Legislative update

February 4, 2010
NHHA is following dozens of bills this session on a wide variety of issues that include patient privacy, cost of care and health insurance, Medicaid, medical liability, quality and property tax exemptions, to name a few. Highlighted below are several key bills for hospitals.

Health Costs
HB 1438, relative to a patient’s right to know regarding charges for health care:
This bill requires all health care providers to provide, upon request of the patient, an estimate of the charge for services to be provided. Included in the estimate are cost variances due to the patient’s health status, discounts and procedure codes. The bill also requires health insurers to provide information on the insured’s coverage, cost-sharing requirements, and pre-certification requirements based on the estimated charges provided by the health care provider.
NHHA is committed to providing meaningful price information, and has begun work on an initiative to have hospitals post their top 50 outpatient diagnostic services and associated charges. We’ll work with other provider organizations to educate legislators about this effort and the challenges that limit providers’ ability to estimate pricing information. The hearing on HB 1438 will be held February 4th.

HB 1426, permitting patients to bring their medications to the hospital or health care facility: NHHA testified in opposition to a bill that presents significant patient safety concerns if hospitals are 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 on the internet. While some hospitals currently do 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. The House Health & Human Services Committee is expected to vote on the bill next week.

Health Insurance
HB 1342, relative to the right of election to submit a claim for medical expenses under a medical payments motor vehicle liability policy or a health insurance policy: This is one of several bills designed to allow patients with auto insurance Med Pay policies to submit their health care claims to the auto insurance carrier with no obligation on their part to reimburse the health provider for services rendered following an automobile accident. The intent of these bills is to make it nearly impossible for health care providers to receive payment directly from the auto insurance carrier, in favor of the insured who will receive the payment and may use it for any purpose s/he so desires. NHHA is working with a subgroup of hospital Patient Financial Services Directors to develop alternative language to ensure that providers can access the Med Pay payments for reimbursement of health related expenses not covered by health insurance.

Medicaid
Protecting Medicaid appropriations is a priority of NHHA as the State of New Hampshire faces unprecedented budget shortfalls in the Medicaid program, with the latest projected deficit for FY 2010 estimated at $38 million. By week's end, the HHS Commissioner is expected to announce budget reductions that are expected to include significant Medicaid hospital payment cuts. No details have been made available yet.

A hearing was held on a separate budget-cutting proposal, HB 1664, that calls for budget cuts throughout state government in State Fiscal Year 2011 beginning July 1, 2010. Included in these cuts are: (1) a $2 million reduction in Medicaid payments to Critical Access Hospital; (2) elimination of Medicaid Catastrophic hospital payments of $2.8 million; and (3) elimination of Medicaid Direct and Indirect Medical Education payments to hospitals of $1,350,000 … a total reduction of $6,150,000 in Medicaid hospital payments in FY 2011. NHHA testified in opposition to this bill last month. Deliberation by the House Finance Committee has been postponed, presumably until the HHS Commissioner's budget reductions are announced.

Medical Liability
The House Judiciary Committee held hearings last week on several bills designed to weaken the state's pretrial malpractice panel law enacted in 2005. NHHA opposes all three bills:
HB 1256, restricting medical injury claims subject to pretrial screening panel review to claims exceeding $250,000.
HB 1257, changing requirements for extensions of time for hearings by pretrial screening panels for medical injury claims.
HB 1258, relative to the award of costs and attorneys’ fees incurred in the medical injury screening panel process.

Another bill that was defeated twice in past legislative sessions has been introduced once again proposing to change apportionment of damages requirements in liability cases. This bill will upset the current balance in New Hampshire’s tort system with regard to settlements and payment of judgments. It would unfairly punish defendants with "deep pockets", regardless of how minimal their degree of fault in a multi-defendant case thus allowing the courts to impose up to 100% of damages to a party found to have had minimal responsibility. NHHA opposes HB 1255.

Privacy/Health Information
HB 1649, relative to health information and patient rights and establishing a commission to study adding certain information to a driver’s license:
This bill would establish more restrictive requirements relative to disclosure of protected health information for treatment, as well as a patient’s right to a report detailing a named provider’s access to the patient’s electronic medical record. NHHA, along with other privacy stakeholders, opposes this bill due to provisions that conflict with federal HIPAA requirements. The hearing on HB 1649 will be held February 9th.

Quality
HB 1169, deleting the repeal of the NH Health Care Quality Assurance Commission: This bill reauthorizes the Health Care Quality Commission which is due to sunset July 1, 2010. The Commission has been extremely effective in bringing hospitals and ASCs together to promote initiatives and share best practices to enhance patient safety. HB 1169 would allow the Commission to continue this important work. NHHA supports the reauthorization of the Commission. The hearing on HB 1169 will be held February 9th.

Taxes
HB 1583, relative to the property tax exemption for organizations with charitable activities: NHHA opposes HB 1583 which inserts a financial means test to be applied in the determination of a not-for-profit's tax exemption for charitable purposes. NHHA testified in opposition to this bill. A subcommittee of the House Local & Regulated Revenues Committee has recommended the bill be killed.

NHHA’s complete list of bills is available here.

2010 Legislative Updates:

New Hampshire Legislature’s 2010 Session is in Full Swing

Janaury 14, 2010

The New Hampshire General Court returned to Concord January 6th for its 2010 legislative session. While many of the bills NHHA will be watching are now available, we’re still awaiting publication of a number of proposals. Highlighted below are bills concerning hospitals, quality and patient safety, health insurance, Medicaid, privacy, workforce, medical liability, and property tax exemption.

The entire list of bills NHHA is watching is available on our website, and includes our position on selected bills, links to NHHA testimony, and information on where each bill is in the legislative process.

Health Costs
HB 1438, relative to a patient’s right to know regarding charges for health care: This bill requires all health care providers to provide, upon request of the patient, an estimate of the charge for services to be provided. Included in the estimate are cost variances due to the patient’s health status, discounts and procedure codes. Also, the bill requires health insurers to provide information on the insured’s coverage, cost-sharing requirements, and pre-certification requirements based on the estimated charges provided by the health care provider.

NHHA is committed to providing meaningful price information, and has begun work on an initiative to have hospitals post their top 50 outpatient diagnostic services and associated charges. We’ll work with other provider organizations to educate legislators about this effort and the challenges that limit providers’ ability to estimate pricing information.

Insurance
HB 1488, relative to New Hampshire Health First: This bill requires health carriers offering coverage under New Hampshire HealthFirst in the small employer market to offer a basic wellness plan in addition to the standard wellness plan. The intent of the bill, requested by the Insurance Department is to lower the cost of the New Hampshire HealthFirst premium.

HB 1342, relative to the right of election to submit a claim for medical expenses under a medical payments motor vehicle liability policy or a health insurance policy:  This is one of a collection of Med Pay bills designed to allow patients with auto insurance Med Pay policies to submit their health care claims to the auto insurance carrier with no obligation on their part to reimburse the health provider for services rendered following an automobile accident. The intent of these bills is to make it nearly impossible for health care providers to receive payment directly from the auto carrier, in favor of the insured who will receive the payment and use it for any purpose s/he so desires. NHHA is working with a subgroup of hospital Patient Financial Services Directors to develop alternative language to ensure that the provider can access the MedPay payments for reimbursement of health related expenses not covered by health insurance.

Medicaid
Protecting Medicaid appropriations is a priority of NHHA as the State of New Hampshire faces unprecedented budget shortfalls in the Medicaid program, with the latest projection deficit at $38 million!

HB 1664, making appropriation reductions in the operating budget for FY 2011: HB 1664 calls for state agency cuts throughout state government in State Fiscal Year 2011. Included in these cuts are: (1) a reduction of Critical Access Hospital rate cuts of $2 million by reducing Medicaid outpatient hospital payments to 85% of Medicare allowable costs; (2) elimination of Medicaid Catastrophic payments at $2.8 million; and (3) elimination of Direct and Indirect Medical Education payments by Medicaid at $1,350,000 … for a total proposed reduction of $6,150,000 in SFY 2011. NHHA offered testimony at the hearing on this bill on January 19th. The Finance Committee work session on HB 1664 is scheduled for February 2nd.

HB 1355, relative to certain Medicaid appropriations: HB 1355 would prohibit the transfer of Medicaid funds for the purpose of provider rate reductions.

Medical Liability
Several bills propose to weaken the pretrial screening panel law enacted in 2005. NHHA opposes the following three bills:

HB 1256, restricting medical injury claims subject to pretrial screening panel review to claims exceeding $250,000.

HB 1257, changing requirements for extensions of time for hearings by pretrial screening panels for medical injury claims.

HB 1258, relative to the award of costs and attorneys’ fees incurred in the medical injury screening panel process.

Privacy/Health Information
HB 1649, relative to health information and patient rights and establishing a commission to study adding certain information to a driver’s license:
This bill would establish more restrictive requirements relative to disclosure of protected health information for treatment, as well as a patient’s right to a report detailing a named provider’s access to the patient’s electronic medical record. NHHA is working with privacy stakeholders to follow up with the bill’s sponsor and the Department of HHS, as well as to further analyze the bill relative to HIPAA.

HB 1531, prohibiting NH physicians and medical staff from sharing patient records in a health information exchange without the patient’s written authorization: This bill changes the law relative to HIE from an opt-out to an opt-in.

Quality
HB 1169, deleting the repeal of the NH Health Care Quality Assurance Commission: This bill reauthorizes the Health Care Quality Commission which is due to sunset July 1, 2010. The Commission has been extremely effective in bringing hospitals and ASCs together to promote initiatives and share best practices to enhance patient safety. HB 1169 would allow the Commission to continue this important work.

Taxes
HB 1583, relative to the property tax exemption for organizations with charitable activities: This bill excludes bad debt from consideration for purposes of property tax exemption for charitable purposes.

Workforce
HB 1228, relative to criminal record checks by health facilities: This bill streamlines the background check process for health facilities.

HB 1645, relative to freedom of choice on whether to join a labor union: This bill prohibits collective bargaining agreements that require employees to join a labor union. As with all labor-related bills, NHHA will be watching this bill closely in the event it’s amended in favor of the unions.
 

NHHA’s complete list of bills is available here.

2010 Legislative Updates: