LEGISLATIVE UPDATE

During its deliberations the Senate had been poised to eliminate hospital catastrophic aid payments, indirect medical education payments, and an increase in payments for specialty neonatal and pediatric services at the Children’s Hospital at Dartmouth. All three were restored, though CHaD payments were scaled back from the House-passed $3.5 million to $1 million per year, and enhanced maternity payments were limited to only those hospitals located in Coos County. We’re also concerned about the Senate’s $2 million cut to the Judiciary which, if adopted in the final budget, will spell the end of pretrial screening panels for medical malpractice cases for the next two years

Unlike the House version, the Senate budget includes revenues from expanded gambling, suspension of the business enterprise tax (BET) credit against the business profits tax (BPT), increased fees, and increased tobacco and rooms-and-meals taxes. The House budget relies on capital gains and estate taxes. However, one area on which both the House and Senate agree is the raid on the JUA medical malpractice funds of $110 million.

We’re very disappointed that budget conferees are continuing to rely on major cuts to hospitals through the Medicaid program as a means to balancing the State’s budget, especially when New Hampshire will be receiving $250 million in stimulus/FMAP funds. We have serious concerns that the proposed budget will not adequately fund Medicaid due to overly optimistic caseload estimates understating the growing number of people who will become eligible for Medicaid and their demand for health care services.

Victory on Privacy
The Senate killed HB 580 (relative to health information and patient rights), 24-0, the privacy bill that hospitals, healthcare providers and businesses all opposed. Senators heard our concerns that passage of the bill would have compromised treatment and impede the development of EMRs. Furthermore, they were concerned that the bill would conflict with new HIPAA regulations that will be adopted by the federal government later in the year.

Victory on Medical Liability
The Senate killed the pretrial screening panel bill HB 572 (relative to proceedings of medical injury claims screening panels). The vote was a stunning 18 to 6, despite the Senate Judiciary Committee’s recommendation for passage. Senators listened to our concerns that changing the screening panel statute after only two years of panel experience would interfere with two independent studies on the new process to be completed in 2010.

Four other bills designed to repeal or weaken the medical liability statutes were either killed or retained/tabled with no further action this year.

State Prison Medical Costs
SB 185 (relative to rates and charges for medical services to state prisoners) passed the House with changes that require the Department of Corrections (DOC) to pay hospitals and healthcare facilities 110% of Medicare allowable costs for outpatient, as well as inpatient and emergency services. The bill adds “healthcare facilities” to the statute to include ambulatory and specialty facilities, including surgical, rehabilitation, long term, oncology, and dialysis centers. The bill excludes physician practices and community health centers. SB 185, as proposed, would have prohibited the DOC from paying rates higher than the lowest payments received. In other words, the DOC would have been required to pay NH Medicaid rates.

Health Insurance
The House and Senate passed SB 138 (relative to insurance coverage for telemedicine services), despite persistent efforts by the health plans to prevent coverage of telemedicine services. The legislation assures providers that health plans will cover this service.

SB 188 (establishing a commission to study hospital billing practices of health care providers), was amended by the Senate thereby creating a study commission to look into billing practices of hospitals and hospital-owned facilities. The intent of the original version of SB 147 was to require hospitals to bill using only the CMS 1500 for all services provided outside the four walls of the main hospital building. Despite the sponsor’s intent to assure equivalent charges for co-pays and deductibles regardless of the provider setting, the heart of the issue seemed to have been that health insurers’ systems are not appropriately programmed to distinguish among various types of service providers and settings, e.g. urgent care and emergency care.

In addition, the House killed HB 359 (requiring health care provider bills to state the portion of payment covering costs of the uninsured).

Quality and Patient Safety
The House and Senate passed the adverse events reporting bill – HB 592 (relative to adverse events in hospitals and ASCs), requiring hospitals and ambulatory surgery centers to report adverse events to the DHHS beginning January 1, 2010. The bill requires facilities to report on any of 28 adverse events listed in the bill and include a root cause analysis and corrective action plan. This bill is part of a national trend of states requiring adverse events reporting.

The House and Senate passed HB 433 (funding the law requiring reporting of hospital infections). The state will assess hospitals a fee based on their inpatient average annual census, however no fees will be assessed until the Department of HHS adopts rules on such rates.

Uninsured Data Collection; Uncompensated Care Pool
SB 158 (establishing a commission to study the creation of an uncompensated care fund) has been retained by the House HHS Committee. This bill would have required a commission to consider the design and operation of an uncompensated care fund. However, this issue has been addressed in the Senate’s version of the budget – with responsibility placed on the HHS Commissioner to convene a workgroup to study uncompensated care (Medicaid disproportionate share hospital (DSH) funds.

SB 147 (relative to the data collection practices of health care providers and relative to the development of an uninsured healthcare database.) The House passed SB 147 requiring hospitals and community health centers to submit data to the State on care provided to uninsured patients by hospitals, providers employed or “legally controlled” by a hospital, hospital-owned physician practices, and community health centers. The Departments of Health & Human Services and Insurance will develop the uninsured healthcare database into which the provider data will be inserted. The State will employ the Uniform Hospital Discharge Data Set (UHDDS) for inpatient and outpatient hospital data, however, hospitals will be required to report data on behalf of hospital-owned or controlled providers that are not captured by UHDDS. NHHA has been working with legislators and stakeholders to help them understand the complexities associated with the latter reporting requirements. Reporting will not be required until rules are promulgated and no earlier than January 2010. The bill returns to the Senate for its concurrence with the House changes.

Certificate of Need
The House and Senate passed HB 234 (establishing a committee to study the CON process.) The committee is charged with studying the entire certificate of need statute (RSA 151-C), including the standards of need, procedures, board membership, services regulated and financial thresholds. The committee’s report will be due February 2010.

NHHA’s complete list of bills is available here.