ACT NO. 27
Health care facilities; hospitals; certificates of need
Bill of Rights for hospital patients. This act allows the number of hours worked during a shift to be either eight or 12 hours for a registered nurse, licensed practical nurse, or licensed nursing assistant to be counted as a
full-time equivalent. Prior law only counted eight hours worked during a shift as a full-time equivalent. The act also requires patient census and staffing information, already mandated to be reported under the Bill of Rights for Hospital Patients, to be reported consistent with the reporting requirements for nursing staff that the commissioner of the banking, insurance, securities, and health care administration (BISHCA) selects for use in hospital community reports.
Hospital licensing. The act specifies that circumstances warranting the board of health to issue a temporary license to a hospital include issues concerning indicators in the hospitals community report such that the board may issue a license conditioned upon corrective measures or a temporary license with conditions. The act also directs the licensing agency conducting reviews of hospitals, health centers, or nursing homes to evaluate the quality and financial indicators that BISHCA publishes in the community reports on its public website.
Public participation and strategic planning. The act replaces a provision requiring hospitals to conduct community needs assessments every four years with a new provision requiring hospitals to implement a protocol for meaningful public participation into their strategic planning process for identifying and addressing health care needs the hospital does or could provide in its service area. It directs needs identified through the process to be integrated as part of the hospitals long-term planning and become part of the four-year capital expenditure projections it provides to the public oversight commission.
Health Resources Allocation Plan. The act requires the commissioner of BISHCA to revise the states health resource allocation plan every four years, instead of every two years, and removes a requirement that he or she do so in consultation with the public oversight commission. Instead, the act directs the public oversight commission to recommend plan revisions at least every four years or more often, as warranted. The act also removes expired provisions regarding the health resource allocation plan.
Certificates of Need. The act eliminates provisions requiring hospitals and other health care facilities to file letters of intent with the commissioner of BISHCA if they are exempt from the certificate of need (CON) requirement because the scope of their projects fall below specified financial thresholds. Under that provision, the commissioner could still require a hospital or other facility to obtain a CON if he or she had certain concerns about the proposed development.
The act raises from $20 to $30 million the threshold above which a project requiring a CON also must secure a conceptual development phase CON. It also limits allowable expenditures in preparation for obtaining a conceptual development phase CON to $3 million for hospitals and $1.5 million for non-hospitals.
Prior law gave the commissioner 30 days from receipt of a CON application within which to notify an applicant that all of the necessary information was present or that additional information was required. The act extends the commissioners timeframe from 30 to 90 days from receipt of the application and changes the options to (1) all necessary information is present or (2) the application review period is complete despite the absence of necessary information. The act allows the commissioner to extend the 90-day application review period for an additional 60 days or, with the applicants consent, even longer. The time it takes the applicant to respond to the commissioners notice that more information is required does not count toward the statutory maximum allowable review period. The act allows the public oversight commission to recommend, or the BISHCA commissioner to decide, to deny a CON application if the applicant fails to provide all information necessary to review the application.
The act allows an applicant to seek an expedited review of a CON application, including a health information technology project CON application, by simultaneously filing a letter of intent and an application with the commissioner. If the commissioner determines that the proposed project may be uncontested and does not substantially alter services, the act directs the commissioner to issue public notice of the application and request for expedited review and to specify a date by which a competing application or a request for interested party status must be filed. If no competing application is filed and no one is granted interested party status, the act allows the commissioner to declare the application uncontested and issue a traditional CON with abbreviated or no further process. For health information technology project applications, the act specifies that the commissioner may declare an application uncontested and issue a CON with abbreviated or no further process if he or she finds the application consistent with (1) the preliminary health information technology plan issued by the Vermont information technology leaders on January 1, 2007, or with the final information technology plan, if it has been issued at the time the CON is filed; and (2) the health resource allocation plan. The act allows the commissioner to rely on the written opinions of people with expertise in health information technology. For both traditional and health information technology projects, if a competing application is filed or someone is granted interested party status, the act requires the applicant to follow the regular CON standards and procedures. The act will repeal the specific provisions for health information technology project CONs upon the legislatures approval of the health information technology plan and the adoption of implementing rules.
Existing law specifies that if an applicant fails to respond to the commissioners request for further information within six months, the application will be deemed inactive, and if the applicant fails to respond within 12 months, the application becomes invalid. The act allows an applicant to file an amended letter of intent within six months to avoid inactive status, and to request an extension within 12 months to avoid invalidating the application.
Hospital budget review. The act specifies the legislatures intent that hospital cost containment conduct be afforded state action immunity under antitrust laws if the conduct is (1) authorized or required by the commissioner of BISHCA; (2) in accordance with standards and procedures prescribed by the commissioner; and (3) actively supervised by the commissioner.
Mobile health facilities. As the result of the legislatures acknowledgment of concerns about the practices of private mobile health facilities entering the state to provide one-day diagnostic screenings to Vermont residents for a fee, the act directs the commissioner of health, in consultation with the attorney generals office, to determine whether these mobile health facilities practices serve Vermonters best interests and to report such findings by November 30, 2007.
Repeals. The act repeals provisions requiring an annual report on collaboration among hospitals and defining a community needs assessment.
Effective Date: July 1, 2007, except that the provisions on health information technology planning took effect upon passage.
The Vermont General Assembly
115 State Street