Hunting Certificate Template
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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 Printed on 100% Recycled Paper 394 JOURNAL OF THE SENATE 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. 396 JOURNAL OF THE SENATE 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 398 JOURNAL OF THE SENATE 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. 402 JOURNAL OF THE SENATE (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 404 JOURNAL OF THE SENATE (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. 406 JOURNAL OF THE SENATE (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.