2010 Legislative Wrap Up
June 16, 2010
STATE BUDGET: Medicaid Payments to Hospitals
Facing a $295 million deficit for SFY 2010 and 2011, the New Hampshire House and Senate approved a bill (Special Session HB 1) during its June 9th special session that includes $52 million in spending cuts throughout state government; $44 million in savings from dedicated funds and money expected to be left over in state agency budgets; and $187 million in one-time budget changes including bonding, selling state assets and refinancing debt. Another $3 million will come from taxes and fees, and $5 million will be taken from the state’s rainy day fund to fill the shortfall in SFY 2010, though the money is to be repaid in 2011.
Impact on Hospitals
The following reductions in Medicaid hospital payments contained in the
approved special session bill had all been previously included in numerous
budget bills throughout the regular legislative session:
- Outpatient Hospital Visits – Reduced from 12 per year to 6 per year
- General funds: $350,000 - Federal funds: $350,000
- Indirect Graduate Medical Education – Payments Suspended as of Apr 1,
2010
- General funds: $1,200,000 - Federal funds: $1,200,000
- Catastrophic Aid – Payments Suspended as of June 15, 2010
- General funds: $1,700,000 - Federal funds: $1,700,000
- Reduction in Medical Payments to Providers (unspecified impact on
hospitals)
- General funds: $1,455,000 - Federal funds: $1,455,000
- New Hampshire Hospital reduction in adult inpatient beds
- Adult inpatient psychiatric beds at NHH will be reduced due to the relocation of children’s psychiatric services from the Philbrook Center facility to the NHH facility. Currently difficulty in finding inpatient beds at NHH for a record number of referrals for admission is already resulting in delays in admissions thus placing additional pressure on the entire mental health system and on community hospitals.
The budget bill, however, does retain an earlier effort to amend the method
by which Medicaid catastrophic aid claims will be paid once the program is
reinstated presumably on July 1, 2011. Rather than prioritize claims based on
date of service, all eligible claims will qualify for a portion of the
catastrophic aid appropriation. Thus more hospitals will be able to access
catastrophic aid funds.
Finally, a provision in the bill calls for the implementation of a payment
reform model to be built around an accountable care organization model.
HEALTH COSTS
Commission on Health Care Cost Containment
Significant progress was made on SB 505, establishing the
commission on health care cost containment since its introduction in
January – a draconian effort to mandate hospital rate setting for all private
payers. SB 505 calls for the creation of a Health Care Cost Containment
Commission to study New Hampshire’s health care payment system and recommend
cost containment measures.
Members to be appointed to the Commission include legislators,
representatives of the Citizens Health Initiative, Department of HHS, Insurance
Department, experts in health care policy and health care economics, as well as
a consumer representative. The Commission must begin to meet no later than
September 1, 2010 and complete its work by July 2, 2012.
Public Hearings on Insurance Cost Increases; Hospital Charges
SB 392, requiring public hearings concerning health insurance cost increases
in health care services. Significant improvements were made to
ensure that the intent of the bill is to examine health insurance premium
increases, not health provider costs. This includes the removal of
language “compelling” health providers to provide information or documents to
the Insurance Department. Instead, providers may be “invited” to provide
information. NHHA worked to ensure that the Insurance Commissioner will have no
authority over hospitals.
In an unrelated measure, legislators tacked on a provision on billing limits for uninsured patients. To ensure consistency with federal requirements, NHHA was successful in revising this section to mirror the recently enacted federal health reform mandate that hospitals bill uninsured patients the amount “generally billed to health carriers” in a manner consistent with the Patient Protection and Affordable Care Act of 2009. This will ensure that any state requirements are based on the federal rules.
Pricing Transparency
The House killed HB 1438, relative to a patient’s right to know
regarding charges for health care that would have required
healthcare providers to estimate the charges for services – including those for
services provided by other health care providers treating the patient such as
anesthesia, pathology and radiology. A legislative panel concluded the bill
would create an undue burden on providers thereby increasing the cost of care,
and is unnecessary due to NHHA’s pricing transparency initiative focused on
providing hospital charge estimates to patients.
PRIVACY
Both the House and Senate passed a significantly scaled-down version of
HB 1649, relative to health information and patient rights,
stripping the bill of the more restrictive consent requirements, with just the
audit trail provisions remaining in the bill. As amended, HB 1649 provides
patients a way to check whether someone they identify has had access to their
electronic medical records during a specified period within the previous three
years. It requires medical providers to examine any audit trail associated with
the patient’s record and to report whether the identified person had access or
not and to what extent. This is consistent with current practice at many New
Hampshire hospitals.
QUALITY
The House and Senate passed HB 1169, relative to the NH Health Care
Quality Assurance Commission, reauthorizing the Health Care Quality
Commission through 2015. HB 1169 will allow the Commission to continue to bring
hospitals and ASCs together to promote initiatives and share best practices to
enhance patient safety. The bill adds a governor-appointed “member-at-large” to
the Commission, and requires the Commission to report annually to the Joint HHS
Oversight Committee, in addition to legislative leadership.
PATIENT MEDICATION
Legislators killed HB 1426, permitting patients to bring their
medications to the hospital or health care facility. Legislators
agreed with NHHA about potential harm to patients if hospitals were to be
required to allow patients to bring medications from home that either cannot be
identified, may be damaged due to improper storage, or were obtained from an
unknown source over the internet. While some hospitals allow patients to bring
their own medications to the hospital under very limited and controlled
circumstances, this practice is best left to the discretion of each facility.
All hospitals have strict processes in place to prevent medication errors and to
ensure that the right medication in the right dosage is given to the right
patient at the right time.
TAXES
The Legislature supported NHHA’s position on HB 1583, relative to the
property tax exemption for organizations with charitable activities,
thus killing the bill which would have inserted a financial means test to be
applied in the determination of a not-for-profit's tax exemption for charitable
purposes. As stated in the Committee report, the definition of charitable
organization as defined by the IRS does not confer automatic exemption from
property taxes and that it is up to the local authority to determine whether the
nonprofit provides charitable services to the community.
MEDICAL LIABILITY
Continued efforts to water down the pretrial screening panel law were
thwarted with the demise of three bills that would have restricted those claims
subject to review, awarded costs and attorneys’ fees incurred in the panel
process, and altered the requirements for extensions of time for hearings. A
proposal regarding apportionment of damages was also killed.
NHHA’s complete list of bills is available here.
