NHHA
LEGISLATIVE UPDATE
March 1, 2005
The Legislature is taking its mid-winter break this week and
will reconvene on March 7th.
Awaiting their return are an assortment of medical liability
and small group insurance bills, as well as an important end
of life care bill, which proposes to update New Hampshire’s
statute on healthcare decision-making.
Meanwhile, there’s good news from the Senate regarding the
Prompt Pay legislation - SB 78, Relative to Payment of
Healthcare Providers by Health Carriers. The Senate Banks
and Insurance Committee voted unanimously in favor of SB 78,
which strengthens the insurance statute requiring timely
payments to healthcare providers. SB 78 also requires
automatic interest to be paid to providers when payments are
delayed. Under the current law, though health insurers are
required to pay providers within a specific timeframe, many
claims are not paid in a timely manner.
Small Group Health Insurance – SB 110 Reform
Just as the Senate Banks & Insurance Committee settled in for
a full-day hearing on 5 bills designed to fix the problems
created by Senate Bill 110 (small group insurance rating
legislation passed in 2003), a compromise was announced
endorsed by Governor John Lynch, Senator Maggie Hassan
(D-Exeter), Senator Ted Gatsas (R-Manchester) and 11 other
Senators – a sufficient number to ensure passage in the
Senate.
In an effort to undo the damage created by SB 110 – sharp
increases in the cost of small businesses’ health insurance –
Senate Bill 125 was modified to eliminate the medical
underwriting and geographic rating factors for small employer
groups. The bill creates a reinsurance pool for employees with
medical problems costing insurers 2 cents per day per person.
Insurance companies would then be allowed to shift high-risk
employees into the pool after premiums are set, thereby
removing the possibility of discrimination against less
healthy employees.
Still in the mix is Senator Bob Flanders’ bill, Senate Bill
6, which would establish a reinsurance mechanism for small
group insurers that is smaller than the proposed pool in SB
125, as well as remove geographic location as a rating factor
for premium rates.
Three additional bills proposing fixes to problems created by
SB 110 are scheduled for hearings in the House Commerce
Committee on March 15th.
Medical Liability
The House passed legislation to create the New Hampshire
Health Care Quality Assurance Commission responsible for
the collection, analysis and dissemination of quality
assurance information on a statewide basis. This is an
important step in reducing medical errors and improving the
quality of healthcare by allowing medical practitioners to
share data among hospitals statewide. Every acute care
hospital and ambulatory surgical center will be represented on
this new Commission. The Commission may delegate the functions
of data collection and analysis to the Foundation for Healthy
Communities - a nonprofit organization whose purpose is to
improve health and health care, and includes New Hampshire
hospitals, health plans, clinicians, home care agencies and
public policy leaders.
The Senate Judiciary Committee held hearings last week on two
controversial medical liability bills: SB 47, definition of
“party” or “parties” for the apportionment of fault in civil
litigation; and SB 139, admission into evidence of certain
medical bills, reports and records. SB 47 would change the
law regarding joint injury-causers as set forth in a 2003 NH
Supreme Court decision, Nilsson v. Bierman. In most (but not
all) situations in which there are multiple people responsible
for an injury, current law apportions liability for payment
according to each person’s fault. SB 47 would undo what the
Legislature adopted previously in terms of ascribing to
defendants only their fair share of the jury award. Current
law does not need to be changed.
SB 139 would make admissible all kinds of medical records and
reports that currently must be brought in through a witness or
by agreement. Parties work out these issues regarding what
records and reports will be admitted. This practice should not
be changed. This bill would make everything admissible,
thereby making it easier for plaintiffs in some situations,
but may be subject to abuse and create problems with
statements in records that should not be available to juries.
Medicaid & the State Budget
While House and Senate Finance Committees meet to hear State
agencies present their 2006-2007 budgets, the House Health &
Human Services’ GraniteCare Subcommittee continues it sessions
on DHHS Commissioner John Stephen’s GraniteCare proposals to
overhaul the Medicaid program. HB 690 – Medical services
for children and pregnant women – would replace the
Children's Health Insurance Program with capped ‘Health
Services Accounts’ (HSAs) for Medicaid and Healthy Kids
patients. The Committee did not warm up to this proposal, and
members were critical of the lack of details as to how HSAs
and companion incentives would work. The Governor’s budget, on
the other hand, not only maintains the children’s health
insurance program –NH Healthy Kids – but proposes to enroll an
additional 6,000 children in the program.
HB 691, Medicaid and long term care proposes to reduce
Medicaid-covered nursing home admissions by 30% by employing
stricter admission standards. However, shifting the burden to
community-based care will require a significant investment for
more intensive services to be provided in people’s homes. In
addition, HB 691 would extend the look-back period to five
years that permits the state to claim assets that an elderly
person transferred to children; and ten years for transfers of
assets to a trust.
Reporting of Burn Injury Information
The NH State Fire Marshal's Office and the NH Fire Chiefs
Association proposed a burn injury registry bill (HB 574) that
would have required healthcare providers to report all types
of burns to the Department of Safety. Their interest was to
obtain information on incidents for statistical purposes as
well as for investigations.
The New Hampshire Hospital Association and the New Hampshire
Medical Society worked with the Fire Marshal's Office and the
Fire Chiefs Association on a revision to HB 574 limiting
reporting only on those burns that would require
investigation. The House Health and Human Services Committee
voted 16-1 to adopt the amended version of the bill. The House
will vote on HB 574 next week.
Upcoming Hearings:
End of Life – Health Care Decision Making
HB 656, Medical decision making for those adults without
capacity to make health care decisions for themselves.
This bill would update the current laws related to a Living
Will, Durable Power of Attorney for Healthcare (last amended
over a decade ago), and add a component to guide health
providers in honoring the preferences of seriously ill people
who do not want resuscitation attempted.
The hearing will be held March 14th at 10:00.
Medical Liability
HB 463, Evidence of admissions in medical injury actions.
This bill would make certain statements made by providers to a
patient and the patient’s relatives inadmissible as evidence
in a medical injury action. Such statements include
expressions of apology, fault, sympathy, condolence, or
compassion that relate to the discomfort, pain, suffering,
injury or death as the result of an unanticipated outcome of
medical care. In states where statements of sympathy are
inadmissible, fewer lawsuits have been brought because the
incidents are recognized and the patient’s incurred expenses
are reimbursed. The hearing on HB 463 will be held March 14th
at 2:00. NHHA supports HB 463.
HB 473, Screening Panels for Medical Injury Claims.
This bill creates screening panels for the review of medical
injury claims and requires a party who chooses to continue
with a court action after a panel finds against him or her, to
post a $10,000 bond to cover certain potential expenses. The
hearing will be held March 15th at 1:00. NHHA does not support
this bill.
HB 496, Limits on Non-economic Damages in Medical Injury
Actions. This bill limits damages for non-economic losses
to $250,000 in medical injury actions. The hearing will be
held March 15th at 10:00.
HB 584, Evidence of Admissions of Liability in Medical
Injury Cases. This bill is similar to HB 463 but adds a
statement that this provision does not apply to a statement of
fault, negligence, or culpable conduct. The hearing will be
held March 14th at 1:00. NHHA opposes this bill.
HB 648, Frivolous Medical Injury Actions. This bill
requires the plaintiff’s attorney in a medical injury case to
investigate and certify that there are good faith grounds for
the action, and requires mediation in medical injury actions.
The hearing will be held March 15th at 11:00.
HB 702, Screening of Medical Malpractice Claims. This
bill establishes a 3-member panel consisting of a superior
court judge, a doctor, and a lawyer to review medical
malpractice claims. If a finding is made for the defendant,
the plaintiff may pursue the claim through the usual judicial
process only upon filing a $6000 bond. If the bond is not
posted within 30 days of the panel’s finding, the action will
be dismissed. The hearing will be held March 15th at 2:30.
NHHA does not support this bill.
Small Group Health Insurance Reform
HB 77, Geographic location for small group insurance coverage.
This bill eliminates the use of geographic location as a
rating factor for small group insurance coverage.
The hearing will be held March 15th at 11:00.
HB 337, Small group health insurance study. This bill
establishes a committee to study small group health insurance
and the small brokerage health insurance community.
The hearing will be held March 15th at 2:00.
HB 611, Small group insurance. This bill establishes the
small group reinsurance association and a reinsurance
mechanism for small group insurance carriers who may reinsure
eligible employees for cost sharing purposes; changes the
definition of small employer to 2-50 employees; and deletes
geographic location as a rating factor for premium rates for
small group health insurance. The hearing will be held March
15th at 10:00.
Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA will be tracking in 2005. Additional bills will be added as we become aware of them.
