Legislation Supports Non-Profit Home Care System
(For a copy of the legislation click here)
Vermont lawmakers this session passed legislation designed to establish clearly defined state protection to the 12 nonprofit home care agencies. The legislation was passed in response to an investigation by the federal Department of Justice concerning whether the state's 12 nonprofit home health agencies constitute an illegal monopoly. The legislation was approved by the House on a unanimous 132-0 vote and by the Senate on a 24-2 vote.
"There is bipartisan support, which means it is a good bill," Rep. Margaret Flory, R-Pittsford, the House minority leader, told her colleagues. Flory and fellow Republicans Patti O’Donnell, Carolyn Branagan and Don Bostic and Democrat Floyd Nease helped lead the support in the House. Also crucial to the success were the 12 members of the House Health Committee led by Chair John Tracy, the six members of the Senate Health and Welfare Committee, led by Senator Jim Leddy and Speaker of the House Gaye Symington.
"It seems that just about everyone on the two health committee played a key role," said Peter Cobb, VAHHA Director. "From Republicans Joe Baker, Chris Louras and Malcolm Severance to Democrats Steve Mier, Bill Keough, Lucy Leriche, Topper McFaun, and Ginny Milkey. Janet Ancel ably carried the cause to the floor of the House and Harry Chen helped thwart a proposed eleventh-hour rewrite that could have delayed the bill and prevented passage this year. It was the same in the Senate, bi-partisan, across-the-board support. Support from all six Senators, Leddy, White, Flanagan, Kittell, Lyons and Mullin was crucial. Senator Bartlett, Chair or the Appropriations Committee and Rep. Martha Heath, Chair of the House Appropriations Committee also played key roles as did House Human Services Chair Ann Pugh, whose support was very important. Rep. Tom Koch, who initially opposed the legislation, helped rewrite the final draft. His work was crucially important in gaining the unanimous vote in the House. There were so many who helped that unfortunately I can’t name everyone."
Vermont's 12 non-profit home-health agencies are under investigation by the Justice Department because Vermont allows the non-profit caregivers to cooperate in administering care. The home care agencies contend that cooperation allows for a more effective way to contain health care costs and ensure access to quality care. Legislators agreed.
"We don't want the federal government dictating how we deliver care in this state more than they already do. This bill is intended to protect a Vermont-solution to providing care for the home bound that works," said Senator Jim Leddy, the Chair of the Senate Health and Welfare Committee. The legislation started in Leddy’s committee and received a 6-0 vote there. The House Health Committee also voted unanimously for the legislation as did both the House and Senate Appropriations committees.
"The proposed legislation provides the best hope of keeping these decisions in the hands of Vermonters and the best chance of moving this process along as quickly as possible, to the benefit of all involved - VAHHA members, the state of Vermont, Vermonters who get home care services and the Department of Justice. The legislation also presents the best chance of preserving Vermont’s role in defining exactly what kind of home health system best serves the citizens of this state." VAHHA Director Peter Cobb told both the Senate and House Health Committes.
The legislation establishes an explicit state policy permitting and regulating the existing cooperation and coordination currently investigated by the Justice Department. Senator Leddy said the current system that fosters cooperation helps keep costs down. He said the investigation interferes with states' efforts to efficiently and effectively deliver health care. Vermont has the lowest cost-per-visit for home-health of any state.
"We are fortunate in Vermont to have a non-profit, cooperative home health system for the efficient delivery of this kind of care," said President Pro Tem Peter Welch.
"I am disappointed that the Bush administration continues to obstruct states' best efforts to control health care costs, whether on prescription drugs or non-profit care, while it shifts more and more of the burden of health care to the states," he added.
"It is long overdue that we place in statute a part of the health care system that works so well. Our home health agencies provide great services and save us all money," added Chair of Appropriations Senator Susan Bartlett.
"We are really pleased," said Ron Cioffi, chief executive officer of the Rutland Area Visiting Nurse Association and Hospice. "It allows Vermont to make decisions about how to do home health care rather than the feds telling Vermont how Vermont should do home health care."
Under the legislation for-profit services can still apply for a certificate as the CON rules were not changed.
"We felt it was important for a new home health agency to be able to apply for a certificate of need under certain circumstances," Rep. Janet Ancel, D-Calais reported to fellow House members. "But at the same time we did not want to hurt our existing system, which we think provides great care."
Ancel said the nonprofit noncompetitive relationship allows Vermont’s 12 nonprofit agencies to treat more patients per capita than any other state at the cheapest price in the nation. In 2002 Vermont served 108 per thousand Medicare eligible people compared to the national average of 61 per thousand and the New England average of 81 per thousand. Vermont also has had the lowest cost per visit every year for which VAHHA has collected data from the federal government (1990-2002) and had the lowest cost per episode (60 days of care) of the 50 states in 2002, according to the National Association for Home Care.
What Does This Legislation Do?
The proposed legislation codifies the existing system of home health agencies in Vermont. It expressly designates geographical areas to be served by each of the existing, non-profit home health agencies. It makes a clear statement of state policy that supports the existing non-competitive community based non-profit model for the delivery of home health services and reiterates the responsibility of the existing home health agencies to meet the needs of their respective communities. It continues the present standards for approving new, competing home health agencies. It continues the collection of data on cost, access, and quality by the Department of Banking Insurance Securities and Health Care Administration (BISHCA) and the current oversight by the Agency of Human Services, and adds additional oversight functions by AHS.
It codifies long standing state policy in the area of home health services as reflected in Vermont’s State Health Plans of 1980-1985, 1985-1990 and 1990-1993, Health Resources Management Plans of 1993-1996 and 1996-1999 and the CON Guidelines that have been in effect since 1999. The state policy enunciated in these plans favors the delivery of home health services by community based and supported, non-profit home health agency system and expressly favors collaboration among these agencies over a competitive, market driven system. It expressly recognizes that Vermont’s system has 1) demonstrated both the commitment and capacity to provide universal access to medically necessary home health services to all Vermonters, regardless of ability to pay or location of their residence and 2) has consistently maintained the lowest average cost per visit of any state in the nation for at least the past 15 years.
Along with this clearly articulated state policy, the act expressly provides for active supervision of that policy. It continues the active oversight of the system as it exists today and adds additional oversight functions to the Agency of Human Services.
It expressly states that the intent of this legislation is to displace state and federal antitrust laws and provide state action immunity for the home health agencies acting in furtherance of and within the scope of this act and its purposes.