Legislative update

March 29, 2010

Health Care Costs
Last week the New Hampshire Senate voted to overhaul Senator Maggie Hassan’s (D-Exeter) hospital rate setting bill, SB 505, establishing the commission on health care cost containment and appropriating a special fund … from a rate setting commission to a study commission with a broader focus than just hospitals. Though the bill still needs more work, the changes so far are a significant improvement due to Senators’ reluctance to vote for something their local hospitals could not support.

SB 505 now moves to the House for further consideration. NHHA will work to ensure that the language creating this new cost containment study commission reflects the commitment made by Senators for a much broader focus.

The Senate passed a related bill, SB 392, requiring public hearings concerning health care cost increases in health care services and relative to hospital billing for services to uninsured patients, which would set up a process in which health plans and providers are required to come before the insurance commissioner to justify their rate increases. As it’s currently drafted, there is no context for what information the insurance commissioner would be seeking nor how it will be used to assess costs. Hospitals will continue to oppose this bill as it moves to the House, particularly in light of the passage of SB 505 which will study the same issues.

There was a last minute adoption of an amendment to SB 392 related to limits on what uninsured patients could be charged by hospitals. This was a provision that was part
SB 505, but removed as that bill was further amended. Its utility is completely overshadowed by the provision in the federal health care reform bill that was signed into law by the President last week, which limits what hospitals can charge to patients qualifying for charity care to the best discount offered to those patients with private insurance. Therefore this provision is unnecessary.

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.

Privacy/Health Information
The Senate Health & Human Services Committee voted last week to recommend passage of HB 1649, relative to health information and patient rights as passed by the House. HB 1649 would provide patients the ability 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.

Proposal to Restore Medicaid Funds for Hospitals
Last week the Senate passed SB 489 that would introduce gaming in New Hampshire to raise new revenues. The bill includes a provision to restore Medicaid funding - $50 million - for a variety of health and social services programs that were cut last month. NHHA has asked legislators to restore hospital rates to the level they were at when the Legislature passed the 2010/2011 budget … general funds $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. SB 489 goes to the House Local & Regulated Revenues Committee for a hearing on Tuesday, March 30th.

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 tabled HB 1664, which recommended budget cuts of approximately $47 million throughout state government. Included in the cuts are Medicaid hospital IME (indirect medical education payments ($1.4 million general funds and $1.4 million federal funds and hospital catastrophic aid payments ($794,000 general funds and $1.2 million federal funds) to hospitals in SFY 2011 (beginning July 1, 2010).

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.

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.

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.