LEGISLATIVE UPDATE

February 18, 2009

The State Budget (HB 1) is front and center since the Governor presented his budget proposal last week.  Additional Medicaid budget reductions include specific hospital cuts including:
§         Continuation of the November 2008 outpatient hospital rate cuts:

o        $27.9 million in 2010

o        $30.4 million in 2011 

§         Continuation of the November 2008 inpatient hospital rate cuts:

o        $6.9 million in 2010

o        $6.9 million in 2011

§         Future hospital rates frozen

§         Elimination of direct graduate medical education payments

o        $877,000 in 2010

o        $877,000 in 2011 

§         Reduction of indirect medical education payments

o        $106,000 in 2010

o        $214,000 in 2011

NHHA is awaiting additional details on the budget from the Department of HHS. The House Finance and Ways & Means Committees will hold hearings on the budget in three locations around the state:
March 9: Salem High School, Salem – 6:00 pm
March 12: River Valley Community College, Claremont – 6:00 pm
March 16: White Mountain Regional High School, Whitefield – 6:00 pm

Medicaid
HB 30: Hospitals are targeted by the Governor, the House and Senate for another round of cuts NHHA estimates at $4 million through June 30, 2009.  HB 30 attempts to prohibit hospitals from billing the NH Medicaid program for provider-based physician services by codifying into NH statute what is now a defunct federal Medicaid rule, thanks to the federal stimulus package. The House Finance Committee is digging into the matter to determine the true impact of HB 30 on hospitals and to work out the disparities between hospitals and DHHS in our projections

Quality and Patient Safety
A hearing on the adverse events reporting bill, HB 592 was held yesterday.  Modeled after the Minnesota reporting law, HB 592 would require hospitals to report to DHHS any of 28 adverse events along with their root cause analysis and corrective action plan.  The bill also requires DHHS to publish an annual report describing, by facility, the adverse events reported.  Our efforts on this bill will focus on hospitals’ continued collaborative efforts to improve quality and patient safety through the NH Quality Commission.   A subcommittee of the House HHS Committee will work on the bill over the next few weeks (Rep. Bob Bridgham (Eaton Center), Tom Donovan (Claremont) and Susan Emerson (Rindge).

The House passed HB 40 to establish the HHS Commissioner’s authority to impose sanctions on hospitals that fail to report infection rates.  NHHA testified that the legislation is not needed, as all New Hampshire hospitals are collecting infection data as of January 1, 2009, and will be submitting their first reports to DHHS by May 31, 2009.  The bill leaves it to the discretion of the HHS Commissioner to take any action.

HB 433 proposes to fund the DHHS hospital infection reporting program.  In anticipation of being turned down for funding, the bill’s sponsor offered an amendment to the bill that would impose an annual fee on hospitals that would be used to fund the program.  However, DHHS is already carrying out the infection reporting program without additional funds.  NHHA is on record in opposition to the amendment.  There’s been no activity on HB 433 in the House Finance Committee.

Privacy
NHHA is closely following three bills that are nearly identical to the privacy bill that failed last year.  The most problematic of the three is HB 580, “relative to health information and patient rights,” which imposes restrictions on the use of electronic medical records; allows for individual patients’ opt-out for disclosure of personal health information; and requires providers to provide audit trails (the entire audit report) to patients upon request.  NHHA will continue to work with our partners (NH Medical Society, BIA insurers, counties, and many more) to oppose such restrictions.  The hearing on  HB 580 will be held March 5^th.

HB 542, “relative to health information exchange,” is proposed as a placeholder in the statute to accommodate a future HIE entity; and HB 619, “relative to medical records and patient information,” redefines HIPAA’s definition of marketing and fundraising, and includes a reporting requirement to the Attorney General for unauthorized disclosures by business associates.  Both hearings will be held Thursday, February 19^th.

Health Insurance
SB 63, “relative to ensuring consumer access to care upon the termination of a participating provider,” requires insurers’ Network Adequacy reports to be available to consumers and employers so they can make informed decisions about the health insurance coverage and provider networks that they purchase.  Currently, network adequacy reports are not readily accessible to the public, and if the carrier so wishes, are not accessible at all.  NHHA supports this bill.  The Senate HHS Committee recommended the bill for passage.

Senator Jackie Cilley will be introducing a bill, “relative to standardizing health insurance claim forms.”  The bill would prevent hospitals from billing carriers using the provider-based methodology.  The health plans are attempting to stave off future billing practices.  However, NHHA asserts that this issue should be addressed by the carriers through the contracting process – and not in state law.

Health Care for the Uninsured
Senator Maggie Hassan has reintroduced legislation from 2008, SB 147, “relative to data collection practices of health care providers,” requiring healthcare providers to submit to the state ‘pseudo’ claims for services provided to uninsured patients.  This claims data would be integrated into the state’s Comprehensive Health Information System.  We opposed this bill last year due to the excessive burden this bill would place on providers.  NHHA and member hospitals have been meeting with DHHS and Insurance Department representatives and other stakeholders, and so far have been successful in convincing the state to accept the new UHDDS data instead of pseudo claims. A hearing on SB 147 will be held March 3^rd.

Senator Hassan has introduced a companion bill, SB 158, “establishing a commission to study the creation of an uncompensated care fund to provide payments to certain healthcare providers.”  Members of the commission would include NHHA, the NH Medical Society, HHS Commissioner, Insurance Commissioner, the Endowment for Health, Citizens’ Health Initiative, legislators, insurance carriers, and other provider representatives.  While NHHA is not generally opposed to study commissions, the commission’s charge as stated in the bill is to create an uncompensated care fund to pay healthcare providers who serve a disproportionate share of uninsured patients.  Note that the creation of such a commission would be based on the premise that healthcare charitable trust assets be allocated to entities outside the trust’s service area.  Furthermore, this approach undermines the heart of New Hampshire’s community benefits statute which recognizes that each community is unique with its own specific health needs. A hearing is scheduled for March 17^th.

Medical Liability
A slew of bills have been introduced designed to weaken the laws that require pretrial screening panels in medical liability actions. HB 50 would repeal the entire screening panel statute.  HB 203 would retain the law but eliminate the requirement that the judge present unanimous findings of the panel to the jury.  HB 572 would make pretrial screening panels optional.  NHHA is working with the Business & Municipal Coalition to Preserve Fairness to defeat these bills.

Certificate of Need
The House passed HB 234, establishing a committee to study the CON process. NHHA supports this bill, which stems from last year’s efforts to authorize the CON Board to adopt an expedited review process for routine capital projects that exceed the capital threshold.  The bill now moves on to the Senate.

The House passed HB 113, extending the moratorium on nursing home and rehabilitation hospital beds. The bill, however allows for a CON for construction or renovation to repair or refurbish an existing facility or to accommodate transferred beds to an existing facility.

A complete list of bills NHHA is following is available at www.nhha.org/nhha/state_law/bills.php.  Go to http://www.gencourt.state.nh.us/bill_status/ to view the list of bills NHHA is tracking.