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.
