Legislative Update
March 31, 2003

Steep Medicaid Budget Cuts to Hospitals Still on the Table

The House Finance Committee continues its work on Governor Benson’s $2.8 billion budget, with Finance Chairman Neal Kurk stating that the Benson administration may have underestimated the cost of Medicaid services by as much as $40 million.  The Benson budget provides room for neither health care cost inflation nor rising utilization of health services.  NHHA’s analysis of the Medicaid budget cuts reveals that, in addition to the 5% across-the-board reduction for all Medicaid providers, hospitals would be burdened with an additional 15-17% cut if payments for catastrophic cases (such as neonatal intensive care unit cases), capital costs and medical education costs are eliminated.  Budget details are being worked on as the Finance Committee nears its April 10^th deadline. 

Read the Concord Monitor article on the impact of budget cuts on health care

Certificate of Need – House and Senate Bills Conflict

The Senate will vote this week on SB 163, recommended for passage by the Senate Finance Committee. SB 163 updates the CON statute and features a provision to require CON review of medical equipment acquired through operating leases.  NHHA supports SB 163 as introduced.  HB 788, which NHHA opposes, is scheduled for a House vote on April 10^th.   NHHA opposes HB 788 because it abolishes the Health Services Planning & Review Board, and transfers the review of capital projects to the Commissioner of the Department of HHS.  In addition, HB 788 eliminates review of all outpatient services, thereby limiting regulatory oversight to inpatient settings, except for ambulatory surgery centers proposed for rural hospital service areas. 

Medical and Hospital Liability Insurance – Loss of Opportunity

Senate Bill 119 will be heard this week (April 1^st) before the Senate Insurance Committee.  NHHA supports SB 119 and is working with a broad coalition of providers, insurers, and businesses to ensure that the Loss of Opportunity doctrine is kept out of New Hampshire statute.  The Loss of Opportunity doctrine, if not specifically removed from the law, allows patients to recover compensation for a new type of "injury" --  the loss of opportunity for a better outcome.  Under traditional legal principles, a plaintiff could recover damages only if the plaintiff could prove through expert testimony that the plaintiff's medical provider was negligent and proximately caused a tangible injury, such as premature death, disfigurement, loss of some bodily function or some other identifiable physical injury.  The loss of opportunity doctrine expands the definition of "injury," allowing for recovery of damages if the plaintiff can prove merely that the patient would have "done better" if the patient had received proper care.  Thus, in a loss of opportunity case, the injury is the difference between the chance the patient would have had if there were no negligence, as compared to the reduced chance the patient had because of the negligence. 

More on Medical Liability …

Medical liability is addressed in several other bills introduced this legislative session. Last week, the House passed House Bill 776, which grants immunity from civil liability to a physician who provides emergency medical care to a pregnant woman who the physician (or any member of his/her practice) had not previously cared for.  This bill protects the physician from liability for injuries caused by the medical care provided prior to the physician’s rendering of the emergency obstetrical care.  HB 776 now moves on to the Senate.

The House passed a series of bills addressing medical liability including House Bill 287, creating a malpractice claims commission, to study the professional malpractice claims panel under RSA 519-A and determine how this panel can be used to control the cost of liability insurance.  Two of the 18 members will represent hospitals.  House Bill 293 creates a commission to identify medical errors and their causes.  Its findings and recommendations will be due December 2005.  House Bill 296 prohibits the enforcement of any portion of a settlement agreement in a medical injury action that prevents the disclosure of relevant information to the appropriate state medical licensing board.  All three of these bills now move on to the Senate.

NH Poison Control Center

House Bill 280 provides for a sustainable funding mechanism to support the continuation of the statewide Poison Information Center, currently operating out of the Dartmouth Hitchcock Medical Center.  Although current state law places the responsibility for the poison information center with the Department of Health & Human Services, DHMC has for years borne the financial burden of supporting the center.  HB 280 requires the Insurance Commissioner to assess each health insurer in proportion to the number of  its covered lives.  The Commissioner of Health and Human Services will designate a statewide Poison Information Center which meets the certification standards of the American Association of Poison Control Centers.  HB 280 is currently in the House Finance Committee.

Reserved Medical Student Slots at Dartmouth

House Bill 677 was introduced to secure additional medical student slots for New Hampshire residents and create a loan forgiveness program in an effort to attract residents trained as physicians to practice in underserved areas of the state.  The loan forgiveness program may be funded by the Dept of HHS and “any community benefits matching or pooled funds … pursuant to RSA 732-c through 732-l”. 

Safe Haven for Abandoned Babies

Both the House and Senate have passed House Bill 104 allowing a hospital or other safe haven (church, police or fire station) to assume temporary care of an abandoned infant under 7 days old.  Within 24 hours after assuming such care, the hospital or safe haven must notify the Department of HHS and local law enforcement. Upon notice, DHHS will be legally responsible for the infant as well as for all medical costs related to the care of the infant.

Further, HB 104 creates an exception to the crime of endangering the welfare of a child when the parent delivers the child to a hospital or safe haven and does not express intent to return for the child.  This bill will become law 30 days after it is signed by the Governor.

Small Group Health Insurance Market Reform 

The Senate will vote this week on Senate Bill 110, recommended for passage by Senate Insurance Committee. NHHA opposes SB 110 for two reasons. First, it dramatically modifies the current community rating structure. NHHA supports community rating, in its current form.  Secondly, many small businesses, especially in the Seacoast and North Country Regions, will be adversely affected. SB 110 would change the current small group employer market by; changing the definition of small employer from 1-100 to 2-50 employees, changing rating factors that change how premium is calculated for the small group market. These factors include changing age bands from 3:1 to 4:1, which will impact the oldest age groups negatively, adding health status rating factors by requiring employees to submit health status questionnaires, using industry and geography in the small group premium calculations. All these changes could result in increased premiums for small employers. 

Medical Records Privacy

The House Commerce committee recently voted to "retain" HB 832, relative to medical records privacy. The intent of this bill is to prohibit the use of medical records information for marketing without the patient's signed authorization. NHHA initially supported the intent of this bill because it appeared to be consistent with the Health Insurance Portability and Accountability Act (HIPAA), but the bill needed additional clarification. During sub-committee sessions, it became clear that the bill's sponsors intended for this legislation to be stricter than HIPAA through a series of amendments that were introduced. In the end, the Commerce Committee decided to "retain" the bill until further notice. NHHA supported the committee's recommendation to retain the bill.