NHHA LEGISLATIVE UPDATE
February 5, 2007
Medicaid Budget
The HHS Commissioner, John Stephen, submitted a proposed
Medicaid budget to the Governor in which payments to
hospitals are cut by eliminating “provider-based” payments
for physician services and medical education payments to
hospitals with residency training programs.
New Hampshire’s hospitals cannot withstand any Medicaid
payment reductions. Since the early 1990s, Medicaid payments
to hospitals have declined 34% from 91 cents per dollar of
cost to approximately 60 cents per dollar of cost. The DRG
point rate on which inpatient payment is based is lower
today ($3,147) than it was in 1994 ($3,184). By contrast,
the 2006 Medicare DRG point rate was $5,700. Consequently,
New Hampshire ranks second to the lowest on “payment to
cost” ratio in the US.
NHHA has met with the Governor, the House Finance Chair, and
other legislators to discuss Medicaid and hospitals. The
Governor will present his version of the budget to a joint
session of the House and Senate on February 15th.
Health Insurance
NHHA is behind two initiatives to improve New Hampshire’s
health insurance statutes. In an effort to bring uniformity
among health plans as to definitions of “medical necessity,”
we proposed a change in the statute that requires all health
plans to adhere to one standard definition. Currently,
health plans file their own definition with the Insurance
Department. We brought the three major carriers doing
business in New Hampshire together to meet with us to work
on a fair and reasonable definition that protects the
consumer. All parties agreed to a definition of “medical
necessity” based on the definition in Maine’s law. The bill
was well received in committee.
NHHA’s second initiative is to permit physicians awaiting
credentialing by health plans to see the plan’s patients in
several circumstances, including on-call coverage, and to
bill for those services. Verification of a healthcare
practitioner’s credentials is a lengthy process that
involves obtaining a medical license, obtaining hospital
credentials and privileges, and finally obtaining health
plan credentialing. In the face of a shortage of primary
care providers in New Hampshire, hospitals and physicians
hope there can be a resolution to this problem.
Medical Liability
New Hampshire’s medical liability statute is under threat
with a bill proposing to replace the pretrial screening
panel legislation passed in 2005. The new law has withstood
several legal challenges. Screening panels ultimately
facilitate the settlement process, thereby reducing the
costs of lengthy drawn out lawsuits. NHHA opposes any change
or repeal of current law.
Workforce
Numerous employment bills would impact hospitals. They
include mandating the amount of time between shifts;
regulating mandatory overtime for nurses; required pay for
employees called into work; and certification of death
certificates by nurse practitioners and physician
assistants. The bill to mandate 10 hours between shifts
excludes employees who volunteer to return to work. However,
there are instances when employees are called back and this
flexibility is needed to maintain an appropriate level of
services to patients.
Current statute requires employers to pay employees two
hours of pay, even if the time worked is less than two
hours. The House Labor Committee is amending a proposal that
would increase this to three hours of pay.
NHHA will be weighing in on these and other workforce bills.
Legislative Calendar
Tuesday, February 6, 2007
House Health & Human Services, LOB, Room 205
9:00 HB 139, requiring the reporting of burn injuries.
Subcommittee work session
11:00 HB 345, relative to certification of death
certificates. Public hearing.
Wednesday, February 7, 2007
House Commerce, LOB, Room 302
9:00 HB 228, relative to the definition of “medical
necessity” under the managed care law. Subcommittee work
session.
House Children and Family Law, LOB, Room 206
11:00 HB 278, relative to notification of a parent or
guardian by the medical facility treating a minor injured in
an accident. Public hearing
Thursday, February 8, 2007
House Finance, Division III, LOB, Room 209
10:00 Presentation – Medicaid Stakeholders
House Commerce, LOB, Room 302
10:30 HB 298, relative to the Healthy Kids Corporation.
Public hearing
11:15 HB 263, relative to health insurance riders. Public
hearing
Monday, February 12, 2007
Health & Human Services Oversight Committee, LOB, Room 103
1:00 Medicaid
Wednesday, February 14, 2007
House Judiciary, LOB, Rooms 206-206
10:00 HB 40, relative to living wills and durable powers of
attorney for health care. Public hearing
11:00 HB 57, relative to advance directives for durable
powers of attorney and living wills. Public hearing
1:00 HB 244, relative to withholding or withdrawing of
medically administered nutrition and hydration and
developmentally disabled persons. Public hearing
2:00 HB 370, relative to withholding or withdrawal of
life-sustaining treatment. Public hearing
Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA is tracking.
2007 Legislative Updates: