NHHA LEGISLATIVE UPDATE
April 9, 2007
The House will be voting this week on the State’s two-year
$10 billion budget proposal that would fund Medicaid
hospital services at levels that maintain “level” funding
for inpatient and outpatient services and restores medical
education funding for hospitals with resident training
programs.
More good news … the state’s reported revenues are $76
million ahead of last year, thus contributing to a healthy
outlook for the next two years.
The House voted in favor of the two most critical insurance
bills for hospitals that would (1) create a standard
definition of “medical necessity” to which all health plans
must comply, and (2) establish more stringent credentialing
timeframes within which health care practitioners are
approved for participation in each health plan.
The following are highlights from the State House ….
MEDICAID PAYMENTS – PROVIDER-BASED REIMBURSEMENT
The House and Senate are each considering legislation
proposing a legislative study committee to examine current
Medicaid provider-based payment practices and report their
findings by the end of this year. Until the committee
reports its findings, hospitals would continue to bill
Medicaid for hospital-based physician services.
MEDICAID – STATE BUDGET
The House Finance Committee has completed its work on the
budget which moves on to the full House this week for
passage. The Committee recommended full funding of Medicaid
IME and DGME (medical education) payments at $4.4 million
per year. These payments are critical to maintaining the
current level of services provided to Medicaid patients at
New Hampshire’s teaching hospitals. This action affirms the
Legislature’s commitment to support this portion of the
safety net.
House Finance also recommended the full funding level for
hospital services proposed by the Governor. This is a first
in a number of years with no cuts to hospital inpatient and
outpatient services.
HEALTH INSURANCE
The House has supported two of NHHA’s key bills for this
session. The Medical Necessity bill, HB 228 standardizes the
definition of medical necessity so that all health plans
will adhere to the same standards. Next stop – Senate
Commerce Committee.
The House passed our Credentialing bill, HB 636, requiring
health plans to (1) finalize physician credentialing within
30 days (for primary care) and 45 days (for specialists);
and (2) pay physicians for on-call coverage under limited
circumstances. Both bills will soon be heard in the Senate
Commerce Committee.
The Senate passed legislation this week requiring health
plans to pay for lay midwife services in any setting.
Current law limits payment to services provided in a health
care facility. NHHA is already on record as opposing lay
midwife scope of practice regulations in those cases where a
home birth with complications is not transferred to the
hospital in time and results in a very bad outcome for which
the hospital becomes responsible, especially in VBAC cases.
We’ll oppose SB 131 in the House.
CERTIFICATE OF NEED
The Senate Health Committee retained SB 114 that would have
exempted certain ambulatory surgery center providers from
CON regulatory oversight. NHHA opposed this bill on the
grounds that it undermines the Legislature’s repeated
affirmation of the state’s “compelling interest” in setting
standards relative to the size, type, level, quality and
affordability of health services offered.
By retaining the bill, there will be no further action on SB
114 until January 2008 at which time, alternative CON reform
provisions may be offered.
The House gutted HB 727 that proposed to require hospitals
applying for a CON to affirm the provision of health
insurance by the construction project’s contractor for their
workers. Instead, the bill creates a commission to study the
issue of health coverage offered by building contractors
working for all types of non-profit organizations as well as
municipalities. The reference to CON has been removed, and
NHHA is named to sit on the committee.
MEDICAL LIABILITY
NHHA opposes HB 143 which would upset the current balance of
our tort system with regard to settlements and payment of
judgments. If enacted, the bill will unfairly punish
defendants with “deep pockets” regardless of their degree of
fault in a multi-defendant case. Current law allows
plaintiffs to receive compensation for their losses from the
at-fault parties, and defendants who are less than 50% at
fault are not unfairly responsible for the actions of
others. HB 143 affects hospitals, homeowners, towns, cities,
restaurants, ski areas, builders, schools and businesses of
all types and sizes. And the bill makes it more likely that
those with assets or insurance would pay more than their
fair share.
WORKFORCE/PROFESSIONAL
The House killed several workforce bills that would have (1)
required the passage of 10 hours before any employee is
required to return to work; and (2) prohibited employers
from requiring employees to work Thanksgiving and Christmas.
The House, however, passed HB 797 prohibiting mandatory
overtime for nurses and nurse assistants except under
certain circumstances. NHHA opposed this bill even though
hospitals don’t mandate overtime. We supported efforts to
add more exceptions such as the absence of a subsequent
worker; and any situation where the purpose of the overtime
is to prevent imminent harm to a patient. We’ll be working
with the NH Nurses Association, NH Health Care Association,
Home Care Association of NH, and others to pass a more
reasonable version in the Senate.
Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA is tracking.
