Download this document in MS Word format

AutoFill Template



An act relating to the regulation of health care facilities


The Senate proposes to the House to amend the bill as follows:

First:  By striking out Sec. 1 in its entirety and by inserting in lieu thereof the following:

Sec. 1.  18 V.S.A. § 1854(a) is amended to read:

(a)  A hospital shall make public the maximum patient census and the number of registered nurses, licensed practical nurses, and licensed nursing assistants providing direct patient care in each unit during each shift.  The number of nurses shall be reported  Each unit’s information shall be reported in full-time equivalents, with either every eight hours or 12 hours worked by a registered nurse, licensed practical nurse, or licensed nursing assistant during the shift as one full-time equivalent.  The reporting of this information shall be in a manner consistent with the requirements for public reporting for measures of nurse staffing selected by the commissioner of banking, insurance, securities, and health care administration under subdivision 9405b(a)(12) of this title, but shall not in any way change what is required to be posted as set forth in this subsection.  Each unit’s information shall be posted in a prominent place that is readily accessible to patients and visitors in that unit at least once each day.  The posting shall include the information for the preceding seven days.

Second:  By striking out Sec. 6 in its entirety and by inserting in lieu thereof the following:

Sec. 6.  18 V.S.A. § 9405(b) is amended to read:

(b)  On or before July 1, 2005, the commissioner, in consultation with the secretary of human services, shall submit to the governor a four-year health resource allocation plan. The plan shall identify Vermont needs in health care services, programs, and facilities; the resources available to meet those needs; and the priorities for addressing those needs on a statewide basis.

(1)  The plan shall include:

* * *

(C)  Consistent with the principles set forth in subdivision (A) of this subdivision (1), recommendations for the appropriate supply and distribution of resources, programs, and services identified in subdivision (B) of this subdivision (1), options for implementing such recommendations and mechanisms which will encourage the appropriate integration of these services on a local or regional basis.  To arrive at such recommendations, the commissioner shall consider at least the following factors: the values and goals reflected in the state health plan; the needs of the population on a statewide basis; the needs of particular geographic areas of the state, as identified in the state health plan; the needs of uninsured and underinsured populations; the use of Vermont facilities by out-of-state residents; the use of out-of-state facilities by Vermont residents; the needs of populations with special health care needs; the desirability of providing high quality services in an economical and efficient manner, including the appropriate use of midlevel practitioners; the cost impact of these resource requirements on health care expenditures; the services appropriate for the four categories of hospitals described in subdivision 9402(12) of this title; the overall quality and use of health care services as reported by the Vermont program for quality in health care and the Vermont ethics network; the overall quality and cost of services as reported in the annual hospital community reports; information from the hospital community needs assessments; individual hospital four-year capital budget projections; the unified health care budget; and the four-year projection of health care expenditures prepared by the division.

* * *

(4)  The commissioner shall develop a mechanism for receiving ongoing public comment regarding the plan and for revising it biannually every four years or as needed, in consultation with the public oversight commissionThe public oversight commission shall recommend revisions to the plan at least every four years and at any other time it determines revisions are warranted.

(5)  The commissioner in consultation with appropriate health care organizations and state entities shall inventory and assess existing state health care data and expertise, and shall seek grants to assist with the preparation of any revisions to the health resource allocation plan.  Based on this assessment and no later than January 15, 2004, the commissioner shall submit a report to the general assembly stating his or her recommendations regarding the professional assistance, budget, staff, and process needed to integrate available health care data and expertise into the health resource allocation plan.

(6)  The commissioner may retain such professional staff or other staff as needed to assist in his or her responsibilities under this section.  The reasonable expenses of such staff shall be funded to the maximum extent possible with grant money. Any additional amounts needed, not to exceed $300,000.00, shall be assessed and collected from hospitals licensed under chapter 43 of this title, proportionate to their annual operating budgets.  The commissioner’s assessment authority under this subdivision shall begin on July 1, 2003 and shall expire on July 1, 2005.

(7)(6)  The plan or any revised plan proposed by the commissioner shall be the health resource allocation plan for the state after it is approved by the governor or upon passage of three months from the date the governor receives the plan, whichever occurs first, unless the governor disapproves the plan, in whole or in part.  If the governor disapproves, he or she shall specify the sections of the plan which are objectionable and the changes necessary to meet the objections.  The sections of the plan not disapproved shall become part of the health resource allocation plan.  Upon its adoption, the plan shall be submitted to the appropriate legislative committees.

Third:  By striking out Sec. 9 in its entirety and by inserting in lieu thereof the following:

Sec. 9.  18 V.S.A. § 9456(d) is amended to read:

(d)(1)  Annually, the commissioner shall establish a budget for each hospital by September 15 followed by a written decision by October 1.  Each hospital shall operate within the budget established under this section.

(2)(A)  It is the general assembly’s intent that hospital cost containment conduct is afforded state action immunity under applicable federal and state antitrust laws, if:

(i)  the commissioner requires or authorizes the conduct in any hospital budget established by the commissioner under this section;

(ii)  the conduct is in accordance with standards and procedures prescribed by the commissioner; and

(iii)  the conduct is actively supervised by the commissioner.

(B)  A hospital’s violation of the commissioner’s standards and procedures shall be subject to enforcement pursuant to subsection (h) of this section.

Fourth:  By striking out Sec. 11 in its entirety and by inserting in lieu thereof the following:

Sec. 11.  REPEAL

(a)  Sec. 25 of No. 53 of the Acts of 2003 (requiring an annual report on collaboration among hospitals) is repealed.

(b)  Subdivision 9402(2) of Title 18 (community needs assessment definition) is repealed and the remaining subsections renumbered accordingly.

Fifth:  By adding a new section to be numbered Sec. 13 to read as follows:


Sec. 12 of this act shall take effect upon passage.  The remaining sections of this act shall take effect July 1, 2007.

Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont