Legislative update
March 11, 2010
Hospital Rate Setting
NHHA and its members continue to be vocal about our opposition to SB
505 introduced by Senator Maggie Hassan (D-Exeter) to create a new state
government agency for rate setting for all community hospitals in New Hampshire.
NHHA President Steve Ahnen and Board Chairman Bruce King testified before the
Senate Commerce Committee last week. The media has taken great interest in SB
505 as well, through news coverage and editorials. "Regulating Hospital Rates"
was the subject of NH Public Radio's The Exchange last week, featuring studio
guests for the hour, Steve Ahnen and Senator Hassan. The Union Leader and
Concord Monitor are among the newspapers which have published opinion pieces
against the bill.
Later in the week the Commerce Committee authorized the following three provisions to be included in an amended version of SB 505 that Senator Hassan plans to introduce next week:
- Rate Setting: Rather than rate "approval" authority, a Rate Commission would establish "recommended" rates, and therefore affording the public an opportunity to compare the commission’s recommended rates to hospital charges.
- Certificate of Need (CON): Require the commission to consider the recommendations of the HB 234 CON study committee (whose work is not yet complete) and recommend legislation to integrate CON into the commission's work.
- State Health Plan: Require the commission to develop a state health plan.
An amendment is not yet available, and despite a deadline to vote SB 505 out
of the Senate by March 10th, the vote has been delayed one more week. NHHA
remains opposed to any amendment that provides for a paid 3-member ‘PUC’-like
commission.
Proposal to Restore Medicaid Funds for Hospitals
NHHA provided testimony last week before the Senate Finance Committee in
support of Senator Kathy Sgambati's (D-Tilton) amendment to SB 489
to restore Medicaid funding for a variety of health and social services
programs that were cut last month. SB 489 is Senator Lou D’Allesandro’s
(D-Manchester) attempt to introduce gaming in New Hampshire to raise new
revenues. NHHA asked to specifically dedicate a portion of gaming revenues to
restore hospital rates to the level they were at when the Legislature passed the
2010/2011 budget. In terms of State general funds, NHHA urged senators to
restore $2.5 million in FY 2010 and $10 million in FY 2011. By not restoring
these funds, New Hampshire stands to lose federal funds of $3.8 million in FY
2010 and $10.8 million in FY 2011.
More Medicaid Cuts to Come
Last month Governor Lynch announced a projected shortfall of $140 million in
state general funds through the end of fiscal year 2011 related to lagging
revenues, increased demand for state services and the Supreme Court’s decision
regarding the JUA. Since then state agency heads have submitted plans to the
governor’s office to reduce spending by 2 percent for the remainder of FY 2010
ending June 30, 2010 and by 8 percent for FY 2011.
HHS Commissioner Nick Toumpas has submitted his department’s proposed spending
reductions of $15 million in FY 2010 and $70 million in FY 2011. However,
details will not be available until the Governor discloses the reductions in
about two weeks’ time. Caseloads continue to grow and Medicaid beneficiaries now
number 117,000 – a 10 percent increase over the past year. These numbers are
consistent with predictions made last year, but ignored by the Legislature.
Health Costs
The Senate Commerce Committee has recommended an amended version of SB
392 for passage “requiring public hearings concerning health care
cost increases in health care services”. SB 392 would allow the
Insurance Commission to “compel” health care providers and insurance carriers to
provide information for the purpose of studying health cost drivers and cost
trends in New Hampshire. Hospitals oppose SB 392. There is no rationale stated
in the bill as to what type of information hospitals and payers would be
required to submit, and it oversteps the Department of Health & Human Services’
authority to regulate hospitals.
The fate of SB 392 rests on the outcome of SB 505 (see “Hospital Rate Setting”
above), as both bills seek to address health care cost drivers. Hospitals have
urged their senators to vote against passage of SB 392.
Privacy/Health Information
HB 1649, relative to health information and patient rights. The
House passed a much improved version of HB 1649 that stripped the more
restrictive consent requirements, with just the audit trail provisions remaining
in the bill. As amended, HB 1649 provides patients a means 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
HB 1169, deleting the repeal of the NH Health Care Quality Assurance Commission.
The House passed HB 1169 reauthorizing the NH Health Care Quality Commission
through 2015. HB 1169 would 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.
Taxes
HB 1583, relative to the property tax exemption for organizations with
charitable activities: The House is expected to vote this week on HB1583
with a recommendation to kill the bill. NHHA opposed this bill which inserts a
financial means test to be applied in the determination of a not-for-profit's
tax exemption for charitable purposes. According to the House Local & Regulated
Revenues Committee, the definition of charitable organization as defined by the
IRS does not confer automatic exemption from property taxes and that it’s up to
the local authority to determine whether the nonprofit provides charitable
services to the community.
Other
A number of bills NHHA opposed have been killed including:
- HB 1349, relative to requirements for pharmacists in charge which would have restricted experienced pharmacists from out-of-state to be employed as pharmacists in charge.
- HB 1438, relative to a patient’s right to know regarding charges for health care which would have required health care providers to provide, upon request of the patient, an estimate of the charge for services to be provided including cost variances due to the patient’s health status, discounts and procedure codes, as well as the patient’s cost-sharing requirements and pre-certification requirements. NHHA is committed to providing meaningful price information, and is working with hospitals to post their top diagnostic services and associated charges.
- HB 1426, permitting patients to bring their medications to the hospital
or health care facility: This bill presented significant patient safety
concerns if hospitals were to be mandated to allow patients to bring
medications from home that either cannot be identified, may be damaged due
to improper storage, or obtained from an unknown source on 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.
NHHA’s complete list of bills is available here.
