Legislative update

March 19, 2010

Hospital Rate Setting
NHHA and its members continue to be vocal about our opposition to SB 505 introduced by Senator Maggie Hassan (D-Exeter) to create a new state government agency for rate setting for all community hospitals in New Hampshire. NHHA President Steve Ahnen and Board Chairman Bruce King testified before the Senate Commerce Committee last week. The media has taken great interest in SB 505 as well, through news coverage and editorials. "Regulating Hospital Rates" was the subject of NH Public Radio's The Exchange last week, featuring studio guests for the hour, Steve Ahnen and Senator Hassan. The Union Leader and Concord Monitor are among the newspapers which have published opinion pieces against the bill.

Later in the week the Commerce Committee authorized the following three provisions to be included in an amended version of SB 505 that Senator Hassan plans to introduce next week:

• Rate Setting: Rather than rate "approval" authority, a Rate Commission would establish "recommended" rates, and therefore affording the public an opportunity to compare the commission’s recommended rates to hospital charges.
• Certificate of Need (CON): Require the commission to consider the recommendations of the HB 234 CON study committee (whose work is not yet complete) and recommend legislation to integrate CON into the commission's work.
• State Health Plan: Require the commission to develop a state health plan.

An amendment is not yet available, and despite a deadline to vote SB 505 out of the Senate by March 10th, the vote has been delayed until March 24th. NHHA remains opposed to any amendment that provides for a paid 3-member ‘PUC’-like commission.

Proposal to Restore Medicaid Funds for Hospitals
NHHA provided testimony before the Senate Finance Committee in support of Senator Kathy Sgambati's (D-Tilton) amendment to SB 489 to restore Medicaid funding - $50 million - for a variety of health and social services programs that were cut last month. SB 489 is Senator Lou D’Allesandro’s (D-Manchester) attempt to introduce gaming in New Hampshire to raise new revenues. NHHA asked to specifically dedicate a portion of gaming revenues to restore hospital rates to the level they were at when the Legislature passed the 2010/2011 budget. In terms of State general funds, NHHA urged senators to restore $2.5 million in FY 2010 and $10 million in FY 2011. By not restoring these funds, New Hampshire stands to lose federal funds of $3.8 million in FY 2010 and $10.8 million in FY 2011. The Senate Finance Committee voted yesterday to recommend passage of SB 489 including the Sgambati amendment.

More Medicaid Cuts to Come
Last month Governor Lynch announced a projected shortfall of $140 million in state general funds through the end of fiscal year 2011 related to lagging revenues, increased demand for state services and the Supreme Court’s decision regarding the JUA. Since then state agency heads have submitted plans to the governor’s office to reduce spending by 2 percent for the remainder of FY 2010 ending June 30, 2010 and by 8 percent for FY 2011. HHS Commissioner Nick Toumpas reports his department’s proposed spending reductions will be $15 million in FY 2010 and $70 million in FY 2011.

The House Finance Committee voted unanimously this week on HB 1664 to recommend budget cuts of approximately $47 million throughout state government. This is part of the legislature’s efforts to balance the state budget, reported to be $140 million in the red.  Included in the cuts are Medicaid IME payments ($1.4 million general funds and $1.4 million federal funds and catastrophic aid payments ($794,000 general funds and $1.2 million federal funds) to hospitals in SFY 2011 (beginning July 1, 2010). The committee rejected a proposal to cut outpatient payments to Critical Access Hospitals to 85% of allowable costs - $2.8 million (state and federal funds).

DHHS proposed the same IME and catastrophic aid cuts approved by the legislative Fiscal Committee last month. This week’s action would codify in statute the February cuts and employs the term “suspension” versus “elimination” of payments through June 30, 2011, thereby retaining these items on the books for the future.

Health Costs
The Senate Commerce Committee has recommended an amended version of SB 392 for passage “requiring public hearings concerning health care cost increases in health care services”. SB 392 would allow the Insurance Commission to “compel” health care providers and insurance carriers to provide information for the purpose of studying health cost drivers and cost trends in New Hampshire. Hospitals oppose SB 392. There is no rationale stated in the bill as to what type of information hospitals and payers would be required to submit, and it oversteps the Department of Health & Human Services’ authority to regulate hospitals.

The fate of SB 392 rests on the outcome of SB 505 (see “Hospital Rate Setting” above), as both bills seek to address health care cost drivers. Hospitals have urged their senators to vote against passage of SB 392.

Privacy/Health Information
HB 1649, relative to health information and patient rights:  The House passed a much improved version of HB 1649 that stripped the more restrictive consent requirements, with just the audit trail provisions remaining in the bill. As amended, HB 1649 provides patients a means to check whether someone they identify has had access to their electronic medical records during a specified period within the previous three years. It requires medical providers to examine any audit trail associated with the patient’s record and to report whether the identified person had access or not and to what extent. This is consistent with current practice at many New Hampshire hospitals. A hearing on HB 1649 is scheduled for March 23 before the Senate HHS Committee.

Quality
HB 1169, deleting the repeal of the NH Health Care Quality Assurance Commission: The House passed HB 1169 reauthorizing the NH Health Care Quality Commission through 2015. HB 1169 would allow the Commission to continue to bring hospitals and ASCs together to promote initiatives and share best practices to enhance patient safety. The bill adds a governor-appointed “member-at-large” to the Commission, and requires the Commission to report annually to the Joint HHS Oversight Committee, in addition to legislative leadership.

Other
A number of bills NHHA opposed have been killed including:

• HB 1583, relative to the property tax exemption for organizations with charitable activities: NHHA opposed this bill which would have inserted a financial means test to be applied in the determination of a not-for-profit's tax exemption for charitable purposes. According to the House Local & Regulated Revenues Committee, the definition of charitable organization as defined by the IRS does not confer automatic exemption from property taxes and that it’s up to the local authority to determine whether the nonprofit provides charitable services to the community.
• HB 1349, relative to requirements for pharmacists in charge which would have restricted experienced pharmacists from out-of-state to be employed as pharmacists in charge.
• HB 1438, relative to a patient’s right to know regarding charges for health care which would have required health care providers to provide, upon request of the patient, an estimate of the charge for services to be provided including cost variances due to the patient’s health status, discounts and procedure codes, as well as the patient’s cost-sharing requirements and pre-certification requirements. NHHA is committed to providing meaningful price information, and is working with hospitals to post their top diagnostic services and associated charges.
• HB 1426, permitting patients to bring their medications to the hospital or health care facility: This bill presented significant patient safety concerns if hospitals were to be mandated to allow patients to bring medications from home that either cannot be identified, may be damaged due to improper storage, or obtained from an unknown source on the internet. While some hospitals allow patients to bring their own medications to the hospital under very limited and controlled circumstances, this practice is best left to the discretion of each facility.
   

NHHA’s complete list of bills is available here.