NEW OLR REPORT: HEALTHCARE FACILITY CERTIFICATES OF NEED AND SERVICE REDUCTIONS

OLR Report 2015-R-0258 describes state health care facility requirements to obtain a certificate of need (CON) prior to reducing health care. 

Some states, including Connecticut, require health care facilities to obtain a CON before terminating specified services. However, states generally do not require CON authorization to reduce services. While some states (e.g., Maryland) require a CON to change the scope of health care services offered, the applicable law or regulations typically do not include service reductions alone among those changes requiring approval.

Several states, while not requiring CON approval to reduce services, include the impact of service reductions among the review criteria for projects requiring CON approval. Also, some states require facilities to notify the state of service reductions.

According to the National Conference of State Legislatures, 36 states have CON programs. Generally, these programs require health care facilities to obtain regulatory approval before undertaking certain actions, such as building or expanding facilities, offering new services, or purchasing specified equipment. States vary in the scope of facilities and services subject to CON requirements.

Click here to read the full report.

Casinos Raise Slot Payout Percentages

According to a Boston Globe report, due to increased competition, New England casinos are substantially increasing the number of jackpots their slot machines are paying out.

Casino managers are able to change the mathematical formulas used to determine a player’s chance of winning. The Globe, based on data the casinos provided to state regulators between July 1 and October 31, reported that the Foxwoods’ average payout percentage was 91.98%, which was the highest in almost 20 years.  The Mohegan Sun’s payout was 91.79%, the highest since 2010.

Image Source: pixabay.com

Tennessee’s Animal Abuse Registry

Tennessee is the first state in the nation to establish a statewide animal abuse registry. Beginning January 1, 2016, Tennessee will launch its registry as required by a state law enacted this past spring (Senate Bill 1204, effective May 8, 2015). The Tennessee Bureau of Investigation (TBI) will maintain the publicly accessible registry, which will include convicted animal abusers’ names and photographs. Under the law, registrants will have been convicted of aggravated cruelty to animals, felony animal fighting, or certain sex crimes involving animals. A registrant remains on the registry for two years following the date of a first conviction and five years following a subsequent conviction. For more information about the new law and registry, see TBI’s website. Also, click here to read an OLR report on the new law.

Connecticut Efforts to Fight Age Discrimination

According to a National Bureau of Economic Research study, your age may negatively affect your chances of getting a job, especially if you’re female. Researchers submitted nearly identical resumés in response to more than 40,000 job opportunities in fields as varied as administrative, sales, security, and janitorial. The only difference in the fictional resumes? The applicant’s age.

The researchers found that “applicants” age 29-31 received a call back at significantly higher rates that those ages 49-51 and 64-66. According to the researchers, applicants around retirement age (the 64-66 age bracket) received calls at lower rates than middle age applicants (the 49-51 age bracket). Researchers found especially “robust evidence” of age discrimination against older women. The results of this study contrast with the goals of federal law.

  

Age discrimination against people 40 or older is prohibited by the federal Age Discrimination in Employment Act. AARP’s Age Discrimination website offers advice and guidelines for filing an age discrimination claim.

Connecticut is stepping up the battle age discrimination. The Agency on Aging of South Central Connecticut recently launched the Stop Ageism Now campaign to inform people about ageism’s effects and collaborate on solutions. Ageism, according to a letter by the agency’s CEO Ted Surh, is the systematic discrimination against older people. The campaign’s website includes a quiz to help identify ageism in your life, a place to share stories of ageism, and information on ageism. 

Virtual Net Metering

OLR Report 2015-R-0264 describes the virtual net metering program, including data on (1) projects that are currently operational or approved but waiting to proceed, (2) the value of distributed virtual net metering credits, and (3) the program's cost to ratepayers.

Traditional net metering allows a renewable energy system's owner to receive billing credits for power generated by the system, in effect running the meter "backwards."  If the system produces more power than the owner used in a billing period, the credits can be applied to future bills.  With virtual net metering, the system's owner can share these excess credits "virtually" with other owner-designated accounts, thus running their meters backwards too.

In Connecticut, the law limits virtual net metering to municipal, state agency, and agricultural customers who meet certain requirements (CGS § 16-244u).  Among other things, the law specifies (1) which types of renewable energy systems can participate for each customer type, (2) generating capacity limits, (3) the types of accounts that can share virtual net metering credits with the host facility, and (4) that credits are calculated at the wholesale power generation rate plus a portion of the electric company's transmission and distribution rates which decreases from 80% to 40% over three years.

The law also caps virtual net metering credits at $10 million per year, divided between the state's electric distribution companies (Eversource and United Illuminating) in proportion to their respective customers' electrical load.  Within that total, each eligible customer type (municipal, state agency, and agricultural) is further limited to 40% of the allowed credits.

Read the full report here.

San Mateo County Joins California’s Vote-by-Mail Pilot Program

California’s San Mateo County conducted its 2015 election as an all-mail ballot election under a pilot program that previously authorized a more rural county, Yolo County, to do the same. The program authorizes San Mateo and Yolo counties to conduct three elections, other than the 2016 presidential election, by mail.  They must report back to the state on costs, voter diversity, and voter turnout. According to the San Jose Mercury News and The Daily Journal, voter turnout in San Mateo increased to about 29% in 2015 from about 25% in 2013, the last comparable election.    

Under all-mail ballot elections, also called “vote-by-mail” elections, every registered voter automatically receives a ballot in the mail. The voter marks the ballot, puts it in a secrecy envelope and then a separate mailing envelope, signs an affidavit on the mailing envelope’s exterior, and returns the ballot via mail or in person to a designated location.

Proponents of vote-by-mail elections say that they increase efficiency, lower costs associated with hiring poll workers, and increase voter turnout.  Opponents, on the other hand, say that they increase the chances for voter fraud, have a minimal impact on voter turnout, and increase costs associated with printing and mailing ballots. 

According to the National Conference of State Legislature, three states (Colorado, Oregon, and Washington) conduct their elections entirely by mail.  At least 19 others authorize vote-by-mail elections for certain jurisdictions or types of elections (e.g., county elections and referenda).

Connecticut Joins Nationwide Effort to Fight Tax Fraud

Department of Revenue Services (DRS) Commissioner Kevin Sullivan recently announced that DRS has joined a national initiative to protect tax data and combat identify theft.  The Taxes. Security. Together. initiative brings together the IRS, state tax officials, and the tax preparer industry in a coordinated effort to stop tax-related identity theft.

As part of the announcement, Sullivan reminded taxpayers that they’re the “first line of defense” in fraud prevention and indicated several ways in which they can make it harder for identity thieves to steal their personal and financial information.  This includes:

• using reputable security software and keeping it updated;
• shredding old tax returns and documents that contain names, addresses, bank account numbers, and credit card information; 
• being wary of phishing emails that ask you to update a bank account or tax software account;
• being careful about what you post on social media; and
• using a reputable tax preparer.

Deck Your Halls Safely

Each year the federal Consumer Products Safety Commission (CPSC) seeks to educate consumers about decorating for the holidays in a safe manner.

According to a recent CPSC blog post, lacerations were a commonly reported decoration-related injury last year and more than a third of decorating injuries involved falls. Fires related to holiday lights caused 10 deaths last year.

To help the public, CPSC publishes Holiday Decoration Safety Tips with advice for using candles, lights, trees, trimmings, and artificial snow. The guide encourages, as a general rule, planning for safety – identifying and eliminating potential danger spots.

New Report: States Should Make Backseat Passengers Buckle Up

The Governors Highway Safety Association, in “Unbuckled in Back: An Overlooked Issue in Occupant Protection,” reports that rear seatbelt underuse is a significant traffic safety concern and urges states to take steps to increase seatbelt use by backseat passengers.

According to the report, rear seat passengers are three times more likely to die in a crash if they are unbelted. The National Highway Safety Administration estimates that of the 883 unrestrained rear seat passengers who died in motor vehicle crashes in 2013, 400 would have survived if they had buckled up (see figure). Despite the potential benefits of using rear seatbelts, nationwide rear seatbelt use is 78%, which is significantly less than front seatbelt use (87%), the report stated.

Rear seat passengers who buckle up also increase the chances of front seat passengers surviving a crash. As the report notes, front seat passengers are twice as likely to die in a crash when seated in front of an unbelted rear seat passenger (who can become a projectile) than they are when seated in front of a belted rear seat passenger.

The report discusses several reasons why rear seatbelts are underused. Some states don’t have laws requiring rear seatbelt use (Connecticut is one of them), others don’t adequately enforce their laws requiring such use, and many don’t focus on rear seatbelt use in public awareness campaigns. To increase rear seatbelt use, the report recommends that the states take several actions, including:

1. enacting a primary enforcement rear seatbelt law (primary enforcement allows police officers to ticket someone for a violation at any time);
2. making rear seating positions a regular part of belt use enforcement; 
3. including rear seatbelt use in public education efforts; and
4. continuing efforts to increase front seatbelt use, because rear seatbelt use is higher in states with high front seatbelt use rates. 

A Closer Look at Pass-Through Businesses and How Much They Pay in Taxes

A recent study conducted by economists at the U.S. Treasury and the National Bureau of Economic Research yielded surprising findings about pass-through entities.  The study’s authors sought to answer two questions: Who owns pass-through entities and how much do they pay in taxes?

The Brookings Institution’s David Wessel recently highlighted the study in a Wall Street Journal blog.  Wessel breaks down the study’s findings as follows:

• Pass-through business participation and income is concentrated among high-earners.  
• The average federal income tax rate paid by individuals who report pass-through business income was 19% in 2011.
• Across all business entities except for sole proprietorships, the study estimates that the average tax rate of U.S. business income in 2011 was 24.3%.
• The migration of business activity out of the C-corporate sector and into the pass-through sector has likely substantially reduced U.S. tax revenue.
• Even with access to tax returns, the Treasury economists couldn’t trace all partnership income to the ultimate owner or originating partnership because businesses have created such complicated mazes (often designed specifically to reduce their U.S. taxes).

http://www.nber.org/papers/w21651
http://www.brookings.edu/research/opinions/2015/09/24-surprising-data-who-owns-us-firms-how-much-they-pay-in-taxes-wessel

US Department of Veterans Affairs Will Likely Miss Goals

According to the Associated Press, the US Department of Veterans Affairs is likely to miss its two year end goals of ending (1) veteran homelessness and (2) the backlog in disability claims.

Although the department is likely to miss these goals, there has been progress in both areas.  Since 2010, there has been a 33% decline in veteran homelessness.  Additionally, there has been a downward trend in the backlog of disability and pension claims, particularly with those that were pending for more than 125 days (from 611,000 in March 2013 to 76,000 in November 2015).

http://bigstory.ap.org/article/2383048bc5664738967a7c44e5f54ad7/va-enters-stretch-goals-homelessness-claims-backlog

DEA Drug Threat Assessment Highlights Heroin and Painkiller Abuse

The federal Drug Enforcement Administration recently released its 2015 National Drug Threat Assessment. Among the report’s findings:

• There were over 46,000 drug-induced deaths nationally in 2013.
• Since 2008, drug overdose deaths have been the leading cause of injury-related deaths in the U.S. (motor vehicle-related deaths are second and firearm-related deaths third).
• In 2013, drug overdose deaths from opioid analgesics (prescription pain medications) exceeded the deaths from cocaine and heroin combined.

The report is based on several sources, such as the National Drug Threat Survey (which includes responses on a number of topics, submitted by over 1,100 state and local law enforcement agencies). When asked to rank the greatest drug threat, the most common response in the 2015 survey was heroin, followed by methamphetamine, controlled prescription drugs, cocaine, and marijuana.  As recently as 2011, heroin ranked fourth.

In addition to detailed drug statistics, the report contains information on topics such as drug trafficking and illicit drug-related finance.

Watching the Holiday Weight Gain – of Trash!

There’s no place like home for the holidays, or so the song goes. And writing of homes, how do you ensure that your holiday home is minimizing the amount of materials that end up in the trash?

According to an article published on Recyclebank, a website that educates consumers about household waste and recycling and that gives rewards for environmentally friendly behavior, household waste increases by about 25% (totaling about an additional one million tons) between Thanksgiving and New Years.

The article provides several suggestions for how to reduce the amount of holiday waste that is generated. For example, it suggests (1) consolidating online orders to save packaging material and (2) using reusable shopping bags when purchasing gifts at stores. The article advises against using gift wrap because wrap isn’t always recyclable, and instead suggests covering gifts in things such as fabric, newspaper, or decorative cardboard boxes.

The article also advocates for using a real holiday tree instead of an artificial one, though it mentions that there is no definitive answer as to which is more environmentally friendly. (For more information about the environmental-based arguments supporting real versus fake trees, see OLReporter blog post: The Real vs. Fake Debate: Which Christmas Tree is “Greener.”)

Malloy Establishes Permanent Work Group to Strengthen State’s Emergency Weather Preparedness

On October 26, Governor Malloy signed  an executive order establishing the Safe Agencies Fostering Resilience (SAFR) Council to coordinate the creation of a statewide policy on resisting and rapidly recovering from the shock of tropical storms, hurricanes, ice storms, and other natural hazards.

The 12-member council is the successor of the State Agencies Fostering Resilience working group and includes state agency heads and experts.  The council’s charge,  among other things, is to “collaborate on the creation of a Statewide Resilience Roadmap based on the best climate impact research and data including extensive research studies that inform land use patterns” and help municipalities incorporate this and other information in their coastal resilience and land use plans.

Private Child Placing Agencies in Connecticut

OLR Report 2015-R-0226 explains Connecticut regulations concerning child-placing agencies.

By law, private child-placing agencies must be licensed by the Department of Children and Families (DCF) to place a child in Connecticut. Additionally, DCF regulations distinguish between “child placing agencies” and “non-approved child placing agencies.” The regulations prohibit non-approved agencies from placing a child, for any purpose, in Connecticut.

According to DCF regulations (1) a “child placing agency” is an agency in or outside of Connecticut licensed or approved by DCF for the placement of children for adoption purposes and (2) a “non-approved child placing agency” is an agency anywhere in the United States that is licensed or regulated by its local jurisdiction but not approved by DCF.

For additional information about these agencies and applicable regulations, click here to read the full report.

Cybersecurity and the Grid

The North American Electric Reliability Corporation (NERC), the not-for-profit international regulatory authority tasked with assuring the reliability of North America’s bulk power system, ran a two-day drill simulating a series of coordinated cyber and physical attacks on various automated systems and key transmission and generation facilities. NERC conducts these types of exercises every two years to give participating utilities and governmental agencies the opportunity to assess their emergency response and recovery plans. While NERC did not release any findings from the test, called “GridEx III”, they expect to complete a report on the test and resulting recommendations by early next year. Read NERC’s press release here.

NERC conducted the last such exercise (“GridEx II”) in November 2013. The report following that test recommended, among other things, that stakeholders:

1. review communication infrastructure to identify redundancies or alternatives to maintain communication during a crisis,
2. build relationships with relevant government agencies to establish communications procedures prior to a crisis,
3. clarify reporting roles and functions, and
4. develop mechanisms to preserve evidence and collect forensic data following a physical or cyber attack.

Connecticut's School Immunization Requirements

OLR Report 2015-R-0231 describes Connecticut's school immunization requirements and the medical and religious exemptions from these requirements. Connecticut requires immunizing school-aged children attending both public and private schools against certain diseases, but provides exemptions to these requirements in certain circumstances.

To read more about the required immunizations and exemptions, click here to read the full report. 

Medicare to Reimburse Separately for End-of-Life Consultations

As reported in the New York Times, federal rules taking effect in January authorize separate Medicare payment rates for doctors’ end-of-life consultations with patients. The rules cover “advance care planning” to discuss options for end-of-life care (such as discussing whether the patient would welcome aggressive life-sustaining treatment).  These discussions must occur “at the discretion of the beneficiary.”

More information on the new rule is available on the Kaiser Family Foundation’s website.  For example, the Kaiser website explains that, prior to the new rule taking effect, Medicare would reimburse for advance care planning only if it occurred during (1) an appointment for another illness or (2) a beneficiary’s one-time “Welcome to Medicare” visit.  The new rule instead allows for reimbursement even if the advance care planning is the sole purpose of the visit.

The Kaiser website also has information on related topics, such as advance directives, palliative care, and Medicare coverage for hospice care.

Jepsen Calls for Expedited Implementation of Chip and PIN Credit Cards

Attorney General George Jepsen, along with eight other attorneys general, are urging the nation’s large credit card issuers (e.g., Visa, MasterCard, American Express) to voluntarily speed up implementation of chip and PIN technology. This technology is largely considered to be a more secure way of processing credit cards.

These credit card issuers have collectively begun to implement a new chip-and-signature system. But the attorneys general feel that the system that requires a signature rather than PIN identification as a secondary form of verification still leaves citizens more vulnerable to data breaches.

The Connecticut Attorney General’s office received approximately 515 data breach notifications from FY 2014 to 2015. 

More information can be found on the Attorney General's website.

Examining the Broad Economic Impact of Land-Use Regulations

In an effort to encourage cities and states to be “more thoughtful” in designing land-use restrictions, the Council of Economic Advisers (CEA), the President’s economic policy advisors, is drawing attention to the link between land use restrictions and the country’s slowing worker productivity rates and rising income inequality.  As the Wall Street Journal recently noted, this discussion comes out of a body of research the CEA produced this year to highlight the slowdown in productivity growth and the growing wealth gap.

The CEA’s chairman, Jason Furman, focused on this link in a recent speech at a housing conference co-hosted by the Urban Institute and CoreLogic, a data company.  In his speech, Furman maintained that excessive or unnecessary land use or zoning regulations discourage housing production, thus creating an artificial supply constraint. This, in turn, creates upward pressure on housing prices and “may undermine the market forces that would otherwise determine how much housing to build, where to build, and what type to build, leading to a mismatch between the types of housing that households want, what they can afford, and what is available to buy or rent.”

The result is a barrier to geographic mobility, which Furman contends “reduce[s] the productive use of our resources and entrench[es] economic inequality.”

Obesity-Related Health Issues Contribute to Medicaid Costs

A recent report in Health Affairs found that, in 2013, severe obesity in adults cost state Medicaid programs almost $8 billion. The researchers defined “severe obesity” as “having a body mass index (BMI) of 35.0 kg/m² or higher – meaning that the person is more than 100 pounds above a healthy body weight.” BMI is the ratio of a person’s mass to his or her height (see Table 1 for more information about BMI and weight status).

The report noted that overall obesity-related spending (both public and private) was generally higher for women than men, and it rose for both genders as they aged. According to the report, “compared to having moderate obesity [BMI 30.0-34.9], having severe obesity predicts having more than twice the obesity-attributable medical spending across all age groups and for both men and women.”

The report also puts the $8 billion Medicaid dollars spent on obesity into a larger context of almost $69 billion overall spent on obesity-related medical costs that year, of which $21 billion was paid by Medicare and other federal programs, $18 billion by private payers, and $22 billion by patients and other sources.

The report noted that only 26 states covered nutrition consultation and 10 states covered obesity-related drug therapy under their Medicaid programs, while 45 covered bariatric surgery. (Connecticut covers nutrition consultation and bariatric surgery in certain circumstances.)

As noted recently on NPR, the U.S. adult obesity rate remained virtually unchanged from 2011 to 2014 (about 36%). It seems unlikely that obesity-related medical costs will decrease if this trend continues.

www.cdc.gov

Traffic Deaths in Crashes Involving Alcohol or Cell Phone Use

OLR Report 2015-R-0232 compares the number of people who died nationwide as the result of alcohol-impaired crashes with the number of people who died in crashes involving the use of cell phones.

A 2006 University of Utah study found:

Drivers using a cell phone exhibited a delay in their response to events in the driving scenario and were more likely to be involved in a traffic accident . . . Drivers in the alcohol condition exhibited a more aggressive driving style . . . With respect to traffic safety, the data suggest that the impairments associated with cell phone drivers may be as great as those commonly observed with intoxicated drivers.

According to the National Highway Traffic Safety Administration (NHTSA), 10,076 people were killed in alcohol-impaired crashes in 2013 compared to 445 who died in fatal crashes involving the use of cell phones. The number of people who died in crashes involving cell phones was about 4.4% of the number who died in alcohol-impaired crashes.

While alcohol-impaired crashes caused 31% of the 32,719 U.S. traffic deaths in 2013, NHTSA reports that fatalities in alcohol-impaired crashes decreased by 23% between 2004 and 2013.

Read the full report here.