NHHA LEGISLATIVE UPDATE
February 15, 2008
Privacy of Health Information
HB 1587, relative to patient health care information.
This
bill seeks to expand the scope of federal laws regulating
health information and to bring enforcement of health
privacy laws within state jurisdiction. Though the intent is
to give patients more control over information in their
medical records, in practice, the provisions in this
legislation could interfere with the efficient delivery of
care, create confusion among medical office workers and
patients, and diminish the quality of patient care provided
to New Hampshire’s citizens.
Patients are entitled to privacy, particularly with respect
to their personal health information. An appropriate balance
must be achieved between the protection of privacy and
factors such as coordination of care among providers,
potential impact on the use of electronic medical records,
and inconvenience for consumers and their families.
HB 1587 is currently in the House Health & Human Services
Committee. The complexity of the proposed language under
consideration poses substantial operational impacts on
health care services. Small providers, in particular, will
be hard-pressed to comply.
This is a very complex bill that
deserves more time for study. NHHA and other healthcare
provider groups, including county nursing homes, physicians,
home health providers, and dentists, have shared our
concerns with the Committee. In addition to providers,
others opposed to the bill are the Business & Industry
Association, the NH Health Information Management
Association, and the Medical Group Management Association.
Our position on health privacy is:
· The Health Insurance Portability and Accountability Act (HIPAA) provides the right balance of privacy of and access to critical health information for the patient.
· Imposing stricter or contradictory HIPAA language in New Hampshire will have serious implications on the care and treatment of patients.
· Imposing stricter or contradictory HIPAA language in New Hampshire will cause major operational and financial burdens on all healthcare providers.
State Budget Woes
Since Governor Lynch announced a $50 million
deficit for SFY 2008, agency heads have been busy
identifying where to cut their budgets. The Joint
Legislative Fiscal Committee is expected to hear what the
Governor proposes as budget cuts for the remaining four
months of the current fiscal year.
HHS Commissioner Nick Toumpas has been instructed to
recommend over $21 million in cuts to DHHS programs. What’s
more, with every dollar cut in the Medicaid program, the
state loses another dollar in federal matching funds. We’re
told that outpatient hospitals payments are at risk, even
though enrollment and utilization of these services are
significantly higher than was projected when the budget was
passed last year.
Statewide, hospitals are paid approximately 56 percent of
what it costs them to provide care. To further penalize
hospitals that are already subsidizing the state’s Medicaid
program is wrong. The state has an obligation to pay a
reasonable amount for these services.
Certificate of Need (CON)
Senator Betsi
DeVries (D, Manchester) is expected to introduce a bill that
would establish an expedited process for Certificate of Need
reviews, raise capital expenditure thresholds, and provide
certain exemptions from the review process. The proposed
bill would single out urgent care centers and permit
the offering of this service with no CON review if the cost
of the project is less than $3 million (up from $1.8
million).
The bill
would also create an expedited review process for
refurbishments, and exempt repairs and maintenance projects
from CON review. Hospitals support the development of a
process to allow for a more streamlined review of projects
which are solely for the purpose of repair and maintenance
within an existing facility. We also believe that
capital projects, the sole purpose of which is energy
improvement, pollution control, or conservation of natural
resources, should be exempt from review. However,
legislation is not needed to implement these changes, which
can be achieved through rulemaking.
Hospitals do not support de-regulation of health care
services. The creation of carve-outs for certain services
and increases in capital threshold levels are surefire ways
to virtually eliminate oversight of the health care system
by weakening the CON statute to mere window dressing.
Hospitals neither support a carve-out for urgent care
centers, nor an increase in threshold levels for any
services. Urgent care centers should be examined as any
other outpatient service using the current threshold level.
NHHA recognizes that delivering health care is not business
in the conventional sense. There is not a level playing
field among competitors in the market because some
providers, but not others, are required to provide free care
to low income patients, at a loss, or to make services
available in locations or at times which would not be
prudent from a strictly business perspective. Therefore,
NHHA supports continuation of a robust CON regulatory
program which applies equally to everyone offering or
proposing to offer healthcare services.
Affordable Health Insurance and the Uninsured
Last year, the
Legislature created several commissions to study ways to
provide health insurance to the uninsured in New Hampshire.
The HB 305 Task Force on Affordable Health Insurance
continues its work to develop legislation for 2009. In
addition, several bills have been introduced this year to
address the cost of health care for the uninsured.
One bill, HB 1195, relative to health care provider reimbursement for services provided to uninsured patients, would require providers to accept as payment in full from uninsured patients the average payment they receive from by health insurers. Hospitals and other providers voluntarily provide free care, subsidized care, and discounted care through the NH Health Access Network and Hospital Access Plus. NHHA testified that the problem of the uninsured in New Hampshire requires a more comprehensive solution, currently under study by the HB 305 Task Force on Affordable Health Insurance. Further, it’s likely that this proposal, if enacted, would prompt people to drop their insurance, thus creating a larger uninsured population in the state. A subcommittee of the House Commerce Committee recommended ITL. The full Committee will vote on HB 1195 next week.
A complete list of bills NHHA is following is available at
www.nhha.org/nhha/state_law/bills.php.
Go to
http://www.nhha.org/nhha/state_law/bills.php to view the
list of bills NHHA is tracking.