Legislative Update
May 27, 2004
2004 LEGISLATURE ADJOURNED
With the legislative session ending this week, the following is a summary of the key issues that affected NHHA members at the Legislature. If you would like to check on a specific bill, please go to http://www.gencourt.state.nh.us/ie/billstatus/quickbill.html.
MALPRACTICE - MEDICAL LIABILITY REFORM
The Coalition for Available and Affordable Liability Insurance coordinated its efforts to pass legislation modeled after Maine’s successful pretrial screening panel law in order to contain the escalating costs of malpractice premiums for physicians and hospitals. HB 1413 died in Committee of Conference, while other medical liability bills were referred to interim study.
HB 1413: Mandatory Pretrial Screening
Panels
Died in Committee of Conference
This bill would have required the parties in a medical malpractice case to participate in a panel process that encourages early resolution of the claim. A three-person panel would evaluate the merits of the claim, and if the parties are unable to settle their claims after the panel hearing and decision, they would proceed to trial. Unanimous panel decisions would be admissible if the parties go to trial. The intent of this bill was to reduce the number of malpractice cases that go to trial, lower the rate of increase in malpractice insurance costs, and help keep physician specialists from leaving New Hampshire to practice in states where insurance premiums are lower. Presently, New Hampshire hospitals' malpractice premiums are 40% higher than Maine's. New Hampshire physicians' premiums are double.
SB 452: Testimony of Expert Witnesses
Passed as amended
Effective July 16, 2004
This bill adopts federal standards for expert testimony to be applied to all malpractice cases, including medical malpractice. It establishes certain requirements for the admissibility of expert testimony including the court’s finding that the testimony is based upon sufficient facts, reliable principles and methods, and that the witness has applied such principles and methods reliably to the facts in the case.
To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0452.html.
SB 465: Testimony of Witnesses about
Confidential Settlements
Passed as amended.
Effective January 1, 2005
This bill provides for disclosure of relevant information of prior litigation which was the subject of a confidential settlement agreement. If the court finds information relevant to a pending proceeding, other than the settlement amount, the relevant information must be disclosed. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0465.html.
Other Malpractice Reform Bills Sent to Interim Study
The Senate referred to interim study:
SB 462 limiting non-economic damages in
medical injury actions
SB 463 limiting attorney contingency fees
in civil actions for medical injury
SB 464 permitting an award of damages in
a medical injury action to be paid in either periodic payments
or a lump sum.
HEALTHCARE CHARITABLE TRUSTS
The legislative study committee on property tax exemptions for non-profit hospitals recommended legislation to require healthcare charitable trusts to submit their audited financial statements to the Division of Charitable Trusts, along with their community benefit reports and IRS Form 990.
HB 1408: Reporting Requirements for
Healthcare Charitable Trusts
Passed as amended
Effective 60 days after signed by
Governor
This bill requires any charitable organization with revenue, gains, and other support of $500,000 or more to submit its latest financial statement to the Division of Charitable Trusts, along with the required IRS Form 990. An exemption is provided if compliance constitutes a financial burden. A provision to require reports of audits of endowments was removed because reporting of these funds are included in audited financial statements.
This bill also extends the requirement under RSA 7:32-f to update community needs assessments from three to five years. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/HB1408.html.
HB 1403: Extending the Property Tax
Study Committee
Passed as amended
Report due November 1, 2004
This bill extends the life of several legislative study committees including the committee on Exemption from Property Taxes for Not-for-Profit Hospitals and the Community Benefits Law.” This committee was established in 2001, after several years of legislative studies on not-for-profit tax exemptions. Despite continuous positive findings by all these committees, legislators continue to push this issue looking for a way to impose a tax structure on hospitals.
NHHA will continue our efforts to provide accurate information to dispel the myths about the conduct of private not-for-profit healthcare charitable trusts.
SB 441: Dental Clinics Owned by
Healthcare Charitable Trusts
Effective July 23, 2004
This bill amends the dental practice statute to allow healthcare charitable trusts to own, lease, maintain, or operate dental clinics. Therefore, the Board of Dental Examiners has authority over the dentists who work in the clinics, but not the clinics themselves. The healthcare charitable trust must notify the dental board of the name and location of the clinic, the name of the supervising dentist, and any change of the supervising dentist. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/sb0441.html.
MANAGED CARE CONTRACTING
SB 389: Health Carrier and Provider
Contract Disputes
House killed
As introduced, SB 389 would have allowed patients to have continued access to their physicians in the event of a dispute concerning the negotiation of a contract between a hospital and a health plan. The House Commerce Committee felt that an existing legislative committee (the SB 470 study committee) should examine the effects of such disputes, the mediation approach, and other responses in depth. That committee is already charged with examining the points of conflict between insurance carriers and health care facilities. The SB 470 committee was extended by the Legislature with a new reporting due date of November 1, 2004.
SB 430: Mandated Insurance Benefits
Passed as amended
Effective July 23, 2004
Report due November 1, 2004
In response to annual proposals to add mandated benefits to health insurance policies, SB 430 was passed to require that legislative proposal that mandates insurance benefits be evaluated by the NH Insurance Department before being enacted into law, if a legislative committee requests such an evaluation. The Insurance Commissioner may contract for an external review and evaluation of mandated benefits. SB 430 also establishes a committee to study the feasibility of requiring health insurers to provide medical loss information to small group employers. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0430.html.
MEDICAID
SB 376: “Omnibus” Rural
Hospital/Medicaid/Long Term Care/CON/Group Purchasing Bill
Effective upon passage except:
Purchasing authority effective 7/1/04
Medicaid enhancement tax calculation
effective 7/1/05
CAH exemption effective 60 days after
passage
This bill evolved into a collection of state law changes covering a variety of health issues:
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It gives non-profit hospitals the option of participating in the State's group contract for the purchase of pharmaceuticals and other products and services. Any savings realized would be retained by the hospital;
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It amends the Medicaid Enhancement Tax calculation from '6% of gross patient service revenue' to '6% of net patient service revenue' as required by CMS;
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It requires the Department of Health & Human Services to get Legislative Fiscal Committee approval for certain changes to the Medicaid Program including any change that would cap the federal payments to the State, or change the Medicaid state-federal matching rate; and
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It provides an exemption from the State’s nursing home bed moratorium for Androscoggin Valley Hospital and Franklin Regional Hospital seeking critical access hospital designation, allowing them to reclassify their swing beds as a distinct part unit not to exceed 10 beds;
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It prohibits the CON Board from granting a Certificate of Need for rehabilitation beds in any facility. However, it allows the transfer of rehab beds between two facilities;
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It establishes a commission to study long term care reimbursement;
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It amends the county nursing home “Proportionate Share Payment” program; and
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It amends the statewide nursing home tax designed to 'enhance' Medicaid payments to nursing homes.
To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0376.html.
HOSPITAL CARE FOR PRISON INMATES
SB 382: State Prisons - Hospital
Reimbursement and Medical Parole
Effective upon passage
This bill brings State prison hospital payments in line with county prison reimbursement, i.e. limiting hospital reimbursement to 110% of Medicare or 125% if the hospital had a negative operating margin in the previous year. NHHA objected to the bill’s major cost-saving provision which allows the granting of medical parole to inmates whose cost of care will be excessive due to a “terminal, debilitating, incapacitating, or incurable medical condition”. The State estimated that this provision would cover six inmates in SFY 2005 and an additional two or three each year thereafter. The state assumes these prisoners will qualify for Medicaid, with the federal government paying for half of the cost of care. At best, hospitals would be paid no more than 60% of the cost to provide care versus 110% of the Medicare rate if the patient remained in prison. If the patient does not qualify for Medicaid and has no health insurance, the hospital will not likely be paid at all. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0382.html.
IMMUNIZATIONS
SB 438: Immunization Requirements
Effective January 1, 2005
SB 438 requires hospitals, residential care facilities, and assisted living facilities to immunize consenting patients for flu and pneumonia subject to the availability of an adequate supply of the vaccine, and subject to exemptions for medical contraindications and religious beliefs. Also, each healthcare facility must provide annual flu vaccines to consenting employees, Burdensome documentation requirements regarding patients’ refusal were removed from the final version, and reporting requirements were eased, although facilities will be required to submit aggregate data annually to the Department of Health & Human Services beginning July 1, 2005 for calendar year 2004.. To view the bill, go to: http://www.gencourt.state.nh.us/legislation/2004/SB0438.html.
PAYROLL DEDUCTIONS
SB 316: Payroll Deductions for
Salaried Employees
Effective January 1, 2005
After years of attempts to expand the provisions of the Labor Department’s regulations regarding voluntary payroll deductions, it took legislation to achieve these changes. As a result, SB 316 allows employers to deduct certain items from employees’ wages when the employee requests the withholding in writing. Such items include pharmaceutical items, gift shop, and cafeteria items purchased at a hospital by the hospital’s employees. To view the bill, go to http://www.gencourt.state.nh.us/legislation/2004/SB0316.html.
