Representatives John Tracy (Co-Chair), Steven Maier, Janet Ancel, Francis “Topper” McFaun; Senators Jim Leddy (Co-Chair), Ann Cummings, Jane Kitchel, Kevin Mullin; John Bloomer, Jr., Walter Freed

MEMBERS ABSENT:

None

Also Present:

Legislative and Joint Fiscal staff, members of the Administration, the press, and the public.

Meeting Recorded:

CD HCRC 8/28/06, CD #1, 2, 3, 4.

1.         Convene; Review and Approve Minutes from July.                 [CD #1, tr. 2]

Senator Leddy and Representative Tracy convened the meeting at 9:45 AM in Room 10 at the Statehouse, Montpelier, Vermont. Sen. Leddy asked for a motion to accept the minutes. The motion passed unanimously.

2.         Update on national interest in Catamount Health, Senator Leddy

Senator Leddy has presented at several national conferences; there is strong interest from the Robert Wood Johnson Foundation re implementation, Sen. Leddy and Susan Besio will meet with Foundation representatives.

Overall, increasing national interest, interest from other states, but most seem to be focused on tinkering, not broad change.

3.         Report on Single Payer, Ken Thorpe, Consultant to the Commission   [CD 1, tr. 3]

Document distributed: Costs and Implications of a Single Payer Healthcare Model for the State of Vermont

Dr. Thorpe presented his report, commissioned by the HCRC.

His introductory comments: the report shows one possible design; pretty typical; one set of uniform health care benefits; includes all residents of Vermont except those using Medicare. His focus was to include the principles in the Blueprint for Health—those of chronic care management.

 [See the Report online at http://www.leg.state.vt.us/CommissionOnHealthCareReform/single_payer_report_by_Ken_Thorpe_draft_august_29__2006.htm    ]

Data sources are CPS (Census), BISHCA, Payroll data. He has consulted with the Legislative Economist, Moody's Economy.com and others.

Overall, the analysis sees a possible overall reduction in health care costs for the State of Vermont.

The discussion included issues such as nursing home long-term-care costs (not included in the study),  reduction in hospital administrative costs, reduction in payroll and possible layoffs in health care administration (future economic studies need to consider this), sources of financing, possible upward pressure on benefit levels, and the overall challenge of containing rapidly rising health care costs.

 4.        Implementation,  Susan Besio, Director of Health Care Reform Implementation 

Documents distributed:

• Vermont Health Care Reform Activities: Sorted by date and topic—August 24, 2006
• Draft AHS letter to CMS re CMS Waiver Amendment Request for Premium Assistance
• Chronic Care management RFP Development Process
• ICAR Draft 8/18/06: Dept. of Labor: Rules for the Administration and collection of the Employers’ Health Care Premium Contribution
• BISHCA Memo and Rule draft: Catamount Health Insurance

Director Besio noted the increased involvement of members of the HCRC in task forces and activities of implementation. This has been incredibly helpful, and she would hope to continue that model.

a.  Blueprint

Work groups are moving forward well. The financial group is moving more slowly, being very careful re R.O.I (Return on investment) estimates re Blueprint costs and savings. There is a possibility of help from the Robert Wood Johnson Foundation with this issue.

b.  CMS Waiver

Need to have approval in place as soon as possible. [See Draft AHS letter handout, above.]

c.  OVHA RFP for Chronic Care

OVHA is doing more internal review; discussed how to get input from HCRC commissioners in this process.

d.  ESI operational options

Betsy Forrest of OVHA said they would appreciate a few HCRC members to review the preliminary internal working document. 

Sen. Kitchel volunteered, as a member as well of the Health Access Oversight Committee.

Rep. Maier may contribute also.

e.  5-Year strategic plan

Susan Besio asked for members of the HCRC to meet with her re this plan.

Sen Leddy suggested himself and Rep. Ancel.

f.  Seasonal employees

Discussion of how the implementation process is getting information out to Vermont employers. Plans for outreach? Especially re the employer contribution.

g.  Employer Contribution Rules                                                  [CD #2, tr. 3]

Tom Dowse, Deputy Commission of Labor, discussed ICAR Draft 8/18/06: Dept. of Labor: Rules for the Administration and collection of the Employers’ Health Care Premium Contribution.

Tom Dowse discussed the definitions of “employer” and “employee,” and definitions of “FTE”. Other issues include public and private coverage, methods for collecting the employer contribution, possible technical amendments, “employee leasing,’ seasonal employees, penalties.

(At this point, Ken Thorpe clarified an issue from his earlier presentation:

Supplementation of benefits: he picked a typical package of benefits for his study.  But if an organization or employer currently offers a more generous package, that is also built into his model. However, if many more employers began offering supplemental packages above Catamount Health, administrative costs could increase.)

h.  BISHCA—update on Rules                                                     [CD #3, tr. 2]

First, Cassandra Edson of the Legislative Council reviewed the issues and comments re the proposed rules, from discussions of the HCRC subcommittee on the Rules.

Then BISHCA staff discussed the Rules.

Christine Oliver, Deputy Commissioner; Herb Olson, General Counsel; and Rebecca Heintz, Director of Rates and Forms and Health Care Administration Counsel.

Their documents included BISHCA Memo and Rule draft: Catamount Health Insurance, plus the 75 pages of comments which BISHCA received on the Rule.

They discussed the timeline and several specific issues. Under Catamount Health benefits, key areas include balance billing, consumer choice of benefit plans, and statutory amendment of benefit requirements. Under eligibility for Catamount Health insurance, key issues include coordination of eligibility determinations and information with the AHS Premium Assistance Program, carrier outreach to potential insureds, potential negative impacts on existing health insurance costs, and voluntary loss of employment. They also discussed concerns re the rate-setting process for Catamount Health insurance premiums.

[CD #4, tr. 1]

HCRC members raised concerns that the proposed Rule goes counter to the legislative intent regarding voluntary vs. involuntary loss of employment. Commissioners stated that the legislative intent was that the Rules match VHAP. This will need to be discussed during the LCAR review of the Rule.

Sen. Leddy stated the Commissioners’ appreciation for the extraordinary work BISHCA has done to prepare this draft Rule.

5.         Updates: Health Care IT, Medical Record Ownership, Indemnification Issue; VITL, Hans Kastensmith, Consultant to the Commission,  [CD #4, tr. 2]

Document distributed: Article from “Health Lawyers News”: Blame it on the RHIO: Potential Liability Concerns with Electronic Health Information Exchange

Hans Kastensmith raised concerns re legal issues re indemnification and utilization of data in people’s health care records. This has created a last-minute snag in contract negotiations re health care IT records management. VILT and General Electric are discussion changes in liability language in the contract.

HCRC Commissioners asked legislative staff to consult with NCSL (National Council of Sate Legislatures) and other sources, to get advice and information on this issue.

Aside from this, the Blueprint information systems project is in good shape, and preparing to go forward. Re the Blueprint, it is important to present IT issues clearly to providers, and to manage and respond to the perceptions that are out there.

Final issue: ownership of medical records. Nowhere in the laws does it clearly state that patients own their medical records. Many providers believe that providers own them. This issue needs to be addressed—both in Vermont and nationally as well. Does anyone own this data? It is not clearly addressed in HIPPA.

6.         Studies / Data Update, Catherine Benham for Steve Kappel, Joint Fiscal Office

Catherine Benham said that meetings are being held soon re the big financial studies commissioned by the HCRC. Tom Kavet (Legislative Economist) would like to have more collaboration from Jeff Carr, the Administration Economist. Discussions are ongoing.

Was there a HCRC subcommittee for this? Need to check the Minutes from two meetings ago.

[Note from staff: from June 19, 2006 Minutes:

“Financing studies subcommittee: Rep. McFaun and Sen. Cummings.”]

7.         Public Input scheduled

No one signed up to testify.

6.         Commission Overview Report, Catherine Benham, Joint Fiscal Office 

Benham: Re the October HCRC meeting, there are no rooms available in the Statehouse or in nearby Montpelier offices. Commissioners said to keep the date and find another location.

Discussion re setting a November date: Catherine Benham will e-mail HCRC members to try to resolve a date.

NEXT MEETINGS: 

Tuesday, September 26, 9:30 AM.  Statehouse.

Tuesday, October 24, 9:30 AM. Keep the date, even though rooms in the Statehouse are not available. Staff will find a place—possibly Randolph or Waterbury.

Re a November meeting date: difficulty scheduling it. Catherine Benham will e-mail HCRC members to try to resolve a date.

There will be a press briefing tomorrow on Dr. Thorpe’s Report.

The meeting adjourned at 3:20 PM.

Minutes respectfully submitted by Loring Starr

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