432, to compile a report that would publicly disclose staffing ratios, it would require facilities to post the report daily, report to the commissioner of Banking, Insurance, Securities and Health Care Administration (BISHCA) and the Public Oversight Commission monthly, and would require BISHCA to make the monthly reports available quarterly to the public by publishing the report on a public website. A facility which fails to comply with shall be subject to a fine of $5000 per violation and shall post a notice of failure to comply in the patient care area of each unit of the hospital where the reports are required. VAHHS is opposed to the strike-all amendment.

Representative Francis Brooks, Chair of the committee, is not sure if his committee will keep jurisdiction over the bill or have the bill committed to Human Services.

H. 163 - An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults

The House passed H. 163, An Act Relating to Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults. This bill will now be taken up by the Senate Judiciary Committee. The link to the House-passed version can be found at: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/journal/hj050406.htm

H. 241 – An Act Relating to Prohibition of Smoking in all Public Places
The House spent many hours on the floor debating H. 241. Republicans offered many floor amendments to exclude private clubs as part of the bill. In the end their attempts were defeated and on a roll call vote of 90 to 52 the bill passed. To view the bill as passed the House you may go to: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/journal/hj050406.htm

S. 27 - Safe Haven for Abandoned Babies

The Vermont Senate approved a bill Wednesday that would allow mothers or family members to abandon babies up to 30 days old at "safe havens" without facing criminal charges. As reported last week the legislation was modified last week to add language that allows the parent to call 911 to arrange a pickup location, in addition to health care facilities, churches, police and fire stations. The bill will now be taken up by the House.

S. 84 - An Act Relating to Comprehensive Management of Exposure to Mercury

The House Fish, Wildlife and Water Resources committee took testimony on S. 84. Lucie Garand of VAHHS testified in support of the bill with minor changes. VAHHS recommended that the bill have a baseline year of 2002, the year the Association received the grant from the Department of Environmental Conservation (DEC). The other recommended change is to add a hospital representative to the advisory committee. The committee and DEC approved of these changes and will be included in the bill.

Bills of interest introduced this week:

S. 163 – AN ACT TO REQUIRE PARENTAL NOTIFICATION PRIOR TO PERFORMING AN ABORTION ON AN UNEMANCIPATED MINOR: This bill proposes to require at least one parent or a guardian of an unemancipated minor to receive written notice at least 48 hours before an abortion is performed on the minor. Notification is not required if the abortion is necessary to prevent death or serious bodily injury to the minor, or if a court finds one of the following by clear and convincing evidence: (1) the minor is sufficiently mature to decide whether to terminate her pregnancy and provide for her own postabortion care, and understands the nature, risks, and consequences of the procedure to be performed; (2) notification would place the minor at substantial risk of being physically or emotionally harmed by a parent or guardian; (3) notification would cause irreparable harm to the minor’s relationship with her parent or guardian; or (4) notification is not in the best interests of the minor. The bill also requires health care providers to provide, to the extent already required by the providers’ code of professional conduct, pregnancy counseling and information before providing pregnancy-related services to a minor. The requirement does not apply in cases of medical emergency. This bill proposes to require health insurers to cover well child checkups consistent with a statutorily defined schedule of visits.