NHHA LEGISLATIVE UPDATE

 
2007 LEGISLATIVE WRAP-UP
JULY 19, 2007


The Legislature has completed its work for the 2007 legislative session. Reps and Senators have gone home until their return for next year’s session beginning next January. Some legislators are expected to return to Concord on occasion over the next few months to serve on statutory study committees.


HIGHLIGHTS

Both the Legislature and the Governor were supportive of hospitals this session. We were successful in changing New Hampshire’s managed care statute to address prolonged delays for approval of physicians’ credentialing applications to ensure timely inclusion in the health plans’ provider networks . We also convinced legislators to incorporate a uniform definition of Medical Necessity into the managed care statute.

The Legislature passed a $10.3 billion State budget, that provided for increased Medicaid payments for pediatric specialty services. We were successful in getting legislative budget writers to include a critical provision to halt the bidding process for the Medicaid selective contracting program.

The Legislature also helped us stall efforts by HHS Commissioner Stephen to eliminate Medicaid payments for hospital-based physicians services. A legislative study committee will look into provider-based payments and make its recommendations later this year.

The Governor vetoed a bill that, if passed, would have put hospitals at significantly greater risk for damages in multi-defendant malpractice cases.

Listed below are healthcare issues of particular importance to hospitals and noteworthy legislation affecting these issues. For more information on these and other bills, go to http://www.nhha.org/nhha/state_law/bills.php.



MEDICAID BUDGET

The Legislature increased Medicaid funding for hospital services by 11.8% over the previous biennium for a total appropriation of $268 million for FY 2008 and FY 2009. The two-year Medicaid appropriations for hospitals includes:

 Inpatient services: $110 million
 Outpatient services: $137 million
 Catastrophic payments: $6.1 million
 Direct and indirect medical education: $8.9 million
 Neonatal and pediatric specialty hospital care: New funding of $6.4 million to support higher payment rates; and an   additional $2 million to restructure Medicaid rates for Crotched Mountain Rehab Center.


MEDICAID SELECTIVE CONTRACTING

The budget bill includes a provision preventing the continuation of the GraniteCare Select bidding process. Bids were due July 6th to apply to DHHS to be designated a preferred provider in a program in which Medicaid patients would be steered to providers located as far as 95 miles from the patient’s home. Legislative leaders have long been opposed to this form of “steerage” that creates access barriers to necessary medical care. Approval by the Legislature is required for the bidding process to continue.


MEDICAID PROVIDER BASED PAYMENT

The Legislature supported NHHA’s position on Medicaid hospital-based payments by prohibiting the Department of Health & Human Services from making changes to the current provider-based payment system. To halt efforts by DHHS to eliminate Revenue Code 510, a legislative study committee will be formed to examine Medicaid payment methodologies for physician and outpatient hospital services. Legislators also prohibited DHHS from seeking CMS approval to eliminate provider-based payments at anytime prior to the completion of the study committee’s final report. Any further action will depend on the committee’s findings.


HEALTH INSURANCE

NHHA pushed for and achieved major changes to New Hampshire’s managed care statutes that should improve access to providers and necessary treatment, including billing enhancements.

Provider Credentialing: Health plans are required (as of 8/10/07) to:
 Complete reviews of physician credentialing applications within 30 days (primary care) and 45 days (specialists); and
 Pay physicians for on-call coverage under limited circumstances.

Medical Necessity: The Legislature agreed with NHHA to correct long standing problems attributable to the absence of a uniform definition of medical necessity in the managed care statute. A standard definition of medical necessity to which all insurers must comply, should eliminate much of the confusion on the part of patients and providers alike.

NHHA supported the following health insurance expansions:

Coverage for Dependent Young Adults: The Legislature has extended family health coverage to dependents through age 25 who are working part-time and going to school part-time, or who are living at home and working in low-wage jobs that offer no insurance. It’s expected this will help reduce the level of uncompensated care attributable to young adults, the largest uninsured group.

Coverage for Divorcing Spouses: As of January 1, 2008, divorced spouses will be allowed to retain access their group health insurance for up to three years or until one of the parties remarries. The divorced family will continue to contribute its share of the family health plan as determined by the employer. Employers retain the right to not pay for family coverage. Before this policy, many divorcing spouses in NH lost their coverage.

NHHA OPPOSED:

Patient Notification of Participating Providers: NHHA opposed and the Legislature rejected a proposal that would have required hospitals to notify patients as to whether radiologists, anesthesiologists, and pathologists who conduct their work in the hospital, participate in patients’ health plans. This is an impossible task, given the autonomy of these specialists.


CERTIFICATE OF NEED

ASC Exemption: The Senate retained for further study a bill that would have exempted ambulatory surgery centers from CON regulatory oversight. The Senate HHS Committee will be working on an alternative proposal to deal with CON reforms. NHHA will work with the Senate on this study.

CON and Construction Workers: The Legislature rejected a proposal that would have required hospitals to assure that construction workers on a CON-approved hospital project will be provided health insurance coverage by the contractor. Instead, a commission will be formed to study current practices in the commercial construction industry relative to employer-based health insurance and construction procurement practices of public, publicly-funded or publicly-regulated entities. NHHA will be part of this commission, which will issue its final report in November, 2008.

CON Threshold: The Legislature rejected a proposal to raise the CON dollar threshold for construction projects for nursing homes, ambulatory surgery centers and specialty hospitals.

CON Moratorium: The moratorium on nursing home and rehabilitation beds has been extended through 6/30/09. However, an exception, supported by NHHA, allows for CON review of all applications filed between January and June, 2007.


MEDICAL LIABILITY

Apportionment of Damages: It was a major victory for healthcare providers, businesses, insurers, and municipalities when Governor John Lynch vetoed HB 143, following the bill’s passage in both the House and Senate. Without the Governor’s veto, New Hampshire’s acute and specialty hospitals would have been placed at far greater risk for damages in multi-defendant lawsuits based on misallocation of liability and extreme unfairness to defendants with minimal responsibility for a plaintiff’s injury. NHHA urged the Governor to veto HB 143.

Screening Panels: The House retained a bill for further study that would have repealed the medical liability screening panel law that hospitals and physicians fought hard for in 2005. This law has been in place for less than two years, and the health care community argued that the 2005 statute provides for the study and analysis of the panel process. No changes, least of all repeal, should be considered at this time.


HEALTH ACCESS/HEALTH INSURANCE

 A task force will be formed to develop legislation to expand access to affordable health insurance. Bruce King, CEO, New London Hospital will represent NHHA on this Task Force.
 A public education and outreach program will be initiated to increase enrollment in the NH Healthy Kids Program. This effort carries out the Governor’s goal of enrolling 10,000 more children in NHHK.
 A commission will be formed to investigate cost drivers in health care. NHHA has a seat on this commission.
 The NH Rx Advantage Program will be created to enable qualified NH residents to purchase prescription drugs at a discounted price.
 A Commission to study pharmaceutical costs and the 340B Drug Pricing Program is being formed to propose cost savings methods for public pharmaceutical programs including Medicaid and Corrections. Henry Lipman, EVP/CFO of LRGHealthcare will represent NHHA on the commission.
 A Commission will be formed to study lowering the costs of health insurance for small businesses, including identifying approaches and products to reduce the rate of cost increases.


WORKFORCE

 Legislators rejected a bill that would have prohibited an employer from requiring employees to work on Thanksgiving and Christmas, with no exceptions for healthcare personnel.
 We defeated a bill that would have required at least 10 hours between shifts with no exceptions.
 The Legislature could not be persuaded to reject a bill that prohibits mandatory overtime for nurses. Hospitals lobbied for additional exceptions to the prohibition (surgery and critical care are exempt). Once passed, NHHA urged the Governor to veto the bill on the basis that the bill’s exceptions did not include certain emergency situations, the absence of relief staff, and those situations when the purpose of overtime is to prevent imminent harm to a patient.


HEALTH INFORMATION

 A new law spells out patient protections to ensure confidentiality while promoting the use of electronic prescribing. This bill furthers the goal of the NH Citizens’ Health Initiative to improve patient health and safety through electronic prescribing.


PUBLIC HEALTH

 An Automated External Defibrillator Advisory Commission will be formed to encourage all schools to obtain and maintain automated external defibrillators for the safety of students participating in school athletic and related activities. The Commission will provide leadership, education, coordination and advocacy to carry out its purpose.
 A Comprehensive Cancer Plan Fund is established with $6 million to be used to implement the NH Comprehensive Cancer Plan. Funds will be targeted for tobacco use prevention and cessation programs, diet and exercise, breast and cervical cancer screening, colorectal cancer screening, and to promote treatment and support services for cancer survivors. An oversight board will oversee the allocation of the Cancer Fund. NHHA will appoint two members to the Comprehensive Cancer Plan Oversight Board.


END OF LIFE CARE

 Following last year’s passage of the medical decision-making legislation, a number of bills were introduced to repeal or revise the law. None were enacted, however, several bills were retained in committee for further study.




Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA is tracking.

Click Here for the NH House and Senate Web Site