Legislative update

June 2, 2010

No Agreement on State Budget

Legislators ended week-long talks Friday with no agreement on how to balance the state budget for FY 2010 and 2011 after working to restructure the budget through a combination of cuts, revenue enhancements and debt restructuring.

Up until Friday, conferees had agreed on all but $29 million of the $295 million shortfall. Where negotiations broke down was over gambling … the Senate stood by their position of not accepting any new major revenues except for expanded gambling; the House refused to consider gambling, but supports new taxes and additional cuts; while the Governor affirmed his opposition to any bill that would issue gambling licenses before having the appropriate regulatory structure in place.

The Governor will be calling for a Special Session of the Legislature to keep negotiations going until a balanced budget is reached. Should the impasse continue, however, the Governor will have to close the $295 million budget hole relying mostly on budget cuts – only the Legislature has the authority to raise revenues. That would mean severe cuts to health and human services, including Medicaid.

May 18, 2010

NH LEGISLATIVE SESSION NEARLY OVER
Just another two weeks until the New Hampshire Legislature completes its work for the 2010 legislative session. The state’s budget picture continues to worsen as April revenues fell far short resulting in a newly revised budget gap of $300 million for the remainder of the biennium. Legislators are struggling to find new sources of revenues while they attempt to minimize cuts to the state’s health and human services programs. In addition to the budget crisis, NHHA has focused on two Senate bills that examine health costs in New Hampshire.

MEDICAID BUDGET
Medicaid Payments to Hospitals
This time last year, the Legislature crafted a budget for SFY 2010 and 2011 that was based on unrealistic and overly optimistic Medicaid caseload and utilization projections. And as a result, since February of this year the Governor has turned to legislators to approve a series of budget cuts across state government that include suspension of Medicaid hospital payments for catastrophic cases and IME; reductions in interim outpatient rates; and delayed payments on outpatient cost settlements.

Several more rounds of budget cuts have since been proposed through a series of bills that propose a variety of new revenues and additional state agency cuts. As recently as last week, the Senate rejected SB 450, the House package of spending cuts and new revenues and then offered its own plan to close the budget gap by amending HB 1128. In contrast to the House version, new taxes are gone in the Senate plan to be replaced by a scaled-back plan to expand gambling in the state. For hospitals, HB 1128 is an improvement over SB 450 … the Senate solution prohibits the suspension of Medicaid indirect graduate medical education and catastrophic payments to hospitals. Also gone are the professional rate reductions of $3.9 million. However, it appears that the Senate retained the House proposal to reduce the cap on outpatient hospital service visits from twelve to six visits per year for a “savings” of $700,000.

The House could reject the Senate plan and we’re back to square one. Stay tuned.

HEALTH COSTS
Commission on Health Care Cost Containment
Significant progress has been made on SB 505, establishing the commission on health care cost containment, since its introduction in January as a draconian effort to mandate hospital rate setting for all private payers. The House further amended the bill and the Senate has accepted those changes. SB 505 calls for the creation of a Health Care Cost Containment Commission to study New Hampshire’s health care payment system and recommend cost containment measures. Thanks to hospitals’ grassroots activity, senators were convinced that rate setting is not a solution to the rising cost of health care.  Members to be appointed to the Commission include legislators, representatives of the Citizens Health Initiative, Department of HHS, Insurance Department, experts in health care policy and health care economics, as well as a consumer representative. The Commission must begin to meet no later than September 1, 2010 and complete its work by July 2, 2012.

Public Hearings on Insurance Cost Increases
Last week the House passed its version of SB 392, requiring public hearings concerning health insurance cost increases in health care services, which the Senate is likely to accept. Significant improvements have been made to ensure that the intent of the bill is to examine health insurance premium increases, not health provider costs. These include:

• the removal of language “compelling” health providers to give information or documents to the Insurance Department. Instead, providers may be “invited” to provide relevant information. NHHA worked to ensure that the Insurance Commissioner will have no authority over hospitals.
• clarification on billing limits for uninsured patients. NHHA recommended that this section of the bill mirror the recently enacted federal health reform mandate that hospitals bill uninsured patients “the amount generally billed to health carriers” in a manner consistent with the Patient Protection and Affordable Care Act of 2009. This will ensure that whatever is required by the State of New Hampshire is based on federal rules.

Patients Informed of Charges
Earlier in the session, the House killed HB 1438, relative to a patient’s right to know regarding charges for health care, that would have required healthcare providers to estimate the charges for services – including those for services provided by other health care providers treating the patient such as anesthesia, pathology and radiology. A legislative panel concluded the bill would create an undue burden on providers thereby increasing the cost of care, and is unnecessary due to NHHA’s pricing transparency initiative focused on providing hospital charge estimates to patients.

Patient Medication
The House killed HB 1426, permitting patients to bring their medications to the hospital or health care facility. Legislators agreed with NHHA about potential harm to patients if hospitals were to be required to allow patients to bring medications from home that either cannot be identified, may be damaged due to improper storage, or were obtained from an unknown source over 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. All hospitals have strict processes in place to prevent medication errors and to ensure that the right medication in the right dosage is given to the right patient at the right time.


PRIVACY
Both the House and Senate passed a scaled-down version of HB 1649, relative to health information and patient rights, stripping the bill of the more restrictive consent requirements, with just the audit trail provisions remaining in the bill. As amended HB 1649 provides patients a way 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.


QUALITY
The House and Senate passed HB 1169, relative to the NH Health Care Quality Assurance Commission, reauthorizing the Health Care Quality Commission through 2015. HB 1169 will 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.

TAXES
The Legislature supported NHHA’s position on HB 1583, relative to the property tax exemption for organizations with charitable activities, thus killing the 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. As stated in the Committee report, the definition of charitable organization as defined by the IRS does not confer automatic exemption from property taxes and that it is up to the local authority to determine whether the nonprofit provides charitable services to the community.

MEDICAL LIABILITY
Continued efforts to water down the pretrial screening panel law were thwarted with the demise of three bills that would have restricted those claims subject to review, awarded costs and attorneys’ fees incurred in the panel process, and altered the requirements for extensions of time for hearings. A proposal regarding apportionment of damages was also killed.

 

NHHA’s complete list of bills is available here.