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For the week ending January 12, 2007

Political Overview
House lawmakers received their committee assignments Tuesday morning (see attached list of House and Senate Committees) and many returning lawmakers found themselves assigned to new committees…some by choice and others not.   The speaker attempted to distribute membership based on geography, gender, political philosophy, party affiliation, area of interest and years of experience.  Because of the huge Democratic majority, on average each committee has 3 or 4 Republican members, with 4 Republican members on each money committee, natural resources and energy, and education committees.   The speaker also stated that members would be spending more time in committee to allow more time for committee work and less time on the floor at least in the beginning of the session. Beginning next week, the full House will meet only on Tuesdays and Fridays.  This schedule will continue until enough bills have passed to warrant more time for floor debate.

Senate President Pro Tempore Peter Shumlin and House Speaker Gaye Symington began a 3-week education process for lawmakers on global warming. Eight committees have been devoted to the subject. Leadership sees the climate-change challenge as an economic opportunity for Vermont to build a successful sector of alternative-energy (wind power) and energy-efficiency businesses. It is much too early in the session to say if global warming concerns will lead to any specific legislation.   Many lawmakers are concerned that too much time will be spent on an issue that the state does not have much control over rather than the dealing with more important issues, such as property tax.

The majority of the activity in the health care committees this week focused on agency introductions and overviews of major components of Act 191, An Act Relating to Health Care Affordability for Vermonters that passed last session.  

An Act Relating to Health Care Affordability for Vermonters (Act 191)
A number of committees received testimony on the major components of Act 191 this week.   Susan Besio, Director of the Health Care Reform Implementation reviewed oversight and overarching goals of the health care reform legislation.  Goals include:   increase access to affordable health care coverage, improve quality of care, and contain costs.   Dr. Besio reviewed Catamount Health and the timelines set forth in legislation.   She also discussed the Blueprint alignment across chronic care programs.   Emphasis was placed on the coordination of care across the multiple programs working with the same providers and patients; agreement on best practices for all chronic diseases; use of a consistent health risk assessment; coordination of information technology initiatives to improve access; and support for clinical decision-making; use of consistent metrics for provider feedback, profiling and measurement; and changing fee structures to support care management. Other areas highlighted were wellness and prevention, provider availability, multi-payer database, advance directives registry and forms, hospital adverse events monitoring, SorryWorks program, hospital-acquired infection data, and safe staffing reporting.   Dr. Besio stated that a number of reports are due to the committees and General Assembly this month.   

Acting Commissioner of the Vermont Department of Health (VDH) Sharon Moffatt and VAHHS President Bea Grause gave an overview of the Blueprint for Health and Chronic Care Initiative to the House Health Care Committee.  Moffatt and Grause reviewed the committee structure, membership and VDH Blueprint staff in detail.   They also reviewed the Blueprint accomplishments related to public policy and public health, provider practices, individual and family self management, information systems and health systems.   Both stated that the Blueprint has come a long way, but there is still a long way to go.   

Paul Harrington, Executive Vice President for the Vermont Medical Society, also testified on the Blueprint.   Harrington stated that much of the work of changing how health care is delivered falls to the individual provider and practice teams.   Because of this it is imperative that the Blueprint devise strategies to cover financial costs of adopting new approaches.  It requires funding for information technology, training, practice design and linkages of primary care with community and self management initiatives.  There also needs to be an emphasis to support, sustain and stabilize the primary care workforce. 

Joshua Slen, Director of the Office of Vermont Health Access (OVHA), gave a quick overview of the department and program areas that fall under the OVHA office (traditional Medicaid, Dr. Dynasaur, Vermont Health Access Plan, pharmacy programs, Healthy Vermonters and Catamount Health).  Director Slen gave the committee an update on OVHA’s Chronic Care Management Program (CCMP) and stated that it is currently under development.   The overarching goals of the CCMP are to improve health outcomes and reduce service utilization for Medicaid beneficiaries with chronic health conditions.   Themes that will be incorporated into the program are transparency, sharing results with other state Medicaid programs to enhance the chronic care management methodologies among publicly financed programs, flexibility in developing and modifying processes based on experience, target defined populations and seek to reduce the negative health effects of chronic conditions, and collaborating with other state initiatives.

Chronic Care Information Systems
Many lawmakers attended an informational session hosted by VDH and Vermont Information Technology Leaders (VITL), GE Healthcare and Orion Health on the Chronic Care Information System (CCIS), a statewide patient registry and chronic disease management system, with a securely hosted web-based system with provider and patient portals.   The CCIS will incorporate a registry that contains clinical data of Vermont patients who have chronic disease conditions.   The disease management component will be designed to provide the practitioner with treatment aids such as disease-specific evidence-based guidance.    This is a collaborative effort between VDH and VITL.

Budget Adjustment
The House Appropriations Committee heard from Jim Reardon, commissioner of budget and finance this week on a $16.8 million proposed adjustment to the state budget lawmakers passed last year. Of the $16.8 million, $8.9 million is for emergency farm aid, $1.5 million for town highway emergency funds, $3.2 million to relocate state workers from a Bennington office building, and $2.5 million for additional expenses at the Department of Public Safety.  The committee was surprised that the Agency of Human Services has only small changes with a budget neutral result.

Acting Commissioner of the Vermont Department of Health Sharon Moffat presented her department’s budget adjustment.   Portions of the adjustment have to do with Global Commitment changes and moving programs in or out, depending on approved expenditures.   A few areas to note are:  

• Health Surveillance:  An adjustment of $962,000 is requested for the purchase of anti-virals in the event of a pandemic flu.   The state share is $562,400 with the expectation that hospitals and insurance companies will come up with the additional $399,600.   The goal is to have an anti-viral stockpile in the state for immediate use.  VDH has adopted the category of anti-viral recipients developed by the Centers for Disease Control.  
• Blueprint for Health:  Decrease of $292,866.   This eliminates the FY06 carry forward that was intended for VITL and ORION contracts.  Due to the delay in the program this expense was eliminated.
•  Mental Health:   A transfer of $401,753 to the State Hospital because of savings on the Williamstown project.   The funds will be used for additional staffing needs, food, prescription drugs and supply needs.

Employer Assessment
The House Ways & Committee heard testimony from legislative counsel and the Department of Labor on the employers’ health care premium contribution of Act. 191.    The purpose of the employer assessment is to more equitably distribute the costs of health care to uninsured residents  and to provide a fair and reasonable method for sharing health care costs with employers who do not offer their employees health care coverage.  The revenue collected will be deposited into the Catamount special fund.   Employers who are required to withhold Vermont income taxes will be assessed.  Employees who must be factored into the assessment are full and part time employees over the age of 18, including seasonal, per diem and transitive employment.   The assessment is paid only on the hours of an employee who lacks health insurance coverage.  The assessment will be required from employers:  who do not offer to pay any part of the cost of health care coverage for its employees and have employees who are not eligible for health care coverage offered by the employer to any other employees in the organization; or have eligible employees who were offered coverage by the employer but declined and still have no other health care coverage under either a private or public plan.   The Department of Labor will send a letter to all employers explaining the process and will conduct the following public meetings:

January 30, 9 - 11 a.m., Asa Bloomer Building, Rutland
February 2, 9 - 11 a.m. Northeastern Vermont Regional Hospital, St. Johnsbury
February 6, 9 - 11 a.m., State Office Building, Springfield
February 8, 7 - 8:45 am, Vermont Interactive Television sites in Montpelier, Bennington,  Brattleboro, Newport, St. Albans (see www.vitlink.org)

Provider Tax
The House Ways & Means received background information from the Joint Fiscal Office on the provider tax on hospitals, nursing homes and home health agencies.   Patrick Flood, Commissioner of the Department of Aging and Independent Living, was asked to testify specifically on the home health tax. Commissioner Flood stated that the state has been using the provider tax for a number of years in hospitals, home health and nursing homes in order to leverage federal money. Two years ago when providers were cut, the home health agencies was able to increase their tax to offset some of those cuts.   There is no hold harmless provision for participating providers.  The federal government is now watching this issue very closely.   Vermont has been innovative, but has adhered very closely to the federal rules. 

With continued emphasis on home care with the 1115 Choices for Care Waiver and care being provided by family members, the home health agencies are seeing a decrease in utilization and thus a decrease in reimbursement. 

Medical Marijuana
The Senate Judiciary Committee took testimony on S. 7, An Act Relating to Medical Marijuana.   The bill proposes to increase the amount of marijuana and the number of marijuana plants that a patient in the program may possess, broadens the range of medical conditions which may qualify a patient for the program, and lowers the registration fee for the program from $100.00 to $50.00.  The medical and public safety communities have concerns on increasing the amount of marijuana a patient may possess and broadening the range of medical conditions that qualify. The committee will continue to take testimony on this.

Vermont Department of Banking, Insurance Securities and Health Care Administration (BISHCA)

Senate Finance received an overview of BISHCA and the different departments associated with it.   Christine Oliver, Deputy Commissioner of the Health Care Administration, reviewed the five primary programs to carry out its regulatory responsibilities.   The programs include data, information and research; Certificate of Need and hospital budget reviews; health insurance rate and form review; health care quality improvement; and consumer protection programs.  Deputy Commissioner Oliver also stated that the department manages the contract with VITL for the delivery of two pilot projects and the state health information technology plan.   New efforts for the department include the need to provide price and quality information from Act 53 into budget and CON reviews, updating of statistics and reporting, and the plan to update and improve benchmarks for both CON and budget reviews.

Herb Olson, counsel for BISHCA, presented the Department’s “housekeeping bill” that addressed issues related to banking, insurance, securities, and captives. Olson referred the committee to the Secretary of Administration’s Health Care Reform 5-Year Implementation Plan for a summary of proposed changes related to the health care reform legislation passed last year.  Other health care related legislation “will be determined”.

Legislative Committee on Administrative Rules
The Legislative Committee on Administrative Rules heard testimony on the rule for the new federal requirements applicable to determining financial eligibility for Medicaid payment of long term care services.  The provision of undue hardship and the transferring of resources were discussed at length.    The committee felt that more information was needed before approval of the rules and delayed action on the rule for one week.

Bills of interest that were introduced this week:

H. 43 – AN ACT RELATING TO ASSAULTING A HEALTH CARE PROVIDER OR EMPLOYEE OF A HEALTH CARE FACILITY:  This bill proposes to define aggravated assault to include causing or attempting to cause bodily injury in a health care facility to a health care provider or to an employee of the facility.

H. 44 - AN ACT RELATING TO PATIENT CHOICE AND CONTROL AT END OF LIFE:  This bill proposes, subject to appropriate safeguards, to allow a mentally competent person diagnosed with less than six months to live to request a prescription which, if taken, would hasten the dying process.

S. 21 - AN ACT RELATING TO ELIMINATION OF THE RULE PROHIBITING SMALL BUSINESSES FROM BUYING HEALTH INSURANCE UNLESS 75 percent OF EMPLOYEES ENROLL:  This bill proposes to allow small businesses that offer health insurance to all employees to purchase small group insurance even if less than 75 percent of the employees enroll in the employer’s plan. 

S. 24 - AN ACT RELATING TO PROCEDURES INVOLVING MEDICAL MALPRACTICE ACTIONS:  This bill proposes a number of changes related to medical malpractice actions.  The bill (1)  requires the Vermont property and casualty guaranty association to pay medical malpractice claims which were timely filed against insolvent insurers; (2)  provides for public inspection of all rate filings; (3)  shortens the time period within which minors may bring medical malpractice actions; (4)  sets standards for the qualification of physician expert witnesses; (5)  limits damages for pain and suffering in medical malpractice actions to $250,000.00, adjusted every other year beginning in 2009 based on the Consumer Price Index; (6)  provides limited immunity to health care practitioners providing volunteer or public health services; and (7)  establishes a mandatory arbitration process for medical malpractice actions.

NOTE:   Governor’s Budget Address will be on Tuesday, January 23, 2007 at 2 p.m.