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For the week ending April 29, 2005
Political Overview
Every week there is yet another sign that we are getting closer to adjournment or that everyone is hopeful that it will happen soon. The Senate morning committees have slowed down and some have even stopped meeting. Because each senator serves on two committees, by shutting down the morning committees the two money committees, finance and appropriations, are able to meet all day because members aren’t needed in their other committee. Not only are the two money committees meeting all day, Senate Health & Welfare started meeting all day once they received the health care reform bill.
Although health care and Medicaid have been key issues at the State House this session, so has the storage of spent nuclear fuel at Vermont Yankee. A political showdown is occurring at the Statehouse over whether the owner of the Vermont Yankee power plant should be allowed to store its spent nuclear fuel in dry casks on the plant's grounds in Vernon. The State is pushing for the owners of Vermont Yankee, Entergy, to pay a waste tax of $4 million a year and Entergy is refusing and is threatening to shut down the plant if that is the deal. The plant provides more than a third of the state's current power supply and the larger electric utilities are very concerned to lose this cheap power.
VAHHS Issues
Health Care Reform:
This has been a very intense week. Last week the House passed H. 524, An Act Relating to Universal Access to Health Care in Vermont, after two lengthy days of debate. The bill was referred to the Senate Health & Welfare Committee, which has all but put it aside since Senate leaders have written their own plan. Senate President Pro Tempore Peter Welch hopes this newly drafted and continually evolving draft bill will form a compromise on health care reform between the legislature and the Douglas Administration. We have a long way to go before we know if that compromise will even take place. This bill will be amended by both Senate Health and Welfare and Senate Finance over the next few weeks.
The committee received testimony from a number of individuals including Health Commissioner Paul Jarris on the Chronic Care Initiative, which has broad support in both the House and Senate. The Senate bill has currently has an appropriation of $3 million, but this will likely be decreased during budget talks. The committee also heard testimony from John Franco, an attorney from Burlington about his proposed changes to H. 524. Franco believes that the cost of including hospital care in the package to be offered to the uninsured would add only incrementally to the costs being contemplated for preventive and primary care services (about 25%) and suggested that the committee consider using a premium tax on health insurers to help fund that as a next step. Of real surprise was testimony from Richard Davis, a single-payer advocate from Brattleboro. Davis suggested that the Legislature might be moving too fast and that it would be understandable and acceptable to the persons he represents if they defer real action until next year, which would allow for more public dialogue on the issue. While Davis supports H. 524 as it came out of the House, he is concerned that it could be so watered down by the Senate that he would rather wait until next year. The real clincher was the testimony from BISHCA Deputy Commissioner Paulette Thabault and general counsel, Herb Olson. Thabault and Olson presented the committee with a draft revision to the "global budget" section of H. 524. Their proposal would remove the cap on hospital budget increases (quantified in H. 524 as CPI +3%) in favor of giving the Commissioner broad discretion to impose "such terms and conditions" on hospital budgets as he deems necessary to "reduce the rate of growth" to a sustainable and affordable level. Those terms and conditions could include:
Thabault was explicit that BISHCA believes that it should have the ability to, as necessary, dig very deeply into hospital budgets and manage various items within those budgets. The committee discussed this proposed amendment late Friday and some members are now thinking that the amendment may have merit. Senator Kevin Mullin stated that he would like to hear from hospital folks on this. We have every intention to be heard on this issue, which will be discussed during Monday’s Legal and Legislative call.
The committee also took testimony on what is being dubbed the “Grocers Plan”. Members of the Vermont Initiative for Universal Health Access have put together a plan that address the problem by: requiring efficiencies on the system, bringing more people into the system - so more people are paying into it, redefining the non-group market and establishing a pool for the high "utilizers.” This proposal also aims to connect the patient to the costs associated with the services they are seeking and encourages dialogue between the patient and the doctor. It would require that data be provided to patients so that they can make informed decisions about the health care services they will obtain. The goal is to lower health care costs, expand coverage, and improve quality, safety and effectiveness of health care: Common goals, different approach.
Medicaid and Budget:
The House Appropriations Committee spent the entire week delving into the details of the Medicaid budget. The committee spent a lot of time looking at the Governor’s 23-point savings plan, provider cuts, and long term care issues. Late today, the committee drafters proposed half of the Governor’s recommend for hospital cuts – a total of $9.9 million (this includes out of state hospitals). For Vermont hospitals, we estimate this cut will total approximately $8 million. The committee unanimously agreed to continue to the inflation factor for nursing homes and not go with the governor’s recommend. The occupancy level is still under negotiation and will either be 92 or 93%. The plan at this point is for a “mock session” to be held on Monday in order for the appropriations committee to vote the bill out of committee, the bill will be sent to House Ways & Means on Tuesday for their approval, and then will be debated on the House floor the end of next week.
Provider Tax:
Bea Grause testified in House Ways & Means in support of the Administration's proposal of an additional $13.6 million provider tax to be collected in FY 2005 and redistributed in FY 2006.
S.20/H. 163 - An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults
On a vote of 6-0-0, the Senate Judiciary passed out H. 163, An Act Relating to Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults. The committee essentially left the definition of abuse by restraint in tact from the House language except they added a clause that makes threatening to restrain a vulnerable adult unnecessarily or unlawfully a felony. They retained the language that allows for physical and chemical restraint when "(1) part of a legitimate and lawful medical or therapeutic treatment; or (2) lawful and reasonably necessary to protect the safety of the vulnerable adult or others, provided that less intrusive alternatives have been attempted if doing so would be reasonable under the circumstances." The committee reverted to the definition of vulnerable adult as written in Title 33. They made one change to the clause on home care services. The original language read has been receiving personal care and services for one month from an agency certified by the Vermont department of aging and independent living or from a person or organization that offers, provides, or arranges for personal care. They removed the phrase "for one month" which significantly broadens the definition and could potentially include hospital patients since hospitals "arrange for personal care." This change of the definition will certainly be an issue in the conference committee because the House Judiciary Committee significantly narrowed the definition. The bill is now in Senate Appropriations.
H. 227 – An Act Relating To Safe Staffing and Quality Patient Care
The House Committee on Housing, General and Military Affairs took testimony this week on the strike-all amendment to H. 227. The amendment would require daily reporting of staffing levels by each unit of a hospital, nursing home or other facility. Jill Olson from VAHHS testified that the measures outlined in the amendment have not been tested or validated as appropriate measures of staffing effectiveness. VAHHS recommended that if the legislature is interested in exploring the measuring and reporting of staffing effectiveness it assign the BISHCA community report workgroup the task of determining whether there are valid and reliable measures to use. Susan Nicholls, President of the Vermont Organization of Nurse Leaders supported the testimony of VAHHS and talked about the dynamic process of making staffing decisions. Jennifer Henry from Justice for Healthcare Workers testified in support of the amendment.
H. 258 - An Act Relating to the Disclosure of Rates of Hospital-Acquired Infections
The House Human Services Committee took testimony on H258. Representative Johannah Donovan testified in support of the bill saying that hospital acquired infections are widespread and often fatal. Paulette Thabault, Deputy Commissioner of the Health Care Administration, Jill Olson from VAHHS and Paul Jarris, Commissioner of the Vermont Department of Health each testified that while hospital-acquired infections are serious and that in concept public reporting is a good idea, national organizations are still struggling to identify valid and reliable infection outcome measures. Jarris called the bill "premature" because it is ahead of the state of the art of performance measurement. We expect the committee will take additional testimony on this bill. Jill Olson from VAHHS recommended that the committee hear from a hospital infection control practitioner and from Dr. Lawrence Ramunno from the Northeast Health Care Quality Foundation.
H. 518 – An Act Relating to Capital Construction and State Bonding
As expected, a conference committee will be appointed to work out the differences in the capital bill. House members include: Alice Emmons, D – Springfield, Daryl Pillsbury, I – Brattleboro, and Gail Fallar of Tinmouth. Senate members have not yet been appointed.
S. 113 - An Act Authorizing Nonprofit Hospitals to Convert Charitable Assets
The House Commerce Committee took additional testimony this week on S.113, a bill being pushed by the Attorney General's Office to establish a review process for any proposed conversion of a non-profit hospital to a for-profit entity. Anne Cramer, VAHHS' legal counsel testified against the bill as yet another unnecessary layer of regulation which is already well covered by Act 53 and IRS Section 501(c)(3) requirements. Herb Olson, legal counsel to Banking, Insurance, Securities and Health Care Administration, testified in favor of S.113 as passed by the Senate since it no longer requires review by the Attorney General's office of transfers or conversions to another non-profit entity. David Borsykowsky, an Assistant Attorney General, Donna Sutton-Fay, the State Health Care Ombudsman, and Kathryn Young of VANPO, also testified in favor of the bill.
Home Health
Although the bill that addresses codifying the existing practices and arrangements of home health agencies still does not have a number, the Senate Health &Welfare and Appropriations committees voted out the bill in their respective committees. The attorney general’s office has stated that the bill being moved on might not stop the federal antitrust probe.
Bills of interest introduced this week:
H. 531 - AN ACT RELATING TO REORGANIZING THE AGENCY OF HUMAN SERVICES: This bill proposes to conform the Vermont Statutes Annotated to the reorganization of the agency of human services.
H. 534 - AN ACT RELATING TO MEDICARE PART D PRESCRIPTION DRUG WRAP-AROUND COVERAGE: This bill proposes to provide Vermonters eligible for Medicare with pharmaceutical coverage equivalent to the current coverage of Vermont’s prescription drug programs and recodify the existing statutory authority for state pharmaceutical programs.