PREVIEW OF NEW HAMPSHIRE’S 2010 LEGISLATIVE SESSION
December 18, 2009
The Legislature will commence its 2010 session on January 6, 2010, and NHHA
is gearing up to weigh in on bills that focus on the increasing budget shortfall
in the state’s Medicaid Program, quality and patient safety, and health
insurance payments, just to name a few.
NHHA’s 2010 Advocacy Agenda provides a blueprint of hospitals’ priorities as
we address the many proposals to be offered this coming year including Access
and Coverage; Quality; and the Most Efficient, Affordable Care. In addition to
legislation, our advocacy efforts are also focused on state regulatory activity
as well as voluntary initiatives designed to improve New Hampshire’s health care
system.
The
entire list of bills NHHA is following is available and in time, will
include NHHA’s position on selected bills, links to NHHA testimony, and
information on where each bill is in the legislative process.
2009 LEGISLATIVE WRAP-UP
July 2, 2009NH Legislature Wraps Up 2009 Session
The New Hampshire Legislature has completed its work for the 2009 legislative session. Front and center was the passage of the state’s biennial budget for SFY 2010 and 2011, a great disappointment to the health care provider community due to lawmakers’ continued underfunding of the Medicaid program and other critical state-funded health services. Other legislative matters of concern to hospitals include health insurance, quality/patient safety, data collection on the uninsured, privacy, certificate of need, state prisoner medical costs, and medical liability.
MEDICAID BUDGET
Medicaid Payments to Hospitals
The Legislature narrowly approved the state’s $11.5 billion budget
relying on one-time money (federal ARRA stimulus funds and the JUA medical
malpractice funds), tax and fee hikes, as well as another $20 million of
unspecified cuts to be made by the Commissioner of the Department of Health &
Human Services. Hospitals, along with health care providers of all types, are
flat-funded at current Medicaid rates. Though legislators did not put money back
into the Medicaid program in the way we wanted, the final budget retains current
outpatient and inpatient hospital Medicaid payment rates. In other areas of the
budget, the Legislature adopted a slew of drastic measures that includes layoffs
of hundreds of state employees, closing the Laconia State Prison and the Tobey
School (for students with emotional problems), cutting social services programs,
and raising a wide variety of controversial fines and fees.
The State’s budget for the next two fiscal years – 2010 and 2011 – is based on
overly optimistic and unrealistic Medicaid caseload and utilization projections.
Given the state of the economy, what’s most troubling to hospitals is the
Legislature’s refusal to use economists’ estimates which project a much higher
number of NH residents who will be eligible for Medicaid services. While the
total appropriation for the next two years for Medicaid hospital services at
$281.5 million (state and federal dollars) represents a slight
increase over the previous two-year budget, it cannot possibly be sufficient
enough to keep pace with the increasing demand for hospital care.
Included in the two-year Medicaid hospital services appropriation are: (1) $1
million for maternity services in Coos County; (2) suspension of Direct Graduate
Medical Education for two years; (3) Indirect Medical Education payment
reduction of 60 percent; (4) Catastrophic Aid payment reduction of 20 percent;
and (5) a payment freeze for Boston Children’s Hospital that had been scheduled
for a rate increase next year.
Of serious concern to hospitals is the mandate to the HHS Commissioner to craft
a plan to pay for the uncompensated care costs of hospitals and other providers
by reducing Medicaid DSH payments to certain other hospitals. Legislators
stipulated that this plan generate an additional $5 million for the State’s
General Fund. While the Commissioner is directed to “seek input” from a variety
of stakeholders, including hospitals, in the development of the plan, we are
very concerned by the fact the Legislature has predetermined the plan’s
outcome—generating additional revenue for the General Fund. This mandate grew
out of SB 158, establishing a commission to study the creation of an
uncompensated care fund.
As part of the myriad of state fee hikes, all health care facility licensing
fees have been increased to about the same fee levels charged by surrounding
states. Hospitals, nursing homes hospice, residential treatment facilities, and
adult family care homes will all be assessed at the rate of $25 per bed.
NHHA will be watching Medicaid expenditures very closely, as well as
developments concerning the uncompensated care plan. We’ll also be monitoring
the budget very closely with regard to whether revenues are keeping pace with
expenditures.
HEALTH INSURANCE
Billing Practices
SB 188, establishing a commission to study hospital billing practices of health
care providers, creates a study commission to look into the billing
practices of hospitals and hospital-owned facilities. NHHA convinced legislators
that rather than mandating restrictions on how hospitals bill for off-site
services, a study commission should be formed to take the necessary time to
better understand the complexity of hospital billing.
In addition, despite concerns expressed by the bill’s sponsor about varying
out-of-pocket costs for patients, the heart of the issue was that health
insurers’ systems are not necessarily programmed to distinguish among various
types of service providers and settings, e.g. urgent care and emergency care.
NHHA will be represented on the Commission, and the final report of the study
will be completed by November 2009.
Telemedicine Coverage
Hospitals and health care providers are pleased with the legislature’s passage
of SB 138, relative to insurance coverage for telemedicine services,
despite persistent efforts by carriers to prevent coverage of telemedicine
services. In fact, the new law codifies the carriers’ current practices
of paying for telemedicine services, and it therefore assures providers that
health plans won’t deny coverage on the sole basis that the coverage is provided
through telemedicine as long as the service would have been covered if provided
in person. Before the new law goes into effect (90 days after the Governor signs
it), providers, carriers and the NH Insurance Department will meet to work on
the carriers’ guidance to providers.
Health Coverage for Young Adults
Chipping away at the number of uninsured adults in New Hampshire, the
Legislature passed SB 115, health coverage for young adults,
thereby authorizing an expansion of the NH Healthy Kids buy-in program for young
adults up to age 26 with incomes below 400% of the federal poverty level. This
provision is not a mandate, but rather allows the New Hampshire Healthy Kids
program to develop a product for young adults along with safeguards to protect
the existing program for children. The new product will not be subsidized with
public funds, and the Insurance Commissioner will review the final plan design
to ensure that it does not adversely affect the commercial market. The new law
goes into effect 60 days after it’s signed by the Governor.
Patient Choice
The Legislature supported the passage of SB 102, relative to managed care
and patient choice, to require contracts between health plans and
providers to state that covered persons will have access to any provider in
their insurance network, and that no provider employed by a hospital or
affiliate is obligated to refer only within that hospital/affiliate network.
Plans under the jurisdiction of the state
SB 119, relative to provider contract standards requires every health
insurance card issued after January 1, 2010 to indicate whether or not the
individual’s health plan is under the jurisdiction of the NH Insurance
Department. This will help hospitals and healthcare providers understand the
type of coverage patients carry (fully insured versus self-insured).
Costs of the Uninsured on Provider Bills
NHHA is pleased that the House killed HB 359, requiring health care
provider bills to state the portion of payment covering costs of the uninsured.
As stated in our testimony, hospitals cannot provide the cost of the uninsured
on each hospital bill due to their use of national billing forms that won’t
accommodate this type of information, and the fact that providers don’t know at
the time a claim is prepared, how much of the care provided throughout the year
is attributable to free care and bad debt. Free care and bad debt are reported
on the hospital’s audited financial statements.
Network Adequacy
SB 63, relative to ensuring consumer access to care upon the termination
of a participating provider. SB 63 was introduced to ensure that health
insurance subscribers have access to carriers’ network adequacy reports in the
event that a provider contract is not renewed. With assurance by the Insurance
Department that these reports are considered public information and available
upon request, the Legislature determined the bill was no longer necessary and
killed the bill.
QUALITY AND PATIENT SAFETY
Adverse Events Reporting
New Hampshire has joined a number of other states requiring the
reporting of adverse events with the passage of HB 592, relative to
adverse events in hospitals and ambulatory surgery centers. Beginning
January 1, 2010, hospitals and ambulatory surgery centers will report to the New
Hampshire Department of Health & Human Services any of 28 adverse events listed
in the bill as well as provide a root cause analysis and corrective action plan.
DHHS intends to work with NHHA to develop the format and procedures by which
hospitals and ASCs will report.
Funding for Infection Reporting
The Legislature passed HB 433, funding the law requiring reporting of
hospital infections, that allows the Department of HHS to assess
hospitals a fee to cover the costs of infection reporting program. In the three
years since the passage of the state’s hospital infection reporting law, there
has been no funding to manage the program. The fee will be based on hospitals’
inpatient average annual census, however no fees will be assessed until DHHS
adopts rules on such rates.
Hospital Infection Reporting
HB 40, relative to the reporting of hospital infections requires the
Department of Health & Human Services to adopt rules listing the requirements
for reporting infections to the state. This bill as introduced, stipulated a
penalty provision to fine hospitals up to $1,000 per day per occurrence.
However, a penalty provision is already specified under RSA 151, the health
facilities statute.
UNINSURED DATA COLLECTION; UNCOMPENSATED CARE POOL
Uninsured Healthcare Database
SB 147, relative to the data collection practices of health care providers and
relative to the development of an uninsured healthcare database was
enacted to require hospitals and community health centers to submit data to the
State on care provided to uninsured patients by hospitals, providers employed or
“legally controlled” by a hospital, hospital-owned physician practices, and
community health centers. The Insurance Department will develop the uninsured
healthcare database using the Uniform Hospital Discharge Data Set (UHDDS) for
inpatient and outpatient hospital data. However, hospitals will be required to
report data on behalf of hospital-owned providers not captured by the UHDDS.
Reporting will not be required until rules are promulgated and no earlier than
January 2010.
Uncompensated Care Fund
Although the House stopped any further action on SB 158, establishing a
commission to study the creation of an uncompensated care fund, by
retaining the bill, budget conferees inserted a modification of SB 158 into the
budget bill (HB 2) expedite the process of altering the use of Medicaid DSH
funds by amending the budget bill (HB 2). See above description under
Medicaid Budget.
CERTIFICATE OF NEED
CON Study Committee
The Legislature has decided once again to authorize a study of the
Certificate of Need statute. HB 234, establishing a committee to study the
CON process, comprised of legislators only to review the scope of the
CON regulation, standards of need, procedures, board membership, services
regulated, financial thresholds ... and any other aspect of CON. The Committee
must complete its report by February of 2010.
Moratorium
In anticipation of the June 30, 2009 expiration of the CON moratorium on nursing
home and rehabilitation hospital beds, the Legislature reauthorized the
moratorium through June 30, 2012 with the passage of HB 113, extending the
moratorium on nursing home beds and rehabilitation beds. In addition, a
new provision allows nursing homes and rehabilitation hospitals to obtain a CON
to repair or refurbish an existing facility or to accommodate additional beds
obtained by transfer to an existing facility. For the most part, the CON Board
has allowed for repairs, but the statute did not provide specific authority.
STATE PRISON MEDICAL COSTS
Payment to Hospitals
SB 185, relative to rates and charges for medical services to state prisoners,
as introduced would have required the Department of Corrections (DOC) to pay no
more than the lowest payment rates made by any third party payer, i.e. NH
Medicaid. The House rejected this inadequate payment proposal and substituted
the requirement that the DOC pay hospitals and healthcare facilities 110%
of Medicare allowable costs for outpatient, inpatient and emergency
services as well as ambulatory and specialty facilities. The Senate disagreed
with the House, thus prompting the bill’s proponents to insert the House
requirements in HB 2, the budget bill effective September 1, 2009.
PRIVACY
Privacy of Health Information
Last year’s defeated privacy bill returned this year as three separate
pieces of legislation, the most problematic of which was HB 580, relative
to health information and patient rights. The House passed version was
sent to the Senate which succeeded in overturning a recommendation to pass the
bill. If passed, HB 580 would have compromised treatment and impeded the
development of EMRs, as well as created conflicts with new HIPAA regulations to
be adopted by the federal government later in the year.
Health Information Exchange
NHHA worked with the sponsors of the remaining two privacy bills. The
Legislature passed HB 542, relative to health information exchange,
to develop a framework for future health information exchange entities to
include procedures for access to health care information from health care
providers and business associates of health care providers, as well as an
opt-out provision for patients.
Fundraising Opt-out
HB 619, relative to medical records and patient information
provides patients greater control over the use of their medical information for
non-medical uses, including marketing. The new law, effective January 1, 2010,
will be stricter than HIPAA because it requires the covered entity to seek an
opt-out before the initial fundraising material is disseminated.
MEDICAL LIABILITY
Pretrial Screening Panels
The Senate killed the pretrial screening panel bill – HB 572,
relative to proceedings of medical injury claims screening panels. The
vote was a stunning 18 to 6, despite the Senate Judiciary Committee’s
recommendation for passage. Senators listened to providers’ concerns that
changing the screening panel statute after only two years of panel experience
would interfere with two independent studies on the new process to be completed
in 2010.
Four other bills designed to repeal or weaken the medical liability statutes
were either killed or tabled including HB 50, repealing the laws relative
to screening panels for medical injury claims; HB 203, eliminating the
requirement that the trial judge present unanimous findings of the screening
panel to the jury in medical injury actions; SB 438, relative to admission into
evidence of certain medical bills, reports and records; and HB 197, relative to
apportionment of damages in civil actions
NHHA’s complete list of bills is available here.
