LEGISLATIVE UPDATE

April 15, 2009

Medicaid – HB 1 and HB 2

The Senate Finance Committee is conducting public hearings this week on the State Budget for SFY 2010/2011. 

Hearings Schedule:
April 14 – Laconia
April 15 – State House, Concord, 5:00 pm
April 16 – Manchester City Hall, 5:30 pm

The House passed its version of the budget last week.  For hospitals, the House:

§          Retained outpatient hospital rate cuts for PPS hospitals.  At 54% of allowable costs that’s a loss of approximately $28 million in 2010 and $30 million in 2011.

§          Retained inpatient hospital rate cuts.  The 10% DRG rate cut translates to a loss of $6.5 million each year.

§          Retained HB 30 outpatient hospital payment cuts of $6.9 million each year

§          Eliminated direct graduate medical education (DGME) at $877,000 each year and IME by $106,000 in 2010 and $214,000 in 2011

§          Reduced hospital catastrophic payments by one-third

§          Increased hospital maternity payments for CAHs in Coos and Grafton Counties by $1 million per year

§          Increased hospital payments to CHaD by $3.5 million per year

§          Rejected licensing fee increases

§          Rejected hospitals’ request to use federal stimulus Medicaid funds to restore hospital cuts.

Billing for Professional Services - SB 188

Hospitals were heard by Senators on SB 188.  They eliminated the entire section of the bill that would have required hospitals to bill on the CMS 1500 for all services provided outside of the four walls of the main hospital building.

SB 188 creates a Commission to "study the billing practices of health care providers and the impact of those practices on the cost and delivery of health care services, including but not limited to the billing methods and procedures used by hospitals and hospital-owned facilities and practices."

The bill is scheduled for a hearing in the House Commerce Committee on April 28^th, 1:00 pm.

Privacy- HB 580

The House passed the privacy bill with problems for health care providers which must be addressed by the Senate.

• The bill gives patients the right to prohibit disclosure of their entire health information for treatment purposes
• The bill states that any electronic medical record system that cannot handle the prohibition on disclosure cannot add any new healthcare providers to EMR systems as of January, 2010. This will impede progress in the advancement of EMRs.
• HIPAA changes contained the American Recovery and Reinvestment Act (ARRA) may conflict with New Hampshire statute once regulations are adopted by the federal government..

 Health Care for the Uninsured – SB 147, SB 158

NHHA has grave concerns about SB 147, “data collection practices of health care providers and the development of an uninsured health care database,” and a companion bill, SB 158, “establishing a commission to study the creation of an uncompensated care fund to provide payments to certain health care providers.”

Though somewhat improved from last year’s proposal, SB 147 will require data submission by hospitals, hospital-owned providers, and community health centers to provide data to the NH Insurance Department on services provided to uninsured patients.  We have succeeded in convincing legislators to accept the new UHDDS data set, rather than requiring hospitals to submit dummy claims or data in some other format.  However, hospital-owned physician services are not captured by UHDDS, and any requirement to submit this data will be costly.  As for CHCs, the Insurance Department offered to bear their cost of data submission.

Although the bill creates a commission rather than propose any immediate action to transfer services away from hospitals and the communities they serve, NHHA is opposed to this study commission.

A hearing on SB 147 will be held Thursday, April 16 in the House Commerce Committee.  A subcommittee of the House HHS Committee is in the midst of work session on SB 158.

Medical Liability

HB 572 proposes to amend the pre-trial medical malpractice panel law by prohibiting live testimony and cross-examination at panel hearings. We believe HB 572 is premature and should be defeated. 

• We oppose this bill because it is a fundamental change to the panel law and would undermine its effectiveness. 
• The Senate should allow time for the final report from the legislative oversight committee that was created when the panel law was enacted in 2005. 
• Chief Justice Robert Lynn is conducting his own review of the panel law and has convened a work group consisting of defense lawyers and plaintiffs’ lawyers. 
• It makes no sense to start making legislative changes to the panel law now.  Wait for the conclusions from the oversight committee, which will be based on insurance and court data, and wait for the suggestions from Judge Lynn’s work group. 

HB 438 proposes to allow medical reports to be submitted in trials as evidence without requiring the author of the report to testify. 

• This would require opposing counsel, if he/she wanted to challenge any aspect of the report, to bear the burden and expense of calling the author as a witness. 
• This is a radical change and would result in a significant burden shift from plaintiffs to defendants in most cases. 
• Defending cases would be even more expensive than it is today, thus increasing insurance rates for everyone. 
• Contrary to what proponents say, this bill will not save money 

Quality and Patient Safety

The House passed HB 592 requiring hospitals and ambulatory surgery centers to report adverse events beginning January 1, 2010. The bill will be heard next in 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.