Hunting Certificate Template

							      Journal of the Senate
                              ________________
                      WEDNESDAY, MARCH 13, 2002
   The Senate was called to order by the President pro tempore.
                             Devotional Exercises
  Devotional exercises were conducted by the Reverend Terry Dorset of
Barre.
                       Message from the House No. 30
  A message was received from the House of Representatives by Mr.
Bertrand, its Second Assistant Clerk, as follows:
Mr. President:
   I am directed to inform the Senate the House has passed bills of the
following titles:
   H. 635. An act relating to free hunting and fishing license for a member of
the National Guard who is on active duty.
   H. 753. An act relating to income and estate taxes.
   In the passage of which the concurrence of the Senate is requested.
   The House has adopted a Joint Resolution of the following title:
   J.R.H. 226. Joint resolution saluting the University of Vermont and the
University‟s students, alumni, faculty and staff for their outstanding service on
behalf of our state and nation.
   In the adoption of which the concurrence of the Senate is requested.
                                Bills Referred
   House bills of the following titles were severally read the first time and
referred:
                                      H. 635.
  An act relating to free hunting and fishing license for a member of the
National Guard who is on active duty.
   To the Committee on Natural Resources and Energy.
                                      H. 753.
   An act relating to income and estate taxes.
                                      393
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   To the Committee on Finance.
                    Joint Resolution Placed on Calendar
                                    J.R.H. 226.
    Joint resolution originating in the House of the following title was read the
first time and is as follows:
   Joint resolution saluting the University of Vermont and the university‟s
students, alumni, faculty and staff for their outstanding service on behalf of our
state and nation.
   Whereas, Vermont‟s quality of life and vitality in the agricultural,
economic, educational, environmental, health care and governmental sectors
are closely tied to the activities of the University of Vermont (UVM), and
   Whereas, each year, approximately 2,500 University of Vermont
undergraduate students perform more than 90,000 hours of community service
through programs such as Volunteers in Action and UVM Rescue, and
   Whereas, the University of Vermont has a rich history of supporting
service-learning, and is the first academic institution in the nation to launch a
partnership with AmeriCorps*VISTA, a new initiative called ALIVE
(Academic Learning Integrated With Volunteer Experience) that enables
students to earn academic credit for civic understanding and engagement, and
   Whereas, UVM Medical School has graduated or provided the residencies
for 39 percent, or more than 500, of the state‟s active physicians, and has been
a national leader in introducing the advances of telemedicine to rural
communities, and
  Whereas, more than 2,400 municipal officials annually gain valuable
knowledge and insight through the UVM Extension Service‟s town
government education programs, and
   Whereas, the Vermont Math Initiative (VMI) is a three-year masters program
designed to put a master math teacher in every elementary school in the state,
and 105 teachers are currently enrolled representing 76 schools, and
   Whereas, over 2,500 Vermont youngsters benefit from the university‟s role
in 4-H Club activities, and
   Whereas, 639 University of Vermont alumni who are either current or
former Peace Corps volunteers have shared their skills in education, health, the
environment, agriculture, business, and urban development in 98 different
countries, and
  Whereas, UVM alumni comprise 35 percent of the membership of the
Vermont Air Guard Fighter Squadron unit which has played an important
                           WEDNESDAY, MARCH 13, 2002                       395
defense role since September 11, and whose 22-year-veteran pilot Lt. Colonel
Scott Baldwin ‟76 was honored in 2001 with the Air Force Air Medal and the
American Legion Valor Award, and
   Whereas, internationally distinguished UVM alumni include Nobel
Laureates Jody Williams ‟72, who was awarded the Nobel Peace Prize in 1997,
and John McGill M.D. „78, who is associated with the 1999 Nobel Peace Prize
winner, Doctors Without Borders, and
   Whereas, 24,000 University of Vermont alumni provide daily leadership
within the state of Vermont, including Michele Forman ‟82 of Salisbury who
was awarded the 2001 National Teacher of the Year and David Marvin ‟70 of
Hyde Park who currently serves as board chair of both Shelburne Farms and
the Vermont Land Trust, and
   Whereas, all Vermonters can be proud of the many achievements and
community service of UVM, its students, alumni, faculty and staff, now
therefore be it
   Resolved by the Senate and House of Representatives:
    That the General Assembly is proud to salute the University of Vermont, a
pillar of educational excellence and public service in our state and nation, and
be it further
   Resolved: That the Secretary of State be directed to send a copy of this
resolution to University of Vermont Interim President Edwin Colodny in
Burlington.
   Thereupon, in the discretion of the President pro tempore, under Rule 51,
the joint resolution was placed on the Calendar for action tomorrow.
                            Consideration Postponed
                                     S. 224.
   Senate bill entitled:
   An act relating to reports of abuse, neglect and exploitation of elderly and
disabled adults.
   Was taken up.
   Thereupon, without objection consideration of the bill was postponed until
the next legislative day.
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                              Bill Ordered to Lie
                                      S. 258.
   Senate bill entitled:
   An act relating to the discovery and management of Native American
remains.
   Was taken up.
   Thereupon, pending the question, Shall the bill be amended as
recommended by the Committee on General Affairs and Housing?, on motion
of Senator Greenwood, the bill was ordered to lie.
                    Bill Amended; Third Reading Ordered
                                      S. 286.
   Senator Chard, for the Committee on Health and Welfare, to which was
referred Senate bill entitled:
   An act relating to Vermont hospitals, the certificate of need program, and
the hospital budget review process.
   Reported recommending that the bill be amended by striking out all after
the enacting clause and inserting in lieu thereof the following:
Sec. 1. 18 V.S.A. § 9406(c) is added to read:
   (c)(1) On or before July 1, 2003 for the hospital fiscal year beginning
October 1, 2004, and annually thereafter for the hospital fiscal year beginning
15 months thereafter on October 1, the unified health care budget adopted by
the commissioner shall include an annual, aggregate hospital sector budget
target, including hospitals‟ total operating and capital expenditures, for all
hospitals licensed under chapter 43 of this title.
      (2) On or before January 1, 2003, and annually thereafter, the board of
trustees of each hospital licensed under chapter 43 of this title shall publish a
report to the community concerning the hospital‟s performance on such cost,
quality, access, productivity and other performance standards that have been
adopted by the board of trustees after consideration of the needs of the
community, and that have been developed after a public process that involves a
dialogue with community residents. Hospitals located outside this state which
serve a significant number of Vermont residents, as determined by the
commissioner, shall be invited to participate in the community report process
established by this subdivision. The board of each hospital shall hold one or
more public hearings to solicit community comment on the hospital‟s report
after 30 days‟ notice to each newspaper covering the area served by the
hospital, and to each newspaper, radio station, television station, or other
                        WEDNESDAY, MARCH 13, 2002                             397
person who has requested notice. The board of trustees shall publish its
response to any public comments within 60 days of the public hearing.
       (3)(A) On or before October 1, 2002, and every five years thereafter, the
commissioner shall contract with a qualified entity for a study to evaluate the
Vermont hospital market and the hospital-based service delivery system
serving Vermont residents.          The study shall examine, and make
recommendations concerning, the composition and distribution of
hospital-based health care services in order to control costs, while ensuring
access and maintaining quality. In conducting the study the contractor shall
consult with and seek the involvement of hospitals serving Vermont residents,
other health care providers, health care payers, patients and consumers, and
other affected parties. The results shall be used by the commissioner in
adopting the aggregate hospital sector budget target portion of the unified
health care budget under subdivision (1) of this subsection, in making
certificate of need decisions under subchapter 5 of this chapter, and in making
hospital budget decisions under subchapter 7 of this chapter.
           (B) Expenses incurred by the commissioner under this subdivision
shall be borne as follows: 60 percent by hospitals licensed under chapter 43 of
this title, and 40 percent by health insurers, including nonprofit hospital and
medical service corporations licensed under chapter 123 or 125 of Title 8,
health insurance companies licensed under chapter 101 of Title 8, and health
maintenance organizations licensed under chapter 139 of Title 8. Expenses
allocated to health insurers under this subdivision shall be billed to persons
licensed under Title 8, proportionate to premiums paid for health care
coverage, which, for purposes of this section, include major medical,
comprehensive medical, hospital or surgical coverage, and any comprehensive
health care services plan, but does not include long-term care, limited benefits,
disability, credit or stop loss or excess loss insurance coverage. Expenses
allocated to hospitals under this subdivision shall be billed to hospitals licensed
under chapter 43 of this title, proportionate to their annual operating budgets.
Expenses incurred by the commissioner and billed back to the organizations
identified in this subdivision (B) shall not exceed $150,000.00.
      (C) The commissioner may seek grant funding for all or part of the
study. All such grant funding received shall be used to reduce the expenses
which would otherwise be allocated to hospitals and health insurers under
subdivision (B) of this subdivision (3).
Sec. 2. 18 V.S.A. § 9434(a) is amended to read:
   (a) No new institutional health service shall be offered or developed within
this state by any person, without a determination of need and issuance of a
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certificate of need by the commissioner, as provided in this subchapter. “New
institutional health service” includes:
       (1) the construction, development, or other establishment of a new
health care facility except for the purchase or lease of an existing health care
facility other than the purchase of a hospital;
       (2) any expenditure by or on behalf of a hospital in excess of
$1,500,000.00 or any expenditure by or on behalf of any other health care
facility in excess of $750,000.00, which, under generally accepted accounting
principles, consistently applied, is a capital expenditure;
      (3)    acquisition by purchase, or by lease or other comparable
arrangement, by or on behalf of a health care provider of a single piece of
diagnostic or therapeutic equipment for which the cost, or in the case of a
donation the value, is in excess of $500,000.00. For purposes of this
subdivision, the purchase or lease of one or more articles of diagnostic or
therapeutic equipment which are necessarily interdependent in the performance
of their ordinary functions or which would constitute any health care facility
included under section subdivision 9432(10)(B) of this title, as determined by
the commissioner, shall be considered together in calculating the amount of an
expenditure. The commissioner‟s determination of functional interdependence
of items of equipment under this subdivision shall have the effect of a final
decision and is subject to appeal under this subchapter;
      (4) a change from one licensing period to the next in the number of
licensed beds of a health care facility through the addition or conversion, or
through the relocation from one physical facility or site to another;
       (5) the offering of health services in or through a health care facility
which were not offered on a regular basis in or through such health care
facility within the twelve-month period prior to the time such services would
be offered if such services have with an annual operating expense in excess of
$300,000.00 or if those services have not been offered previously, or if the
services have been newly offered at lower expense levels in the last 36 months;
      (6) the offering of any home health services;
      (6)(7) the purchase of an existing hospital; or
      (7)(8) the offering of any cardiac catheterization laboratory service.
   (b) In the case of a new institutional health service which requires a
certificate of need under subsection (a) of this section, expenditures for which
are anticipated to be in excess of $15 million, the applicant shall first secure a
conceptual development phase certificate of need, in accordance with the
standards and procedures established in this subchapter, and permitting the
                       WEDNESDAY, MARCH 13, 2002                            399
applicant to make expenditures for architectural services, engineering design
services and any other planning services needed in connection with the project.
Upon completion of the conceptual development phase of the project, and
before offering or developing the new institutional health service, the applicant
shall secure a final certificate of need, in accordance with the standards and
procedures established in this subchapter, establishing how the final
architectural, engineering and other plans meet the previously determined level
of need.
   (b)(c) If the commissioner determines that a person required to obtain a
certificate of need under this subchapter has separated a single project into
components in order to avoid cost thresholds or other requirements under this
subchapter, the person shall be required to submit an application for a
certificate of need for the entire project, and the commissioner may proceed
under section 9445 of this title. The commissioner‟s determination under this
subsection shall have the effect of a final decision and is subject to appeal
under this subchapter.
Sec. 3. 18 V.S.A. § 9436(a) is amended to read:
   (a) In making its determination as to whether a certificate of need shall be
issued, the commissioner shall consider only the criteria which have been duly
adopted and published 90 days prior to the submission of the original
application for certificate of need. At a minimum, such criteria shall include:
                                     ***
      (21) Whether the proposal promotes the general good of the state;
      (22) In the case of an applicant subject to the hospital budget provisions
of subchapter 7 of this title, the applicant‟s record of performance within its
budgets established by the commissioner;
       (23) The applicant‟s record of performance in connection with
representations made during other certificate of need application reviews under
this subchapter.
Sec. 4. 18 V.S.A. § 9439(f) is added to read:
   (f) The commissioner may establish, by rule, regular cycles for the review
of applications for certificates under this subchapter, in addition to the review
cycles for skilled nursing and intermediate care beds established under
subsections (d) and (e) of this section. A review cycle may include in the same
group some or all of the types of services subject to certificate of need review.
Such rules may exempt emergency applications, as determined by the
commissioner, from the review cycle process. The commissioner may identify
in advance of the review cycle the maximum aggregate permissible cost, or the
400                        JOURNAL OF THE SENATE
maximum number of the new institutional health services that may be
approved during the review cycle, consistent with the annual hospital sector
budget adopted under subdivision 9406(c)(1).
Sec. 5. 18 V.S.A. § 9440(b), (c) and (e) are amended to read:
   (b) The application process shall be as follows:
    (1) Applications shall be accepted only at such times as the
commissioner shall establish, by rule.
       (1)(2) Prior to filing an application for a certificate of need, an applicant
shall file a letter of intent with the commissioner no less than 30 days, or, in
the case of review cycle applications under subsections 9439(d), (e) and (f) of
this title, no less than 45 days, prior to the date on which the application is to
be filed. The letter of intent shall form the basis for determining the
applicability of this subchapter to the proposed expenditure or action. A letter
of intent shall become invalid if an application is not filed within six months of
the date that the letter of intent is received, or, in the case of review cycle
applications under subsections 9439(d), (e) and (f) of this title, within such
time limits as the commissioner shall, by rule, establish. Public notice of such
letters of intent shall be provided in newspapers having general circulation in
the region of the state affected by the letter of intent. The notice shall identify
the applicant, the proposed new institutional health service, and the date by
which a competing application or a petition to intervene must be filed.
       (2)(3) Upon a determination by the commissioner that a certificate of
need is required for a proposed expenditure or action, an application for a
certificate of need shall be filed.
      (3)(4) The commissioner, upon making an interim determination on the
basis of a letter of intent that a project will be uncontested, may accept a
preliminary application immediately upon making such a determination and
issue proper public notice.        If no interested party comes forth, the
commissioner may then formally declare the application uncontested and may
issue a certificate of need without further process or may declare, on its own
motion, that the application is contested.
      (4)(5) Within 15 days, or, in the case of review cycle applications under
subsections 9439(d), (e) and (f) of this title, within 30 days, of receipt of an
application, the commissioner shall notify the applicant that the application
contains all necessary information required and is complete, or that additional
information is required.
      (5)(6) If an applicant fails to respond to an information request under
subdivision (4)(5) of this subsection within six months, or, in the case of
review cycle applications under subsections 9439(d), (e) and (f) of this title,
                        WEDNESDAY, MARCH 13, 2002                              401
within such time limits as the commissioner shall, by rule, establish, the
application will be deemed inactive. If an applicant fails to respond to an
information request within 12 months, or, in the case of review cycle
applications under subsections 9439(d), (e) and (f) of this title, within such
time limits as the commissioner shall, by rule, establish, the application will
become invalid.
       (6)(7) For purposes of this section, “interested party” status shall be
granted to persons who demonstrate that they will be substantially, adversely
and directly affected by the new institutional health service under review or
that they will materially assist the commissioner by providing nonduplicative
evidence relevant to the determination. The commissioner shall grant or deny
a petition to intervene under this subdivision within 15 days after the petition is
filed, provided the petition is filed within 20 days following public notice of
the letter of intent, public notice that the application is complete, or issuance of
the recommendation of the public oversight commissioner. The commissioner
shall grant or deny the petition within an additional 30 days upon finding that
good cause exists for the extension. Once interested party status is granted the
commissioner shall provide the information necessary to enable the party to
participate in the review process. Such information includes information about
procedures, copies of all written correspondence and copies of all entries in the
application record.
       (7)(8) Once an application has been deemed to be complete, public
notice of the application will be provided in newspapers having general
circulation in the region of the state affected by the application. The notice
shall identify the applicant, the proposed new institutional health service and
the date by which a competing application under section 9439 of this title or a
petition to intervene must be filed.
      (9) The health care ombudsman‟s office established under section 4089j
of Title 8 is authorized but not required to participate in any administrative or
judicial review of an application under this subchapter, and shall be considered
an interested party in such proceedings upon filing a notice of intervention
with the commissioner.
   (c) The review process shall be as follows:
      (1) The public oversight commission shall review the application
materials provided by the applicant and the arguments raised in favor of or
against the proposal, if any, and may request the technical panel‟s advice,
recommendations and comments on the merits of the application.
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      (2) The public oversight commission shall hold a public hearing during
the course of a review if requested by persons directly affected by the review
the applicant, any competing applicants, and any interested party.
       (3) A review shall be completed and the commissioner shall make a
decision within 120 days after the date of notification under subdivision (b)(4)
of this section. Whenever it is not practicable to complete a review within 120
days, the commissioner may extend the review period up to an additional 30
days, or for a reasonable period of time in the case of review cycle applications
under subsections 9439(d), (e) and (f) of this title. Any review period may be
extended with the written consent of all applicants the applicant and all other
applicants in the case of a review cycle process under subsections 9439(d), (e)
and (f) of this title.
      (4) After reviewing each application and after considering the
recommendations of the public oversight commission, the commissioner shall
make a decision either to issue a certificate of need or to deny the application
for a certificate of need. In the event of a certificate of need application
involving interested parties or competing applicants, or in the event the
commissioner has decided to deny the original, amended, or competing
application, the commissioner shall prepare and provide to the chair of the
public oversight commission, the applicant, competing applicants and
interested parties a proposed decision prior to the issuance of a final decision.
The public oversight commission, the applicant, competing applicants and
interested parties shall have 10 days from the date of service to file written
exceptions and to request a hearing with the commissioner for the sole purpose
of commenting on the proposed decision and such exceptions as may be filed.
The commissioner shall maintain a record of such hearing for purposes of
appellate review. Upon review of any such written and oral submissions, the
commissioner shall issue his or her final decision. Notice of the final decision
shall be sent to the applicant, the public oversight commission, competing
applicants and interested parties. This notice shall state the basis of the
decision.
                                       ***
   (e) Any party applicant, competing applicant, or interested party, aggrieved
by a final decision of the commissioner under this section may appeal the
decision to the supreme court.
Sec. 6. 18 V.S.A. § 9454 is amended to read:
§ 9454. HOSPITALS; DUTIES
    (a) Hospitals shall file the following information at the time and place and
in the manner established by the commissioner:
                        WEDNESDAY, MARCH 13, 2002                             403
      (1) a budget for the forthcoming fiscal year;
      (2) financial information, including but not limited to costs of operation,
revenues, assets, liabilities, fund balances, other income, rates, charges, units
of services, and wage and salary data;
      (3) scope-of-service and volume-of-service information, including but
not limited to inpatient services, outpatient services and ancillary services by
type of service provided;
      (4) utilization information. The hospital‟s utilization information shall
include a plan designed to optimize hospital-based health care services,
including a plan to reduce health care services that are unnecessary or not cost-
effective, and a plan to increase preventive and other health care services that
are necessary and underutilized. The hospital‟s plan may reflect the hospital‟s
individual circumstances and the needs of the community which it serves, and
may incorporate collaborations with other hospitals and health care providers,
the Vermont Program for Quality in Health Care, Inc., and other national and
regional organizations with expertise in hospital-based health care utilization.
The hospital‟s plan may include a patient education component that
encourages patient involvement in clinical decision-making to improve quality
and reduce costs, and a health care provider education and dialogue component
that encourages health care providers to consider cost-effective ways to
improve the health of the patient. The hospital‟s plan may adopt an
incremental approach, whereby one or more clinical areas are selected and
addressed during each fiscal year. The hospital‟s plan shall include a method
to measure the effects of the hospital‟s initiatives, and a mechanism to share
the cost savings that accrue from the initiatives with individuals and
organizations that pay for health care services;
       (5) new hospital services and programs proposed for the forthcoming
fiscal year;
     (6) a projected three-year five-year capital expenditure budget and a
proposed five-year capital plan; and
      (7) such other information as the commissioner may require.
   (b) Hospitals shall adopt a fiscal year which shall begin on October 1.
   (c) Whenever variations in expenditures or net patient revenues greater
than three percent occur or are projected to occur for the current fiscal year of a
hospital, the hospital shall:
    (1) notify the division, in accordance with rules adopted by the
commissioner; and
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       (2) file either a revised budget that complies with the annual budget
established by the commissioner under subsection 9456(d) of this title, or a
petition to adjust the budget under subsection 9456(f).
Sec. 7. 18 V.S.A. § 9456 is amended to read:
§ 9456. BUDGET REVIEW
   (a) The commissioner shall conduct reviews of each hospital‟s proposed
budget based on the information provided pursuant to this subchapter, and in
accordance to a schedule established by the commissioner.
   (b) In conjunction with budget reviews, the commissioner shall:
      (1) review utilization information, including the hospital‟s utilization
plan filed in accordance with subdivision 9454(a)(4) of this title;
    (2) consider the goals and recommendations of the health resource
management plan or state health plan, whichever applies;
      (3) consider the expenditure analysis for the previous year and, the
proposed expenditure analysis for the year under review, and the annual
unified health care budget for the year under review, including the annual
aggregate hospital sector budget target established under subdivision
9406(c)(1) of this title;
      (4) consider any reports from professional review organizations;
      (5) solicit public comment on all aspects of hospital costs and use and
on the budgets proposed by individual hospitals;
    (6) consider any public comments made in connection with the hospital
community report process under subdivision 9406(c)(2) of this title;
      (6)(7) meet with hospitals to review and discuss hospital budgets for the
forthcoming fiscal year;
      (7)(8) give public notice of the meetings with hospitals, and invite the
public to attend and to comment on the proposed budgets;
      (8)(9) consider the extent to which costs incurred by the hospital in
connection with services provided to Medicaid beneficiaries are being charged
to non-Medicaid health benefit plans and other non-Medicaid payers;
      (9)(10) require each hospital to file an analysis that reflects a reduction
in net revenue needs from non-Medicaid payers equal to any anticipated
increase in Medicaid reimbursements resulting from appropriations designed to
reduce the Medicaid cost shift; and
    (10)(11) seek the advice and recommendations of the public oversight
commission; and
                        WEDNESDAY, MARCH 13, 2002                            405
      (12) consider the hospital‟s record of performance in connection with
representations made during certificate of need application reviews under
subchapter 5 of this chapter, and the hospital‟s record of performance in
operating within the budget established under this subchapter for the current
and prior fiscal years.
   (c) Individual hospital budgets established under this section shall:
      (1) be consistent with the health resource management plan or state
health plan, whichever applies;
      (2) take into consideration national, regional or instate peer group
norms, according to indicators, ratios and statistics established by the
commissioner, and performance benchmarks relating to costs, quality and
access for highly efficient hospitals adopted by the commissioner. The
commissioner shall consult with and take into consideration the views of
hospitals, health care professionals, the Vermont Program for Quality in Health
Care, Inc., and other national and regional organizations with expertise in
hospital performance measurements during the development of the
performance benchmarks adopted under this subdivision;
      (3) promote efficient and economic operation of the hospital;
      (4) reflect budget performances for prior years. A hospital which has
failed to operate within its prior year budget shall be subject to such budget
adjustments, budget controls, or other measures as the commissioner may
order pursuant to subsections (f) and (h) of this section; and
      (5) include a finding that the analysis provided in subdivision (b)(9)(10)
of this section is a reasonable methodology for reflecting a reduction in net
revenues for non-Medicaid payers.
   (d) Beginning October 1, 1996, and annually thereafter, the commissioner
shall consider the recommendations of the public oversight commission and
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.
   (e) The commissioner may shall establish, by rule, a process to define, on
an annual basis, criteria for hospitals to meet, such as utilization and inflation
benchmarks standards and procedures by which to measure a hospital‟s annual
performance relating to cost, utilization, productivity and other criteria. The
rule may permit the commissioner to waive one or more of the review
processes listed in subsection (b) of this section, but not for more than one year
consecutively.
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   (f) The commissioner may, upon application, adjust a budget established
under this section upon a showing of need based upon exceptional or
unforeseen circumstances in accordance with the criteria and processes
established under section 9406 of this title, if:
      (1) the hospital demonstrates that the adjustment is necessary to prevent
financial harm threatening the financial solvency of the hospital resulting from
circumstances beyond the control of the hospital;
      (2) the hospital demonstrates that the adjustment is necessary to protect
the safety of patients;
      (3) the hospital demonstrates that the adjustment is necessary because of
unanticipated and increased revenue, provided that the hospital also
demonstrates that it has used its best efforts to implement its utilization plan
filed pursuant to subdivision 9454(a)(4) of this title, and has used its best
efforts to implement other performance and productivity measures designed to
enable the hospital to operate within its budget established under this section;
or
      (4) the commissioner, on his or her own initiative, determines that an
adjustment is necessary to:
         (A) ensure that the hospital complies with the hospital‟s budget
established under this section; or
         (B) further the policies and purposes of this chapter.
   (g) The commissioner may request, and a hospital shall provide,
information determined by the commissioner to be necessary to determine
whether the hospital is operating within a budget established under this section.
   (h) If a hospital violates a provision of this section, the commissioner may
maintain an action in the superior court of the county in which the hospital is
located to enjoin, restrain or prevent such violation. The commissioner may
maintain an action in the superior court of the county in which the hospital is
located to enjoin, restrain, or prevent the actions of any hospital which fails to
operate within the budget established under this subchapter, or which violates
any provision established or rule adopted under this subchapter. The
commissioner, after notice and an opportunity to be heard, may issue one or
more of the following orders for any such failure or violation:
      (1) The commissioner may impose an administrative penalty of not less
than $1,000.00 nor more than $10,000.00 for each failure or violation, which
fine shall not be reimbursed by any payer; or
     (2) In the event the hospital exceeds the approved level of operating
margin, the commissioner may order the hospital to lower any or all of its rates
                       WEDNESDAY, MARCH 13, 2002                            407
as the commissioner deems appropriate, and require verification that such rates
have been lowered; or
       (3) The commissioner may order the implementation of budget controls
or such other performance or productivity measures as are necessary to ensure
that the hospital operates within the budget established by this subchapter.
Sec. 8. 16 V.S.A. § 3856(j) is added to read:
   (j) In the case of bonds issued in connection with a new institutional health
service subject to the provisions of subchapter 5 of chapter 221 of Title 18, the
agency shall not authorize bonds on behalf of an eligible institution defined
under subdivision 3851(c)(5) of this title, unless the project and the capital
expenditures associated with the project have been approved by the
commissioner of banking, insurance, securities, and health care administration,
pursuant to subchapter 5 of chapter 21 of Title 18. The agency shall consider
the recommendations of the commissioner in connection with any such
proposed authorization.
Sec. 9. REPORT ON HOSPITAL COST CONTAINMENT INITIATIVES
   The commissioner of banking, insurance, securities and health care
administration shall report to the governor and the general assembly on or
before January 1, 2004 on the health care costs of hospitals serving Vermont
residents, an assessment of the economic and public policy circumstances
affecting the health care environment in which hospitals provide services, the
performance of such hospitals relating to the cost, quality and performance
benchmarks established in 18 V.S.A. § 9456(c)(2), initiatives implemented by
hospitals and other private sector organizations to reduce the rate of growth in
hospital costs, and public sector initiatives to reduce the rate of growth in
hospital costs. The report shall specifically identify the aggregate hospital
sector budget targets established by 18 V.S.A. § 9406(c)(1), whether the
budget targets were met, and if the budget targets were not met the reasons
therefore. The report shall specifically identify Vermont‟s public sector cost
containment mechanisms including the provisions of this act, make an
assessment of the success of each public sector cost containment mechanism in
reducing the rate of growth of hospital costs, and make any recommendations
reducing the rate of growth of hospital costs while maintaining access and
quality. The commissioner shall specifically analyze and recommend whether
or not an aggregate hospital sector budget should be used as a state-wide
hospital sector budget cap for all Vermont hospitals.
   And that when so amended the bill ought to pass.
408                          JOURNAL OF THE SENATE
    Thereupon, the bill was read the second time by title only pursuant to Rule
43, the recommendation of amendment was agreed to, and third reading of the
bill was ordered.
                                   Bills Passed
   Senate bills of the following titles were severally read the third time and
passed:
                                        S. 73.
  An act relating to permits for motor vehicle signal lamps.
                                       S. 111.
  An act relating to emergency care and treatment of an animal.
                                       S. 229.
  An act relating to installation of an object in lieu of an air bag.
                                       S. 249.
  An act relating to bail.
                             Consideration Postponed
                                       S. 245.
  Senate bill entitled:
   An act relating to making it clear that a municipality may use sewer
allocation authority to implement its municipal plan.
  Was taken up.
   Thereupon, without objection consideration of the bill was postponed until
the next legislative day.
                   Bill Amended; Third Reading Ordered
                                       S. 277.
  Senator Snelling, for the Committee on Natural Resources and Energy, to
which was referred Senate bill entitled:
  An act relating to authorizing municipalities to manage stormwater.
   Reported recommending that the bill be amended by striking out all after
the enacting clause and inserting in lieu thereof the following:
Sec. 1. 24 V.S.A. § 3501 is amended to read:
§ 3501. DEFINITIONS
                        WEDNESDAY, MARCH 13, 2002                             409
   The following words and phrases, as used in this chapter and in chapter 101
of this title, shall have the following meanings:
      (1) "Domestic sewage" or "house sewage" is sanitary sewage derived
principally from dwellings, business buildings and institutions.
     (2) "Industrial wastes" or "trade wastes" are liquid wastes from industrial
processes, including suspended solids.
     (3) "Sanitary sewage" is used water supply commonly containing human
excrement.
      (4) "Sanitary treatment" shall be an approved method of treatment of
solids and bacteria in sewage before final discharge.
      (5) "Sewage" is the used water supply of a community, including such
ground water, surface and storm water as may or may not be mixed with these
liquid wastes from the community.
       (6) "Sewage system" shall include such equipment, pipe line system and
facilities as are needed for and appurtenant to the disposal of sewage and
waters, as defined herein, including a sewage disposal or treatment plant as
defined in section 3601 of this title and separate pipe lines and facilities as are
needed for and appurtenant to the disposal of storm, surface, and sub-surface
waters.
      (7) "Storm water" or "storm sewage" is the excess water from rainfall or
continuously following therefrom.
      (8) "Surface water" is water other than storm water flowing on or over
the surface of the ground.
Sec. 2. 24 V.S.A. § 3601 is amended to read:
§ 3601. DEFINITIONS
   The definitions established in section 3501 of this title shall establish the
meanings of those words as used in this chapter, and the following words and
phrases as used in this chapter shall have the following meanings:
      (1) "Necessity" means a reasonable need which considers the greatest
public good and the least inconvenience and expense to the condemning party
and to the property owner. Necessity shall not be measured merely by expense
or convenience to the condemning party. Due consideration shall be given to
the adequacy of other property and locations; to the quantity, kind and extent
of property which may be taken or rendered unfit for use by the proposed
taking; to the probable term of unfitness for use of the property; to the effect of
construction upon scenic and recreational values, upon home and homestead
410                      JOURNAL OF THE SENATE
rights and the convenience of the owner of the land; to the effect upon town
grand list and revenues;
      (2) "Board" means the board of sewage disposal commissioners.
     (3) The phrase "sewage disposal or treatment plant" shall include, for the
purposes of this chapter, such plant, equipment, system and facilities as are
needful for and appurtenant to the disposal by approved sanitary methods of
domestic sewage, garbage, or industrial wastes, storm water, or surface water.
Sec. 3. 24 V.S.A. § 3615 is amended to read:
§ 3615. RENTS; RATES
   Such municipal corporation, through its board of sewage disposal
commissioners, may establish charges to be called "sewage disposal charges,"
to be paid at such times and in such manner as the commissioners may
prescribe. The commissioners may establish annual charges separately for
bond repayment, fixed operations and maintenance costs (not dependent on
actual use), and variable operations and maintenance cost dependent on flow.
Such charges may be based upon: (1) the metered consumption of water on
premises connected with the sewer system, however, the commissioners may
determine no user will be billed for fixed operations and maintenance costs and
bond payment less than the average single family charge; (2) the number of
equivalent units connected with or served by the sewage system based upon
their estimated flows compared to the estimated flows from a single family
dwelling, however, the commissioners may determine no user will be billed
less than the minimum charge determined for the single family dwelling
charge for fixed operations and maintenance costs and bond payment; (3) the
strength and flow where wastes stronger than household wastes are involved;
(4) the appraised value of premises, in the event that the commissioners shall
determine the sewage disposal plant to be of general benefit to the municipality
regardless of actual connection with the same; (5) the commissioners'
determination developed using any other equitable basis such as the number
and kind of plumbing fixtures, the number of persons residing on or
frequenting the premises served by those sewers, the topography, size, type of
use, or impervious area of any premises; or (6) any combination of these bases,
so long as the combination is equitable. The basis for establishing sewer
disposal charges shall be reviewed annually by sewage disposal
commissioners. No premises otherwise exempt from taxation, including
premises owned by the state of Vermont, shall, by virtue of any such
exemption, be exempt from charges established hereunder. The commissioners
may change the rates of such charges from time to time as may be reasonably
required. Where one of the bases of such charge is the appraised value and the
premises to be appraised are tax exempt, the commissioners may cause the
                       WEDNESDAY, MARCH 13, 2002                            411
listers to appraise such property, including state property, for the purpose of
determining the sewage disposal charges. The right of appeal from such
appraisal shall be the same as provided in chapter 131 of Title 32. The
commissioner of finance and management is authorized to issue his warrants
for sewage disposal charges against state property and transmit to the state
treasurer who shall draw a voucher in payment thereof. No charge so
established and no tax levied under the provisions of section 3613 of this title
shall be considered to be a part of any tax authorized to be assessed by the
legislative body of any municipality for general purposes, but shall be in
addition to any such tax so authorized to be assessed. Sewage disposal charges
established in accord with this section may be assessed by the board of sewage
disposal commissioners as provided in section 3614 of this title to derive the
revenue required to pay pollution charges assessed against a municipal
corporation under section 1265 of Title 10.
Sec. 4. 24 V.S.A. § 3672 is amended to read:
§ 3672. DEFINITIONS
   (a) As used in this chapter, the following words and terms shall have the
following meanings unless the context indicates another or different meaning
or intent:
       (1) "Town" means any municipality within the meaning of section 126 of
Title 1.
       (2) "Sewage system" includes such equipment, pipeline systems and
facilities as are needed for and appurtenant to the disposal of sewage and
waters, including sewage treatment plants and separate pipelines and facilities
as are needed for and appurtenant to the disposal of storm, surface and
subsurface waters, and all properties, rights, easements, and franchises relating
thereto and deemed necessary or convenient by the sewer commission for the
operation thereof.
      (3) "Sewage" means the used water supply of a community, including
such groundwater, surface and storm water as may or may not be mixed with
liquid wastes from the community.
      (4) "Storm water" means the excess water from rainfall.
      (5) "Surface water" means water other than storm water flowing or
standing on or over the surface of the ground.
     (6) "Groundwater" means water existing beneath the surface of the
ground.
412                       JOURNAL OF THE SENATE
      (7) "Improvements" means such repairs, replacements, additions,
extensions and betterments of and to a sewage system as are deemed necessary
by the sewer commissioners to place or maintain such system in proper
condition for its safe, efficient and economic operation or to meet requirements
for service in such areas which may be served by the district and for which no
existing service is being rendered.
      (8) "Costs" as applied to a sewage system include the purchase price of
any such system, the cost of construction, the cost of all labor, materials,
machinery and equipment, the cost of improvements, the cost of all lands,
property, rights, easements and franchises acquired, financing charges, interest
prior to and during construction and, if deemed advisable by the sewer
commissioners for one year after completion of construction, cost of plans and
specifications, surveys and estimates of cost and of revenues, cost of
engineering and legal services, and all other expenses necessary or incident to
determining the feasibility or practicability of such construction.
   (b) A consolidated sewer district shall be deemed to be a municipality
within the meaning of section 126 of Title 1.
   And that when so amended the bill ought to pass.
    Thereupon, the bill was read the second time by title only pursuant to Rule
43, the recommendation of amendment was agreed to, and third reading of the
bill was ordered.
            Joint Resolutions Adopted on the Part of the Senate
   Joint Senate resolutions entitled:
                                        J.R.S. 117.
  Joint resolution congratulating the Hartford High School Hurricanes‟ 2002
Division II championship boys ice hockey team.
                                   J.R.S. 118.
   Joint resolution in memory of former Senator E. Douglas McSweeney, Jr.
of Burlington.
   Having been placed on the Calendar for action, were taken up and adopted
collectively on the part of the Senate.
                  Joint Resolution Adopted in Concurrence
                                      J.R.H. 225.
   Joint House resolution entitled:
   Joint resolution honoring the U.S. Navy Seabees on their 60th anniversary
and the U.S. Navy Civil Engineer Corps on their 135th anniversary.
                      WEDNESDAY, MARCH 13, 2002                         413
   Having been placed on the Calendar for action, was taken up and adopted in
concurrence.
                               Adjournment
   On motion of Senator Mazza, the Senate adjourned until eleven o‟clock and
thirty minutes in the morning.