Legislative Update

October 31, 2005

NEW HAMPSHIRE LEGISLATURE RESUMES ITS WORK ON HEALTH CARE ISSUES

· Legislative Study Committees
· Bills Held Over from 2005 Session

STUDY COMMITTEES AND COMMISSIONS
Health care related study committees and commissions created by 2005 legislation have been meeting over the past few months. Topics addressed by these groups include quality assurance, medical malpractice, Medicaid payments to hospitals, and joint purchasing alliances for health insurance. The various committees and their progress to date are described below.

The New Hampshire Health Care Quality Assurance Commission was formed to reduce medical errors and improve the quality of healthcare by allowing medical practitioners to share data among hospitals statewide. The Commission is responsible for the collection, analysis and dissemination of quality assurance information statewide. Quality of care issues to be reviewed include medical errors, unexpected adverse outcomes and near misses, and proposed changes to improve health care.

All New Hampshire acute care hospitals and freestanding ambulatory surgical centers are represented on the Commission. The functions of data collection and analysis have been delegated to the Foundation for Healthy Communities. The Commission held its first meeting September 16th.


The Medical Malpractice Panel and Insurance Oversight Committee was formed as part of the legislation (Senate Bill 214) that mandates pretrial screening panels in medical injury claims. Intended to encourage quicker settlements and lower legal costs, SB 214 includes three provisions: (1) panels are mandatory; (2) an appropriate standard of proof is met by the plaintiff; and (3) unanimous panel findings are admissible at trial. The oversight committee will review and report on its findings regarding medical liability insurance rates and the mandatory panel process December 2008 and December 2010.. The oversight committee held its first meeting October 13th.


The Commission to Study Ways to Alleviate Medical Malpractice Premiums for High Risk Specialties was formed to address the problem of higher than average malpractice premiums for neurosurgeons and obstetricians. Access to these specialists in the North Country and the Seacoast has become increasingly limited. After reviewing data on the number and location of obstetricians and neurosurgeons, as well as where patients go for these services, the Commission suggested that it could not determine whether the shortage of high risk specialties is due to high malpractice premiums and/or low reimbursement for these services. The data will be provided to the Malpractice Panel Oversight Committee. The Commission its report by November 1, 2005.


The Oversight Committee on Outpatient Hospital Payments was established to review the state’s payment system for outpatient hospital services and make recommendations due June, 2007. So far, the Committee has heard from Medicaid administrators describing how the State pays for hospital services, as well as hospital CFOs describing how Medicaid outpatient rates are set, how rates paid by private health plans are negotiated, and how physicians make referrals for hospital services, including the process by which patients select their hospitals, how hospitals work with their physician staffs, and prohibitions on inappropriate referrals. Upcoming meetings will focus on how other states’ Medicaid programs pay hospitals, as well as how Medicaid underpayments result in cost-shifting to private health insurers.


The Committee to Study Joint Purchasing Strategies for Small Business Health Insurance in New Hampshire and in Northern New England has met throughout September and October to investigate joint purchasing strategies that would reduce costs to small businesses. The Insurance Department has drafted a bill for the Committee to consider that would allow multiple employers to consolidate their purchasing resources in order to reduce their overall health premium costs. No recommendations have been made so far. The Committee’s report is due November 1, 2005.


BILLS HELD OVER FROM THE 2005 SESSION

HB 656: Medical Decision Making for Adults Without Capacity to Make Health Care Decisions; and Procedures for Do Not Resuscitate Orders.
The House Judiciary Committee retained HB 656 for further work over the past few months. A subcommittee has finalized its recommendations on healthcare decision-making, including advance directives, guardianship and do not resuscitate orders
The House Judiciary Committee will vote on an amended version of the bill on November 15, 2005. If approved, HB 656 will go to the full House for a vote in January, 2006 and then move on to the Senate for deliberation there. If passed, this legislation will update the state’s laws related to a Living Will and Durable Power of Attorney for Healthcare.


HB 489: Disclosure of Ownership Interest in Certain Health Care Facilities
The House Criminal Justice Committee retained HB 489 to spend more time on reporting requirements by healthcare providers who own facilities to which they refer patients. Current law requires disclosure of ownership and reporting of the number of referrals to the Department of Health & Human Services. The committee amended the bill to require providers to report the percentage of their ownership in the receiving entity, and eliminated the requirement to report the volume of referrals. Rather than report to Department of HHS, providers would be required to report to their respective licensing boards. The bill also requires providers to report any compensation they receive for making referrals to an entity, whether or not the provider has an ownership interest in the receiving facility. A health care provider who fails to report such compensation would be guilty of a felony. Since federal law (the Stark physician self-referral statute) prohibits any remuneration in exchange for referring a patient, HB 489, if passed in its current form, would not impact physicians. If passed by the House, this bill will move on to the Senate.


HB 66: Regulating mandatory overtime for nurses and assistants
Work on this bill will resume in January when an amendment, proposed by Senator Maggie Hassan (D-Exeter), will be voted on by the Senate Internal Affairs Committee. This amendment proposes that exemptions to the prohibition against mandatory overtime include: nurses working in a critical care unit, in a home health care setting until they are relieved, an institutional emergency, and a public health emergency.


HB 37: Health insurance coverage for full-time students on medical leaves of absence
The House Commerce committee continues its work on a bill that would have permitted continued health care coverage for dependent full-time college students who take a leave of absence from school due to illness or injury for one year. Various changes have been considered including coverage of dependents up age 24 if the dependent is: unmarried; has the same legal residence as the parent or is a full-time student; and is financially dependent upon the parent. No final recommendation has been made yet.