Reasonable, actual, adjacent, and proximate.
Four simple words. Except in the context of legislative dickering, where their meaning masks millions of dollars and gets tied up in knots of conflicting meaning, not to mention institutional pride and philosophic fandangos.
As it turns out, resolving those words Friday was a partial key to wrapping up the work of a conference committee of three House and three Senate members tasked with resolving differences in a landmark bill revamping Vermont’s mental health system and adopting a strong community-based model.
They came to agreement with handshakes and combined relief, and perhaps astonishment, Friday afternoon at around 5 p.m. after wearying three-a-day meetings all week.
“That’s it?” asked Sen. Claire Ayer, D-Chittenden.
“That’s it,” said Rep. Ann Pugh, D-S-Burlington, followed by a round of applause from those in the room and handshakes among the panel. They plan to dot the “I’s” and cross the “T’s” Tuesday morning.
Gov. Peter Shumlin Thursday eliminated the big sticking point in the bill, announcing his support for a 25-bed acute care mental health hospital to be built near the Central Vermont Medical Center. That was a major shift since Shumlin had insisted, for cost reasons, on a 16-bed unit, the position the Senate took. The House had nearly unanimously decided 25 beds were needed in the northern part of the state.
The conference committee had danced around that issue carefully all week, but even with that logjam removed, there were a host of niggling and not-so-minor issues to work out.
The phrase “reasonable actual costs” referred to words wanted by the Senate to assure private hospitals providing acute care for the state in the new system are adequately reimbursed, a key issue for Rutland County Sen. Kevin Mullin. Rutland Regional Medical Center will maintain six acute care beds under the new system; Brattleboro Retreat will have 14.
House conferees had concerns about overpaying and paying more than other facilities in the state receive. That was resolved by making clear that those costs will be examined by a rate setting authority and subject to “comprehensive review.”
The words “adjacent” and “proximate” referred to the siting of the 25-bed acute care facility planned for the town of Berlin. There the issue for the Senate was allowing the state flexibility in finding a site and not tying the state’s hands in negotiations. For House conferees, the issue was extensive testimony that a site as close as possible to the hospital was medically important. By eliminating both words, they split the difference, leaving the issue in the state’s hands.
Among other important issues the panel addressed and finally agreed on:
- Providing for an independent consultant’s report by Dec. 1 of this year on how the new mental health system is working.
- Providing the department of mental health a set of five “outcome and financial measures” by which it has to report back to the Legislature Jan 15 of 2012 on the new system.
- Asserting the Legislature’s role in any decision to downsize the proposed facility in Berlin from 25 to 16 beds for financial reasons and, also, spelling out specific conditions for an interim facility in Morrisville should it be approved at the local level.
- Calling for the 25-bed facility in Berlin to be built expeditiously within 24 months. State officials have said it may take three years or more.
Myriad minor technical and word changes were also made in the bill, clarifying everything from goals on use of medications to spelling out definitions to give them more weight.
In case you’ve ever wondered what a conference committee is like, it’s a mix of horse trading, arcane nit-picking, mind-numbing references to “striking subdivision (b)(1) in its entirety and inserting in lieu thereof the following,” and hard-to-follow shifts of sentences and paragraphs from one place to another, all followed in intense detail by a flurry of paper-handing-out and intense scrutiny by a small horde of iPad- and smartphone-toting advocates, lobbyists, mental health officials and legislative draftpersons, and a few hardy print media types.
Which is to say exhausting and a bit exasperating at times, but all part of the legislative process.
With the passions that mental health care brings, never far away was the over-arching view of the big picture, satisfying everyone’s philosophic goals for care and how the dollars would be allocated, plus the always important consideration of institutional pride (Senate versus House).
In the end, a week’s worth of negotiating while trying to eat lunch, staying late and huddled conferences produced a compromise. Now the bill known as H.630 has to be voted on by the full House and Senate.
And then the real work begins: creating a dramatically changed mental health care system to take care of Vermonters.
