NHHA LEGISLATIVE UPDATE
June 5, 2006 - Wrap Up
The New Hampshire General Court has completed nearly all of its work for 2006, with the House convening for the last time June 28th. Legislative action during the 2005/2006 Biennial Session has resulted in a number of improvements for both health care providers and the patients they serve.
Legislators supported much needed health insurance reform for small New Hampshire businesses as well as improvements in the timely payments to health care providers.
In the area of improving health care quality, the Legislature created the New Hampshire Health Care Quality Assurance Commission, thereby enabling health care providers to share information about adverse outcomes and prevention strategies. The Commission recently completed its first year of work with a focus on the identification and prevention of infections. This year, the Legislature passed infection reporting requirements to be fashioned after future national models.
Improvements to New Hampshire’s advance directives statutes will go into effect in January 2007 making it easier for people to express their preferences for health care, as well as establishing procedures for ‘Do Not Resuscitate’ orders.
NHHA was successful in defeating a proposal that would have made it possible to bypass the Certificate of Need Board for elective angioplasty. However, we’re disappointed that a bill to create a Commission to Study Health Care Cost Drivers was unsuccessful.
As for pricing transparency, NHHA supports the use of voluntary initiatives to provide consumers with information. Efforts to mandate price reporting were defeated this year, while NHHA has taken the first step in providing consumers information with the recent introduction of www.NHPricePoint.org.
The following are highlights from the 2005 and 2006 legislative sessions:
End of Life Care/Health Care Decision Making
New Hampshire’s advance directives laws (Living Will and
Durable Power of Attorney for Healthcare) will be updated
based on the passage of HB 656. The changes will make it
easier for people to express their preferences for health
care; simplify into plain English the legal language to make
it more understandable; and establish procedures for ‘Do Not
Resuscitate’ orders. The new law will go into effect January
1, 2007.
Infection Reporting
The hospital infection reporting bill requires the
Department of Health & Human Services to establish criteria,
standards and coding for tracking and reporting of
infections, as well as data collection and analytical
methodologies. However, the requirement goes into effect no
earlier than July 2007, and will rely on the development of
national performance measures
Reporting of ‘Price’ Information
The Legislature rejected efforts to require hospitals to
post their charges and average payments, and report this
information to the Insurance Department, which would then be
posted on the Department’s website. Also, a proposal to
prohibit confidential business arrangements between
providers and insurers was defeated.
Rates Charged to the Uninsured
Lawmakers rejected a measure that would have required
hospitals and other health care providers to charge
uninsured patients the median rates paid by third party
payers – primarily because of a number of innovative
programs adopted by New Hampshire hospitals that help
patients with the cost of their health care. These include
the New Hampshire Medication Bridge Program, the New
Hampshire Health Access Network, and currently under
development, a hospital discount program that will provide
discounts of 15% or more for patients without coverage. Most
of NH’s hospitals provide 100% discounts to patients at or
below 200% of the federal poverty level, and several provide
a 100% discount for people with incomes up to 300% of the
poverty threshold.
Certificate of Need
Legislators killed a bill designed to circumvent the
Certificate of Need (CON) process by prohibiting the Health
Services Planning & Review Board from permitting a hospital
to offer elective angioplasty. The Legislature’s rejection
of this proposal demonstrates its commitment to maintain the
integrity of the CON program and process.
Medical Liability Reform
Legislators passed much needed medical liability reform
legislation creating pretrial screening panels to encourage
quicker settlements thereby lowering legal costs. The law
provides that such panels be mandatory; that an appropriate
standard of proof be met by plaintiffs; and that unanimous
panel findings be admissible at trial.
Small Group Health Insurance Reform
Legislators remedied the effects of earlier legislation
(SB 110) that discriminated against small employers. This
reform stripped away workers’ health status and geography
from insurers’ rate setting calculations. The law also
places restrictions on rate increases, so that the highest
premium an insurer can charge cannot be more than 3.5 times
higher than the lowest premium. It established a high-risk
reinsurance pool to spread the cost for insuring individuals
with catastrophic health conditions.
NH Health Care Quality Assurance Commission
The Legislature created the New Hampshire Health Care
Quality Assurance Commission to enable health care providers
to share information about adverse outcomes and prevention
strategies – an important step in reducing medical errors
and improving the quality of healthcare. The Commission is
responsible for the collection, analysis and dissemination
of quality assurance information statewide.
Prompt Pay
The passage of Prompt Pay legislation is helping to
ensure that insurers pay claims in a timely manner.
Legislators addressed loopholes in state laws that allowed
insurers to delay payments to providers with no
accountability for the money owed. Insurers must act on
denied and pended claims within specific timeframes. And the
law remedies the burden placed on providers to decipher each
insurer’s interpretation of a “clean claim”. Finally,
automatic interest must be paid on overdue claims.
Medicaid Funding
Hospitals defeated persistent attempts to slash Medicaid
hospital payments. Faced with $38 million in proposed
reductions hospital payments, legislators restored funding
for Catastrophic Payments ($5 million), Indirect Medical
Education ($6 million), and Direct Medical Education ($1.7
million) and Outpatient Hospital Payments ($13 million).
However, lawmakers cut outpatient hospital payments by $13
million over 2 years, but spared critical access hospitals
from the outpatient payment cuts.
Efforts to cap outpatient payments were defeated, which would have allowed the DHHS Commissioner to reduce rates if expenditures in any quarter exceeded 25% of the annual outpatient appropriation. Instead, legislators limited the Commissioner’s ability to reduce rates by subjecting such changes to the scrutiny and approval of the Legislature and approval.
Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA is tracking.
