LEGISLATIVE UPDATE

March 6, 2009

Medicaid
The State Budget (HB 1) is front and center for New Hampshire’s hospitals with steep Medicaid budget cuts including:

§         Continuation of the November 2008 Medicaid outpatient hospital rate cuts:

o        $27.9 million in 2010

o        $30.4 million in 2011 

§         Continuation of the November 2008 Medicaid inpatient hospital rate cuts:

o        $6.5 million in 2010

o        $6.5 million in 2011

§         Continuation of HB 30 Medicaid outpatient hospital payment cuts:

o        $6.9 million in 2010

o        $6.9 million+ in 2011

§         Future Medicaid hospital rates frozen

§         Reduction of Medicaid graduate medical education payments

o        $ 983,000 in 2010

o        $1,091,000 in 2011

The House and Senate passed HB 30 enacting yet another round of Medicaid cuts that will cost hospitals $4 million through June 30, 2009.  HB 30 prohibits hospitals from billing the NH Medicaid program for provider-based physician services.  However, a House Finance subcommittee is continuing to study this payment issue to determine the impact of HB 30 on hospitals and to consider an appropriate and fair method of Medicaid payment for hospital-operated physician services for 2010 and 2011.

Quality and Patient Safety
The House Health & Human Services Committee is currently working on a bill requiring hospitals to report “adverse events”.  Modeled after a Minnesota law, HB 592 would require hospitals to report to the Department of Health & Human Services (DHHS) any of 28 adverse or “never” events. The bill requires DHHS to publish an annual report describing, by facility, the adverse events reported.  In our testimony, NHHA highlighted hospitals’ ongoing efforts to prevent adverse events, and noted that such a reporting system is just one piece of a broader initiative to improve quality of care.  Hospitals will comply with the law should it pass.

Privacy
Hospitals are closely following HB 580, “relative to health information and patient rights.”  Hospitals oppose HB 580 because of the excessive restrictions it imposes on the use of electronic medical records. HB 580 goes far beyond HIPAA, the federal privacy law, and if enacted would put New Hampshire out of step with the rest of the nation.  Hospitals are very concerned that

HB 580, if passed will tip the balance in such a way as to create problems by impeding healthcare practitioners’ access to critical health information necessary for the delivery of safe patient care.

Health Care for the Uninsured

SB 147, “relative to data collection practices of health care providers,” would require 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.  Hospitals are working with the NH Insurance Department and the Department of Health & Human Services to craft an amendment to the bill that would achieve the intent of SB 147 – to  understand the use and frequency of health care services by New Hampshire’s uninsured citizens – while minimizing the burden placed on healthcare providers to create claims for uncompensated services.

SB 158, “establishing a commission to study the creation of an uncompensated care fund to provide payments to certain healthcare providers,” is a companion bill to SB 147. The commission’s charge, as stated in the bill, is to create an uncompensated care fund to pay healthcare providers that serve a disproportionate number of uninsured patients.  The creation of this commission would be based on the premise that a hospital’s assets be allocated to entities outside the hospital’s service area.  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.

Medical Liability
A number 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.  Hospitals are 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 Certificate of Need (CON) process. Hospitals support 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.

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.