SmartTranscript of House Health Care - 2025-05-30 - 9:05 AM

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[Dylan Green]: Good [Alyssa Black]: morning. It is I'm sorry. I don't have my computer. I have no idea what day it is. Thank you. The thirtieth. Thank you. It's Friday, the thirtieth, and we are hearing from ledge council on H. Two sixty six. Apparently, the, Senate amended it, so we have to hear the amendment. And go ahead, Jen. [Jen Harvey]: All right. Good morning, Jen Harvey from the Office of Legislative Council. I will put the amendment up on the screen here, and then I will also, remind you of what it refers to. So we are looking at h two sixty six. This is the senate proposal of amendment to the house proposal of amendment to the senate proposal of amendment. And the Senate concurred in the House in your proposal of amendment on h two sixty six and activating to the three forty b prescription drug pricing program, with further proposal of amendment by striking out section five, which is the twenty twenty five provisions around limits on, the average sales price percentage of the average sales price that hospitals can charge for outpatient administered drugs. So they struck out section five, and then in section six, the effective dates, they would strike out subsection b and renumber subsection c to be subsection b. So now let me put up what you sent them so we can look at what language is struck. This is the house proposal of amendment. This is what you sent over to them. You had concurred with further proposal by striking out sections four through seven. That was the white bagging and the effective dates and putting in new sections four through six. So section four, they would leave in. This is the limitation on outpatient admin prescription drugs administered in an outpatient or office setting, limiting that to a hundred and twenty percent ASP, for any drug that they were charging more than that as of April first and then kind of locking in the percentage of ASC for anything they were not charging that much. This is effective January first twenty twenty six. This stays in the bill in their proposal, but they would strike out section five, which is the limited piece from twenty from July first twenty twenty five through December thirty first twenty twenty five. That was the hundred and thirty percent ASP limitation for drugs for which they charged twenty more than hundred and twenty percent as of April first. So this is so they would take out the twenty twenty the July twenty five to December twenty five piece and not start these limits on the, outpatient prescription drugs until January first. And and whatnot, they made a conforming change here just to take section five out of the effective date section. So when you hear some people are describing it as they just changed the effective date, that is you know, that's not mechanically what happened, but in essence, that's what happened is that they just went with the section four January first twenty twenty six effective date on, that limitation and and, struck out the twenty twenty five piece. So [Alyssa Black]: hospitals may continue what they are doing currently until January first of twenty twenty five. [Robert]: Sixth. [Alyssa Black]: I mean, sixth. And then Right. And then they have to go to one twenty. [Jen Harvey]: Status quo until, January first, and then this hundred and twenty percent limitation goes into place. [Alyssa Black]: And just because I know that we made several changes, the piece around appealing to the Green Mountain Care Board because we had originally had it in just one section, did we was that struck out as well, and do we have that projection in the other section? [Jen Harvey]: I mean, being able to demonstrate that there's a negative impact. So, yes, all that was in both sections, and so all of section five section five largely replicated section four, but with a different ASP for the for the charges for the higher priced drugs for the first [Alyssa Black]: six months. Alright. So that [Jen Harvey]: whole section is gone, but all of the protections and the carve out for the critical access hospitals, all of that remains. Okay. [Alyssa Black]: Leslie, and then what do you [Leslie Goldman]: so just so I understand the timeline, that means, the the QHPs have to, submit their budget requests in, July, I believe. And then it gets approved in August, which means that the twenty three percent will stand because we can't we won't have [Jen Harvey]: So they're they've already submitted rates and they've submitted rates for the twenty twenty six plan year. This will affect the twenty twenty six plan year. So whether they need to modify So they they can do that, then there will be a modification. I expect that. I defer to Yeah. [Alyssa Black]: At this time, I understand. Yeah. We'll still be able to do the actuarial calculations for the twenty six plan year. Lowest rates of twenty Okay. And the [Jen Harvey]: board will be looking at that in their rate review analysis. Okay. [Alyssa Black]: Great. Will and I don't see laws in the room, but will it affect the hospitals in their budget [Lori Houghton]: review. Just said we did. Will they [Alyssa Black]: be able to make those calculations in what they submit? [Jen Harvey]: So and and week year starts in October? Fiscal year starts in October, so their fiscal year will reflect three quarters of this provision that takes effect in January of twenty twenty six. So I expect that that would be reflected in their budget requests. [Alyssa Black]: Yeah. [Jen Harvey]: But they won't have had you know, they won't already be experiencing those limitations when they submit their budget request. Okay. Woody? [Speaker 6 ]: So why are we doing this? What's the reasoning behind it when Blue Cross Blue Shield is in crisis mode right now and [Jen Harvey]: I just draft what members asked me to draft. So I it is not my not my my role to explain rationale from the other team. [Speaker 6 ]: Does anyone know what the rationale is? [Jen Harvey]: You could probably ask the hospitals. [Alyssa Black]: Yeah. I who was the amendment, proposed by? Senator Williams. Okay. Terry Williams. [Lori Houghton]: Terry Williams of Redmond. [Jen Harvey]: Devin, do you want me [Dylan Green]: Dylan Green from Buzz. The rationale is that the way the agreement for word process is set up, it happened through August and October and not have the budget orders coming out until October first. Means that hospitals would have to make changes starting July first operational changes July first, and they wouldn't be able to rely on that safety valve that has been set up, and this would give them an opportunity to make their case in the Green Mountain Care Board and let them know what the repercussions are and the Green Mountain Care Board can make adjustments if necessary. The other reason is a lot of the health care plans are on a calendar year, and so we thought that the savings would still be happening the premium savings would still be happening because of that calendar year. [Alyssa Black]: So the hospitals effectively would not be able to absorb July claims? Because they could put in their appeal on August fir in their budget orders on August first. So, basically, we're talking about the month of July. [Dylan Green]: We're talking about a bulk order because the budget order doesn't come out until October first. [Alyssa Black]: Laurie and then Mari. [Speaker 7 ]: So, I'm gonna go back. I sound like a broken record on this bill. And I just wanna remind people that the underlying bill is to protect help protect our FQHCs. And if we don't pass this out of here today with this, not get that bill passed. [Dylan Green]: Thank you for asking us And there [Jen Harvey]: are no more amendments permitted. [Alyssa Black]: Yes. At this stage. More amendments. So no one Right. Amended from [Jen Harvey]: the floor. Last. Right. This is the last stage because it is a senate proposal to a house proposal to a senate proposal. Yes. Another proposal of amendment would be out of order. So we either we either concur Concur or or or die. [Alyssa Black]: Or it dies. [Jen Harvey]: We need to go to conference, but from a timing standpoint, I'm not sure now. So I'm not gonna have Yeah. Nope. [Dylan Green]: That's not good. We are out of here today. [Alyssa Black]: I promise. I can't promise that. Laurie. [Lori Houghton]: I I will support the amendment, picking and screening. I'm really frustrated. Our health care system is I feel like a broken record as well, is, crashing. This is an emergency, and you don't run into emergency and say, hey, let's wait a bunch of months. And I believe that the bill that we sent to the Senate had enough protections for hospitals, access hospitals and for other hospitals, and that the bigger some of our bigger hospitals had enough cushion, enough reserve to make some changes. So again, I will vote for this kicking and screaming. And I hope that, the hospitals that push for this amendment to slow down the process of trying to save our crashing health care system, actually do something in the next few months, to do the things that this bill, around the price caps, was asking them to do, and they that we actually see some work from them, [Alyssa Black]: on this. Think of our system, the whole system. I would encourage anyone I mean, we're gonna vote on this right now, but I would encourage anyone to, go back and watch Senate Health and Welfare yesterday while they were taking testimony on this. I was in the room. There were several of us in the room. And I would encourage people to go back and watch Chair Foster's remarks on this, which were a little bit more when he was here, we had given him a very short time, and he sort of fleshed that out. And it I'm sorry. It was incredibly powerful. He presented a chart with hospitals and the increase in their revenues. And then he proceeded to put slide after slide of every other piece of our health care system and their charts with plummeting everything down. So I share your frustration, representative Curtis. But this is what we have before us. Any other comments or questions, Robert? [Robert]: I just like to say, what we're voting on here today is the amendment. [Alyssa Black]: We are voting on whether to concur with the senate proposal Right. Of amendment on our proposal of amendment on their proposal. Okay. [Speaker 8 ]: And well, I didn't finish. [Robert]: Oh, well, I'm sorry. [Alyssa Black]: I had [Robert]: to reiterate what the representative said. We need this bill in order to do the job that we were trying to do to shore up the health care system. [Alyssa Black]: Alright. Well, I will we'll do a straw poll. All those in favor of concurring with the Senate proposal amendment, ten zero one. Thank you, everyone. Thanks, Tim. And we
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